PHYSICAL-TRAINING OF PATIENTS WITH CHRONI C CONGESTIVE-HEART-FAILURE - IMMEDIATE AND MEDIUM-TERM EFFECTS

Objectives: While physical training is known to improve cardiac perfor mance in patients with chronic congestive heart failure, we conducted this study to evaluate the effect of such training programmes. Methods : The study group included 48 untrained patients with stable chronic h eart failure controled with the same daily oral regimen including 0.25 mg digitoxin, 40 mg furosemide and 50 mg captopril. Halt of the patie nts (n = 24) entered a physical rehabilitation programme for a 3 week period. Each daily session included passi- ve mobilization of the limb s (10 min), respiratory exercises (10 min) and endurance exercise on a n ergometric cycle with a maximum work load of 50, 60 and 70 % of the theoretical maximal load for weeks 1, 2 and 3 respectively. The other 24 patients did not change their physical activity level and served as controls. The immediate and medium term effects (3 months after the e nd of the training programme) were assessed using exercise tests, left ventricular isotopic ejection fraction and plethysmography of the low er limbs. The quality of life was compared using the NYHA functio- nal classification and the Goldsman questionnaire. Results: At the end of the 3-week training period, and compared with the control group, ther e was a moderate improvement of VO2max (p < 0.02) and a 10 % improveme nt in the ejection frac- tion (p < 0.05) in the trained patients. Ther e was a clearly signifi- cant improvement in the anaerobic threshold a nd arterial blood now rate (p < 0.001) and lowered vascular resistance (p < 0.001) and venous tone (p < 0.001). The quality of life was also improved in the training group. However, 3 weeks after the end of the training period, these differences disappeared. Conclusion: Patients with chronic heart failure can benefit from physical training showing functional improvement and no delete- rious effect on left ventricular function. This beneficial effect is nonetheless temporary and would a ppear to be due to improved skeletal muscle oxidative capacity and per ipheral haemodynamics.