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The role of exercise training in chronic heart failure
  1. Robert P Wielengaa,
  2. Andrew J S Coatsb,
  3. Willem L Mosterdc,
  4. Inge A Huisveldc
  1. aDepartment of Cardiology, Ignatius Hospital, Breda, The Netherlands, bRoyal Brompton Hospital, London SW3, UK, cDepartment of Medical Physiology and Sports Medicine, Utrecht University, Utrecht, The Netherlands
  1. Dr Wielenga, Department of Medical Physiology and Sports Medicine, Universiteitsweg 100, PO Box 80043, 3508 TA Utrecht, the Netherlands.

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Chronic heart failure is a major health problem with a gloomy prognosis. It is now the most common discharge diagnosis in patients over 65 years of age and its incidence may be expected to grow in coming years. Characteristic of the failing heart is its inability to maintain an adequate cardiac output, first during exercise and later also at rest. Patients with chronic heart failure have a large end diastolic volume and little contractile reserve.

Cardiac failure is thus a syndrome of circulatory failure, secondary to ventricular dysfunction. This primarily ventricular dysfunction is followed by a variety of neurohumoral, peripheral circulatory, skeletal muscle, and respiratory adaptations which determine the syndrome’s clinical presentation and prognosis more than the primary ventricular dysfunction itself.

Traditionally, avoidance of exercise was thus advocated in all forms and stages of heart failure.1 However, there is now evidence that inactivity leads to a further deterioration of remaining functional capacity. Several studies on physical conditioning in patients with ventricular dysfunction have shown that selected patients can safely undergo exercise training, resulting in an improvement in functional class.2 ,3

Poor left ventricular function is not necessarily synonymous with chronic heart failure, which is characterised by reduced tissue oxygen supply. The best method of evaluating the disease state of a patient with a compromised heart is cardiopulmonary exercise testing, that is, the measurement of oxygen consumption (V˙o 2 in ml/kg/min) during exercise. In recent years studies on chronic heart failure have therefore focused on the combination of left ventricular dysfunction and a low peak oxygen consumption (less than 20 ml/kg/min). Determination of aerobic capacity is necessary to allow proper selection of patients for heart failure studies.4In this review we shall focus on the training studies (table 1) performed with chronic heart failure patients in functional …

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