Effects of Exercise Training in Heart Failure Patients
Effects of Exercise Training in Heart Failure Patients
The purpose of this pilot study was to test the adjunctive effects of a 12-week exercise training intervention vs. standard pharmacologic therapy on quality of life, functional status, and mood in heart failure patients. A randomized, two-group repeated measures design was used to test outcomes at baseline and 12 weeks in 23 subjects (ejection fraction ≤40%, standard pharmacologic therapy [diuretics, angiotensin-converting enzyme inhibitors, β blockers, and digoxin] and no change in medical therapy for 30 days). The exercise group had significantly higher adjusted means on the role physical, role emotional, and mental functioning subscales of the Medical Outcomes Study 36-item Short-Form Health Survey compared with the control group. Confusion/bewilderment (Profile of Mood States subscale) adjusted mean scores were significantly lower for the exercise group, indicating better mood compared with the control group. Exercise training provided adjunctive benefit in terms of role and mental functioning for these heart failure patients.
Dyspnea and fatigue are the cardinal manifestations of heart failure in the nearly 4.9 million Americans with heart failure. Exercise intolerance and fluid retention impair functional capacity and negatively affect quality of life. As the prevalence of heart failure continues to increase (there are 550,000 new cases each year), optimum pharmacologic and nonpharmacologic therapies are imperative to reduce symptoms and improve physiologic and psychologic functioning and overall quality of life.
Standard pharmacologic therapy according to the 2001 American College of Cardiology/American Heart Association (AHA) Practice Guidelines includes four drugs: a diuretic, an angiotensin-converting enzyme (ACE) inhibitor, a β-adrenergic blocker, and (usually) digitalis.In addition to this standard pharmacologic regimen, the guidelines address the benefit of exercise training to lessen symptoms, increase exercise capacity, and improve quality of life in patients with chronic heart failure. Although the scientific evidence clearly points to the benefits of standard pharmacologic therapy and nonpharmacologic therapy in the form of exercise training, few studies are available to evaluate the adjunctive effects of exercise training in heart failure patients receiving the maximum pharmacologic therapy with all four drugs in the standard regimen.
Beta-adrenergic blockade is the most recent addition to the standard, four-drug regimen for treatment of heart failure. Use of β-adrenergic blockade to inhibit the adverse effects of the sympathetic nervous system has been shown to lessen symptoms, improve clinical status, and enhance overall sense of well-being in patients with heart failure. Controlled trials of exercise training in heart failure patients have also been shown to lessen symptoms, increase exercise capacity, and improve quality of life in chronic heart failure patients.What remains unclear are the effects of exercise in heart failure patients receiving the maximum pharmacologic therapy with all four drugs in the standard treatment regimen. The majority of controlled trials of exercise training have been completed in subjects managed on diuretics, ACE inhibitors, and digitalis. Very few subjects in these trials have been on β-adrenergic blockade, therefore the effects of exercise training in subjects receiving optimal pharmacologic therapy with the standard four-drug regimen has not been clearly elucidated.
The only controlled trials of exercise training in heart failure patients being treated with β-adrenergic blocking therapy have demonstrated significant exercise training responses. These studies targeted the physiologic end points of peak oxygen uptake (Vo2) and peak hyperemic blood flow to arms and legs. These physiologic effects do appear to be consistent regardless of type of adrenergic blockade. Subjects in the Curnier et al. study were maintained primarily on the selective agents of metoprolol and bisoprolol, whereas subjects in the Demopolous et al. study were maintained on the nonselective agent carvedilol. A study by Forissier et al. found no difference in peak Vo2 after exercise training in subjects not on β blockers compared with a group on a cardioselective β blocker and a group on the nonselective agent carvedilol. The studies by Curnier et al., Demopolous et al., and Forissier et al. were the only studies found in the literature that specifically studied exercise training effects in heart failure patients maintained on β adrenergic blockade in addition to other standard pharmacologic therapy. These studies did not evaluate the end points of functional status, quality of life, or psychologic mood states.
The purpose of this pilot study was to test the adjunctive effects of a 12-week exercise training intervention to standard pharmacologic therapy on quality of life, functional status, and mood in heart failure patients. The specific aims of the study were to test for differences between the control group (standard pharmacologic therapy) and the exercise training group (standard pharmacologic therapy plus exercise training) on quality of life (i.e., Minnesota Living with Heart Failure), functional status (i.e., Medical Outcomes Study 36-item Short-Form Health Survey [SF-36], 6-minute walk test, and exercise tolerance [duration, maximum Vo2, and Vo2 at anaerobic threshold]), and mood (i.e., Profile of Mood States).
