Some of the neglected areas of research concerning physical conditioning and heart failure were debated in this symposium. Researchers in this field gathered this morning in a well attended session.
The extensive review of the effect of training on all body systems presented by Margherita Vona from Montreux (CH), discussed the latest findings on the anti-inflammatory effect, and the beneficial modifications in the skeletal muscle.
Luc Vanhees fom Leuven went over the contribution of this intervention in two growing subgroups of CHF populations, such as those with cardiac resynchronisation therapy and those with implanted cardioverter defibrillators. The literatures is still poor in these fields, but anecdotal reports show that in both these populations quality of life and exercise tolerance are improved when training was added on top of optimal therapy. No adverse events were reported, in particular there were no inappropriate ICD interventions, the most ominous and deleterious event. The excellent speaker ended by promoting a new endeavour from the Prevention and Rehabilitation Association, ie the RELAX-ICD trial.
Myself, the third speaker, gave an overview of the effect of physical training in elderly patients. The negative message, the presence of definitive detrimental effects of ageing on all physical and mental functions was overcame by a positive one, which stressed that these changes can be almost completely reversed by a properly performed exercise training programme.
However, this physical activity programme should include maintaining cardiovascular endurance, flexibility and muscle strength. Moreover, preliminary available data suggested exercise programme guidelines similar to younger CHF patients may work in elderly CHF patients. Finally, multidisciplinary team management of heart failure may favour compliance and adherence to training programmes.
The possibility to remove a patient from the transplant list because of physical training was the topic of Alan Cohen-Solal from Paris. Several pieces of evidence were in favour of this possibility: the best index that came out of the debate which followed his talk, was peak VO2 (assessed by cardiopulmonary exercise testing), and values above 11-14 ml/kg/min in well treated patients on optimal therapy, including beta-blocker and ACE-inhibition were considered the optimum index.