Optimal Exercise Programming for Individuals with Heart Failure

Heart failure is a cardiovascular disease that is rising in incidence and becoming a significant public health concern [1,2]. Heart failure is the heart’s lack of ability to pump sufficient oxygenated blood throughout the body to meet normal oxygen requirements for metabolic processes [3]. There are two primary ways in which heart failure can occur, abnormal cardiac anatomy and/or weakened cardiac function (specifically in the left ventricle) [3]. An important defining factor in heart failure is the ejection fraction of the left ventricle [3]. Ejection fraction is mathematically determined by [stroke volume/end diastolic volume], and the ejection fraction associated with heart failure is typically low (less than 50%) due to a low stroke volume and a high compensatory end diastolic volume [3].

The lack of sufficient oxygen delivery throughout the body from heart failure causes a marked deficit in physical activity tolerance [2,3]. Symptoms of heart failure that limit physical activity include breathlessness, lethargy, angina, and arrhythmia [1,2,3]. It was previously suggested to individuals with heart failure that exercise should be limited, and inactivity encouraged, as to not overly stress the compromised cardiopulmonary system [1,4]. However, recent scientific evidence suggests that exercise is not only safe for individuals with heart failure, but often beneficial [1,2,4,5,6]. However, when creating an exercise program for those with heart failure, the specific physiological and psychological constraints associated with heart failure must be kept in mind to ensure safety and effectiveness [1,2,4,5,6].

The basic components of exercise programming include duration, frequency, intensity, and mode of training (aerobic and/or anaerobic), and each of these components must be tailored appropriately for those with heart failure [1,2,4,5,6]. Individuals with heart failure typically have an exceptionally low aerobic capacity due to insufficient oxygen consumption, so aerobic training is an effective tool to increase systemic oxygen transportation and utilization [1,2,5]. Those with heart failure must begin aerobic training at a low intensity and duration in order to not over-tax the weakened cardiopulmonary system, as even basic daily tasks can cause breathlessness and fatigue [1,2,4]. A starting aerobic intensity of 60% of max heart rate and starting exercise duration of 15-30 minutes has been found to be safe and effective in training the aerobic system in those with heart failure [1,4,5,6]. Heart rate monitors are a useful tool to ensure proper aerobic intensities [1,4]. An initial exercise frequency of 2-3 sessions per week is appropriate for those with heart failure [1,4,5,6].

As those with heart failure accumulate exercise volume over time, they can safely increase components of their training [1]. Progressively increasing training difficulty can yield even greater aerobic benefits than simply maintaining difficulty [2,4]. After an initial 3 months of aerobic training at the previously prescribed values, those with heart failure can progressively increase their aerobic intensity to 70% max heart rate, exercise duration to 40 minutes, and exercise frequency to 4-5 sessions per week [1,2]. Cycling and walking are acceptable forms of aerobic exercise [1,2,6].

Due to insufficient oxygen consumption derived from a weakened cardio-pulmonary system, those with heart failure can improve oxygen transportation and utilization via aerobic exercise [1,2,5]. Improvements in aerobic capacity can reduce adverse symptoms associated with heart failure, improve quality of life, increase lifespan, and reduce hospitalizations [1,2,4,6].


References

1.) O’Connor, C. M., Whellan, D. J., Lee, K. L., Keteyian, S. J., Cooper, L. S., Ellis, S. J., ... & HF-ACTION Investigators. (2009). Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. The Journal of the American Medical Association, 301(14), 1439-1450.

2.) European Heart Failure Training Group (1998). Experience from controlled trials of physical training in chronic heart failure Protocol and patient factors in effectiveness in the improvement in exercise tolerance. European Heart Journal, 19, 466-475.

3.) McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., ... & Ben Lamin, H. A. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European Journal of Heart Failure, 14(8), 803-869.

4.) Wielenga, R. P., Huisveld, I. A., Bol, E., Dunselman, P. H. J. M., Erdman, R. A. M., Baselier, M. R. P., & Mosterd, W. L. (1999). Safety and effects of physical training in chronic heart failure. Results of the Chronic Heart Failure and Graded Exercise study (CHANGE). European Heart Journal, 20(12), 872-879.

5.) McKelvie, R. S., Teo, K. K., Roberts, R., McCartney, N., Humen, D., Montague, T., ... & Yusuf, S. (2002). Effects of exercise training in patients with heart failure: the Exercise Rehabilitation Trial (EXERT). American Heart Journal, 144(1), 23-30.

6.) ExTraMATCH Collaborative (2004). Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). British Medical Journal, 328(7433), 189.


Disclaimer: The information on this website is not intended to replace or supersede medical recommendations given to you by your physician. Please consult with your physician before making any significant changes to your diet or physical activity levels, especially if you have any preexisting conditions.