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Circulation, Vol 85, 2119-2131, Copyright © 1992 by American Heart Association
AJ Coats, S Adamopoulos, A Radaelli, A McCance, TE Meyer, L Bernardi, PL Solda, P Davey, O Ormerod and C Forfar
BACKGROUND. Many secondary abnormalities in chronic heart failure (CHF) may
reflect physical deconditioning. There has been no prospective, controlled
study of the effects of physical training on hemodynamics and autonomic
function in CHF. METHODS AND RESULTS. In a controlled crossover trial of 8
weeks of exercise training, 17 men with stable moderate to severe CHF (age,
61.8 +/- 1.5 years; left ventricular ejection fraction, 19.6 +/- 2.3%),
increased exercise tolerance (13.9 +/- 1.0 to 16.5 +/- 1.0 minutes, p less
than 0.001), and peak oxygen uptake (13.2 +/- 0.9 to 15.6 +/- 1.0
ml/kg/min, p less than 0.01) significantly compared with controls. Training
increased cardiac output at submaximal (5.9-6.7 l/min, p less than 0.05)
and peak exercise (6.3- 7.1 l/min, p less than 0.05), with a significant
reduction in systemic vascular resistance. Training reduced minute
ventilation and the slope relating minute ventilation to carbon dioxide
production (-10.5%, p less than 0.05). Sympathovagal balance was altered by
physical training when assessed by three methods: 1) RR variability
(+19.2%, p less than 0.05); 2) autoregressive power spectral analysis of
the resting ECG divided into low-frequency (-21.2%, p less than 0.01) and
high- frequency (+51.3%, p less than 0.05) components; and 3) whole-body
radiolabeled norepinephrine spillover (-16%, p less than 0.05). These
measurements all showed a significant shift away from sympathetic toward
enhanced vagal activity after training. CONCLUSIONS. Carefully selected
patients with moderate to severe CHF can achieve significant, worthwhile
improvements with exercise training. Physical deconditioning may be partly
responsible for some of the associated abnormalities and exercise
limitation of CHF, including abnormalities in autonomic balance.
ARTICLES
Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function
Department of Cardiac Medicine, National Heart and Lung Institute, London, UK.
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