Author + information
- Received February 8, 2011
- Revision received April 12, 2011
- Accepted April 19, 2011
- Published online August 2, 2011.
- Jill Downing, MD, MPH and
- Gary J. Balady, MD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Gary J. Balady, Section of Cardiology, Boston Medical Center, 88 East Newton Street, Boston, Massachusetts 02118
Exercise training in patients with systolic heart failure (HF) is an accepted adjunct to an evidence-based management program. This review describes the pathophysiologic features that are thought to be responsible for the exercise intolerance experienced in the HF patient. Significant research has expanded our appreciation of the interplay of hemodynamic, ventilatory, and skeletal myopathic processes in this common, chronic condition. Randomized, controlled exercise trials designed to measure endothelial function, inflammatory markers, sympathetic neural activation, and skeletal muscle metabolism and structure have further defined the pathophysiology, documented the impact of exercise training on these processes, and confirmed the benefit of this therapy. Consistent with prior clinical research and patient experience are the recently published results of the HF-ACTION (Heart Failure–A Controlled Trial Investigating Outcomes of exercise TraiNing), which demonstrated a modest improvement in exercise capacity, reduction of symptoms, and improved self-reported measures of quality of life without adverse events. Consideration is given in this review to the benefits of variable intensity programs and the addition of resistance exercise to a standard aerobic prescription. Despite increasing validation of the role exercise training plays in the modification of exercise intolerance, challenges remain in its routine therapeutic application, including acceptance and use as an adjunctive intervention in the management of the patient with HF, limited insurance coverage for HF patients in cardiac rehabilitation, tailoring of exercise programs to best address the needs of subgroups of patients, and improved short- and long-term adherence to exercise training and a physically active lifestyle.
The authors have reported that they have no relationships to disclose.
- Received February 8, 2011.
- Revision received April 12, 2011.
- Accepted April 19, 2011.
- American College of Cardiology Foundation