Physical activity and training for heart failure

The main symptoms of chronic heart failure are dyspnoe and exercise intoler ance. The pathophysiological basis of these symptoms is not simply the dysf unction of the heart, but a complex interaction of the central circulation, the peripheral vessels, the skeletal muscles, the ventilatory, and the end ocrine system. In contrast to acute heart failure, where bedrest is known t o be beneficial, prolonged limitation of physical activity can be detriment al in the chronic stage of the disease. Therefore, since the 1980s there ha ve been several reports about heart failure patients participating in exerc ise programs. The results were encouraging: the physiological gains were im pressive, and contrary to prior fears, in the great majority of reports no deterioration of the cardiac function could be observed. The net result of training in this condition is an improvement in exercise capacity in the ra nge of the best pharmacological treatment. In detail, blood flow into the w orking muscle is increased, the ventilation for each given workload is redu ced the skeletal muscle overall function (including biochemical and histolo gical aspects) is improved, the increased neurohormonal activity - especial ly of the sympathicoadrenergic system - will be normalized, and the patient 's quality of life is; significantly improved. Whether all of these benefic ial aspects will result in improved survival is not yet proven, although on e recent study provides some evidence in this direction. But even if today no definite answer to this question from a large, multicenter trial is avai lable, application of exercise training for selected heart failure patients can be recommended, if adequate supervision is provided.