IS SEVERE LEFT-VENTRICULAR DYSFUNCTION A CONTRAINDICATION TO PARTICIPATION IN AN EXERCISE REHABILITATION PROGRAM

Objective. To evaluate the effects of an exercise training programme o n patients with chronic left ventricular dysfunction. Design. Interven tion, before and after the trial. Setting. Johannesburg Cardiac Rehabi litation Centre, a phase III community-based cardiac rehabilitation fa cility. Patients. A consecutive sample of 28 patients who were recover ing from acute myocardial infarction and who had a left ventricular ej ection fraction of 30% or less. Twenty-two patients completed the exer cise training programme. Intervention. A medically supervised exercise training programme of 6 months' duration. Type of exercise: walking, jogging or cycling, Intensity: 65 - 85% of the patient's maximal heart rate achieved during treadmill testing. Duration: 30 - 45 minutes. Fr equency: 3 times a week. Patients who attended fewer than 60% of all p rescribed sessions were considered drop-outs. Main outcome measures. H aemodynamic, left Ventricular function and effort tolerance parameters before and after training. Results. Patients who completed the exerci se training programme showed a significant improvement in maximal exer cise capacity and a significant reduction in their cardiovascular dema nds during submaximal exercise. Peak oxygen consumption was increased by 12% after training (19.4 +/- 3 v. 21.8 +/- 4.8 ml/kg/min; P < 0.05) and exercise time to exhaustion by 33% (527 +/- 171 v. 700 +/- 186 se conds; P < 0.001). The double product at the same submaximal workload was significantly reduced (214 +/- 52 v. 194 +/- 44 beats/min x mmHg x 10(2); P < 0.05). These benefits were achieved without any adverse ef fects on resting (25.4 +/- 5 v. 28.5 +/- 7.9%; P < 0.05) or exercise ( 27.3 +/- 7.7 v. 29.9 +/- 9.5%; P. 0.05) left ventricular ejection frac tion. Conclusions. Our results show that patients with chronic left ve ntricular dysfunction can benefit from an exercise training programme and that those benefits can be achieved without risk of further deteri oration in left ventricular function. Physical training constitutes an other therapeutic option which could be added to the comprehensive man agement of these patients.