Combined Aerobic and Strength Training in Congestive Heart Failure Patients: Pilot Project on Saffty and Feasibility

Summary

Patients with advanced congestive heart failure (CHF) may be at increased risk for complications when performing aerobic training alone or in combination with strength training, although there are limited data to support this assumption. In this pilot study, 19 NYHA classes II-III CHF patients, average age 60 years, were allocated to 8 weeks of upper body strength training plus aerobic bicycle exercise, or 8 weeks of milieu therapy (relaxation and health education discussions) in a randomized crossover fashion. Thirteen patients completed the study, two died before randomization, two dropped out, and two others died during milieu therapy. During exercise training, temporary interruptions due to CHF exacerbation were seen in two patients, symptoms of respiratory tract infection in one, and musculoskeletal pain in another. There were no interruptions due to angina, arrhythmias, hypotension, hypertension, bradycardia, or tachycardia. No patient needed hospitalization for CHF exacerbation during the training phase of the study. Thus, upper body strength plus aerobic bicycle exercise training appears to be safe and feasible in stable NYHA classes II and HI CHF patients. These findings should be confirmed and the benefits of such training should be studied in larger randomized controlled trails.

Congestive heart failure (CHF) is a complex clinical syndrome of multiple organ involvement, with variable symptoms and physical signs, resulting in varying degrees of physical disability [1]. Fatigue and exercise capacity limited by shortness of breath are the most common clinical manifestations of CHF

Recent studies suggest that the physical disability associated with CHF is not necessarily related to the degree of ventricular dysfunction, but it may be associated with physical deconditioning and abnormalities in peripheral blood flow [3]. Patients with CHF have been observed to have skeletal muscle abnormalities, which include a reduction in muscle volume and strength, a decline in both oxidative fibers and oxidative enzyme activity, and an abnormal vasodilatory response during exercise [3-6]. A number of studies have demonstrated that patients with poor left ventricular function may benefit from exercise programs intended to improve maximal aerobic power (VO_2max) [7-11]. In addition, in deconditioned CHF patients it may be possible that an exercise regimen consisting of aerobic and strength training will reverse some of the peripheral circulatory and muscle abnormalities, leading to an increase in maximal muscular strength, and VO_2max, which may in turn result in improvements in clinical outcomes and symptoms, occupational and recreational activities of daily living, and quality of life. Traditionally, however, aerobic exercise alone or in combination with strength training has been prescribed for patients with CHF for fear that physical activity may result in further deterioration of left ventricular function and exacerbation of symptoms. This study assessed the safety and feasibility of combined aerobic and strength training in patients with CHF.