Different response of patients with idiopathic and ischaemic dilated cardiomyopathy to exercise training

We looked at the benefits and complications of a home-based exercise progra mme in patients with ischaemic and idiopathic dilated cardiomyopathy. Twent y-four patients with left ventricular end-diastolic dimension >6.5 cm and f ractional shortening (25% entered a cross-over trial of 8 weeks training ve rsus 8 weeks rest. Echocardiography, electrocardiogram and cardiopulmonary exercise testing were performed at baseline, after training and after detra ining. Training resulted in a higher peak oxygen consumption (26.5 versus 2 1.3 ml/kg/min, P = 0.004), a higher peak heart rate (161 versus 152 bpm, P = 0.02) and improved well-being. Patients with idiopathic dilated cardiomyo pathy showed a significant increase in exercise time (879 versus 828 s, P = 0.03) and peak oxygen consumption (31.3 versus 24.3 ml/kg/min, P = 0.02) a nd a decrease in left ventricular end-diastolic dimension (6.4 versus 6.9 c m, P = 0.01) and end-systolic dimension (5.3 versus 5.8 cm, P = 0.04) in co ntrast to those with coronary artery disease, who developed a reduction in septal excursion and shortening rate following training. Complications of t raining were more common in those patients with ischaemic cardiomyopathy, g reater left ventricular dimensions, poorer exercise tolerance and greater v entilation drive at baseline, and included fluid retention and exercise-ind uced ventricular tachycardia. We found that this group of patients with a d ilated, poorly functioning left ventricle can safely derive benefit from a home-based exercise programme, particularly those of idiopathic origin, but they should be closely monitored for the development of complications. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.