Rehabilitation by physical exercise in chronic cardiac failure

The aim of rehabilitation is to improve exercise capacity and, thereby, the autonomy of patients with cardiac failure. For many years, these patients were considered inapt to perform physical exercise and they are in the same situation at the dawn of the year 2000 as patients with myocardial infarct ion forty years ago. The symptoms of cardiac failure (dyspnoea of effort and muscular fatigue) a re not only the consequence of pulmonary hypertension and decreased muscula r perfusion. Prolonged interruption of exercise and long stays in bed or in a chair lead to anatomical and functional amyotrophy, which, in turns, inc ites to further inactivity. Deconditioned respiratory muscles cannot tolera te the increased load of hyperventilation. Neurohormonal changes cause vaso constriction which reduces muscular perfusion. Physical training can significantly improve these abnormalities, though it does not seem to have a measurable effect on cardiac function; based on seg mental work which enables performance of substantial efforts with a minimum of haemodynamic changes, it provides a 20 to 30% gain in capacity, mainly increasing the duration of submaximal exercise rather than maximum performa nce. Muscular fatigue is the symptom which is the most improved. Unfortunately the organisation, which is more difficult than in the post-in farction period, and the generalisation of the practice of long-term, well adapted physical training remains marginal although hundreds of thousands o f patients could benefit; more than the inertia of the official instances c oncerning anything related to cardiac rehabilitation, it is the lack of int erest shown by cardiologists and the absence of flexible structures within the health care organisation for elderly people which are responsible.