The purpose of this pilot study was to test the adjunctive effects of a 12-week exercise training intervention vs. standard pharmacologic therapy on quality of life, functional status, and mood in heart failure patients. A randomized, two-group repeated measures design was used to test outcomes at baseline and 12 weeks in 23 subjects (ejection fraction ≤40%, standard pharmacologic therapy [diuretics, angiotensin-converting enzyme inhibitors, β blockers, and digoxin] and no change in medical therapy for 30 days). The exercise group had significantly higher adjusted means on the role physical, role emotional, and mental functioning subscales of the Medical Outcomes Study 36-item Short-Form Health Survey compared with the control group. Confusion/bewilderment (Profile of Mood States subscale) adjusted mean scores were significantly lower for the exercise group, indicating better mood compared with the control group. Exercise training provided adjunctive benefit in terms of role and mental functioning for these heart failure patients.
Dyspnea and fatigue are the cardinal manifestations of heart failure in the nearly 4.9 million Americans with heart failure. Exercise intolerance and fluid retention impair functional capacity and negatively affect quality of life. As the prevalence of heart failure continues to increase (there are 550,000 new cases each year), optimum pharmacologic and nonpharmacologic therapies are imperative to reduce symptoms and improve physiologic and psychologic functioning and overall quality of life.
Standard pharmacologic therapy according to the 2001 American College of Cardiology/American Heart Association (AHA) Practice Guidelines includes four drugs: a diuretic, an angiotensin-converting enzyme (ACE) inhibitor, a β-adrenergic blocker, and (usually) digitalis.In addition to this standard pharmacologic regimen, the guidelines address the benefit of exercise training to lessen symptoms, increase exercise capacity, and improve quality of life in patients with chronic heart failure. Although the scientific evidence clearly points to the benefits of standard pharmacologic therapy and nonpharmacologic therapy in the form of exercise training, few studies are available to evaluate the adjunctive effects of exercise training in heart failure patients receiving the maximum pharmacologic therapy with all four drugs in the standard regimen.
Beta-adrenergic blockade is the most recent addition to the standard, four-drug regimen for treatment of heart failure. Use of β-adrenergic blockade to inhibit the adverse effects of the sympathetic nervous system has been shown to lessen symptoms, improve clinical status, and enhance overall sense of well-being in patients with heart failure. Controlled trials of exercise training in heart failure patients have also been shown to lessen symptoms, increase exercise capacity, and improve quality of life in chronic heart failure patients.What remains unclear are the effects of exercise in heart failure patients receiving the maximum pharmacologic therapy with all four drugs in the standard treatment regimen. The majority of controlled trials of exercise training have been completed in subjects managed on diuretics, ACE inhibitors, and digitalis. Very few subjects in these trials have been on β-adrenergic blockade, therefore the effects of exercise training in subjects receiving optimal pharmacologic therapy with the standard four-drug regimen has not been clearly elucidated.
The only controlled trials of exercise training in heart failure patients being treated with β-adrenergic blocking therapy have demonstrated significant exercise training responses. These studies targeted the physiologic end points of peak oxygen uptake (Vo2) and peak hyperemic blood flow to arms and legs. These physiologic effects do appear to be consistent regardless of type of adrenergic blockade. Subjects in the Curnier et al. study were maintained primarily on the selective agents of metoprolol and bisoprolol, whereas subjects in the Demopolous et al. study were maintained on the nonselective agent carvedilol. A study by Forissier et al. found no difference in peak Vo2 after exercise training in subjects not on β blockers compared with a group on a cardioselective β blocker and a group on the nonselective agent carvedilol. The studies by Curnier et al., Demopolous et al., and Forissier et al. were the only studies found in the literature that specifically studied exercise training effects in heart failure patients maintained on β adrenergic blockade in addition to other standard pharmacologic therapy. These studies did not evaluate the end points of functional status, quality of life, or psychologic mood states.
The purpose of this pilot study was to test the adjunctive effects of a 12-week exercise training intervention to standard pharmacologic therapy on quality of life, functional status, and mood in heart failure patients. The specific aims of the study were to test for differences between the control group (standard pharmacologic therapy) and the exercise training group (standard pharmacologic therapy plus exercise training) on quality of life (i.e., Minnesota Living with Heart Failure), functional status (i.e., Medical Outcomes Study 36-item Short-Form Health Survey [SF-36], 6-minute walk test, and exercise tolerance [duration, maximum Vo2, and Vo2 at anaerobic threshold]), and mood (i.e., Profile of Mood States).
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