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Train to maintain: exercise and prevention of heart failure

Rehabilitation


The positive effects of exercise

Volker Adams (Leipzig, DE) brought good news from the basic science field, showing that regular exercise has a net positive effect on the cardiovascular system cells, both at the heart and at the vessels level. These effects work by creating conditions for the cardiovascular system to perform better during exercise, increasing for instance their vasodilatation capability and protecting it from aggressions that are secondary to exercise, like oxygen free radicals production. In the discussion period, he emphasized that the positive effects at the cellular level will only last for 2 to 3 weeks after interruption of regular exercise.

Pantaleo Giannuzzi (Veruno; IT) demonstrated that a program of moderate intensity aerobic exercise is safe and has beneficial effects on LV function, producing a reverse LV remodeling in HF patients. He also showed a recent meta-analysis where reverse remodeling could be found on aerobic training programs, but not in programs that combined aerobic and resistance training. This was debated in the discussion and it was agreed that the data to support this conclusion are insufficient for the moment.

Viviane Conraads (Edegem, BE), started to argue that the increase of Quality of Life and exercise tolerance must be central goals in every cardiac rehabilitation program for HF patients and showed evidence supporting that respiratory muscles, resistance and interval training must be integrated in exercise program. She also showed provocative data coming from a small study of her group, where good results could be found in HF patients who were allowed to perform the type of exercise of their personal preference, instead of being submitted to a classical program.

Cristopher O’ Connor (Durham, US), discussed the results of HF-ACTION which got modest benefits regarding the study endpoints in the global study population, but showed a clinically relevant benefit in high adherence and high weekly exercise volume patients, which are a big challenge for every program team.

Conclusion:

In summary, exercise training has clear benefits at the vascular and at the heart level in HF patients. Classical exercise programs must be changed to integrate the new types of physical training and must actively promote patient adherence and motivation. Some studies support the idea that exercise intensity must be set at a higher level than usual, but we have to wait for further evidence to make a final recommendation.

References


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Train to maintain: exercise and prevention of heart failure

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.