Circulation, Vol 78, 506-515, Copyright © 1988 by American Heart Association
MJ Sullivan, MB Higginbotham and FR Cobb
We studied the effects of exercise training in patients with chronic heart
failure attributed to left ventricular dysfunction (ejection fraction, 24
+/- 10%). Twelve ambulatory patients with stable symptoms underwent 4-6
months of conditioning by exercising 4.1 +/- 0.6 hr/wk at a heart rate
corresponding to 75% of peak oxygen consumption. Before and after training,
patients underwent maximal bicycle exercise testing with direct measurement
of central hemodynamic, leg blood flow, and metabolic responses. Exercise
training resulted in a decrease in heart rate at rest and submaximal
exercise and a 23% increase in peak oxygen consumption from 16.8 +/- 3.8 to
20.6 +/- 4.7 ml/kg/min (p less than 0.01). Heart rate, arterial lactate,
and respiratory exchange ratio were unchanged at peak exercise after
training. Maximal cardiac output tended to increase from 8.9 +/- 2.7 to 9.9
+/- 3.2 1/min and contributed to improved peak oxygen consumption in some
patients, although this change did not reach statistical significance (p =
0.13). Rest and exercise measurements of left ventricular ejection
fraction, left ventricular end-diastolic volume, and left ventricular end-
systolic volume were unchanged. Right atrial, pulmonary arterial, pulmonary
capillary wedge, and systemic arterial pressures were not different after
training. Training induced several important peripheral adaptations that
contributed to improved exercise performance. At peak exercise, systemic
arteriovenous oxygen difference increased from 13.1 +/- 1.4 to 14.6 +/- 2.3
ml/dl (p less than 0.05). This increase was associated with an increase in
peak-exercise leg blood flow from 2.5 +/- 0.7 to 3.0 +/- 0.8 l/min (p less
than 0.01) and an increase in leg arteriovenous oxygen difference from 14.5
+/- 1.3 to 16.1 +/- 1.9 ml/dl (p = 0.07). Arterial and femoral venous
lactate levels were markedly reduced during submaximal exercise after
training, even though cardiac output and leg blood flow were unchanged at
these workloads. Thus, ambulatory patients with chronic heart failure can
achieve a significant training effect from long-term exercise. Peripheral
adaptations, including an increase in peak blood flow to the exercising
leg, played an important role in improving exercise tolerance.(ABSTRACT
TRUNCATED AT 400 WORDS)
ARTICLES
Exercise training in patients with severe left ventricular dysfunction. Hemodynamic and metabolic effects
Department of Medicine, Duke University Medical Center, Durham, NC 27710.
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