Monitored exercise programmes encouraged in heart failure
14 March 2003
Low- to moderate-intensity aerobic or endurance exercise seems safe and beneficial overall in improving exercise capacity and quality of life for people with chronic heart failure, according to the American Heart Association.
But close monitoring and possibly postponement of exercise training may be needed in some patients with stenotic or regurgitant valvular disease (heart valve disease involving back flow of blood in the circulation), and some with diastolic dysfunction (poor filling of the heart chamber with blood prior to each heart beat), according to the association's statement on exercise and heart failure (Circulation 2003; 107: 1210-25).
Heart failure refers to the reduced ability of the heart to pump blood efficiently around the body. Despite what the term may suggest, this does not usually mean that the heart has failed completely or is about to stop. Typical symptoms relate to accumulation of excess fluid in the body and include shortness of breath, cough and swelling in the legs and ankles.
Exercises studied included jogging, walking, cycling, rowing, aerobics and callisthenics exercises.
The authors said an individual approach to exercise was necessary, taking into account age, the presence of heart disease and exercise intensity.
While 4 to 20 per cent of heart attacks occurred during or after exertion, the risk was greater in people who did not regularly exercise.
The authors said people with heart failure had higher death and disease rates than those with most other forms of heart disease, but 21 exercise training studies in 467 chronic heart failure patients found a low overall adverse event rate.
The incidence of sudden cardiac arrest was lowest in cardiac patients during controlled exercise such as walking or cycling.
The lead author of Australian management guidelines on chronic heart failure, Professor Henry Krum, said the statement was in accordance with the Australian guidelines (Medical Journal of Australia 2001; 174: 459-66), which recommend regular physical activity and referral to an exercise programme specifically for such patients.
The exceptions are people with acute exacerbations or clinically unstable disease, who should rest until stable.
'Exercise is encouraged rather than discouraged, including rehabilitation programmes which have an aerobic component and are quite vigorous,' Professor Krum said.
'People need to build up from low intensity. There are certain exclusions, but elderly people should not be excluded on the basis of age.'
Last Reviewed: 17 March 2003
- 1. Medical Observer Weekly 14/3/03
