Exercise training in chronic heart failure: why, when and how

The management of patients with chronic congestive heart failure has change d considerably during the last decade. Until recently, restriction of physi cal activity was recommended for patients with chronic heart failure. Howev er, the knowledge that training influences largely the periphery rather tha n the heart itself has led to a dramatic change in the approach toward trai ning in patients with chronic heart failure. Why to train patients with chronic heart failure: Training increases exerci se tolerance by an average of 20% in chronic heart failure regardless of et iology (ischemic or non-ischemic cardiomyopathy) or severity of left ventri cular dysfunction. Available data, while limited, demonstrate that increase s in exercise capacity are paralleled by an improvement in quality of life. Studies have consistently demonstrated that training has no deleterious eff ect on central haemodynamics, left ventricular remodeling, systolic or dias tolic function, or myocardial metabolism. At present, there are insufficien t data to determine the effect of training oil prognosis, but trials are cu rrently underway to address this. When to train patients with chronic heart failure: Exercise training Should be performed only with the patients that have been in a stable clinical co ndition for a period of at least 3-4 weeks. Clinical stability is defined a s no change in symptoms, weight,drug regimen, or NYHA class over this perio d. How to train patients with chronic heart failure: Initially, the program Sh ould be supervised for a period of 2 to 4 weeks; home-based programs are us ually, appropriate thereafter. Activities that call be maintained for a lif etime should be encouraged, and the focus Should be oil aerobic-type activi ties. The intensity, level should be targeted to about 50%-70% of peak VO2 and/or Borg ratings of 12-14 (" walk and talk ").