Chronic heart failure is the single-most common reason for emergency room visits in the United States. It is a frequent cause of death and disability and, according to the American Heart Association, more than a half-million new diagnoses are made each year. Regular exercise can help people with chronic heart failure improve their health, fitness level and quality of life.
Characteristics
In people with chronic heart failure, the heart is unable to effectively distribute blood and oxygen to the body. According to the American College of Sports Medicine, about 60 percent of people with heart failure have systolic dysfunction, meaning that the heart is unable to contract effectively. The remaining cases are of diastolic dysfunction, or the inability of the heart to fully relax and fill with blood. Both types of dysfunction compromise the body's circulatory system and lead to shortness of breath with activity (or at rest in severe cases), muscular fatigue and fluid retention.
Misconceptions
Prior to the mid-1980s, people with chronic heart failure were told to rest and to avoid exercise for fear that exercise would strain and further damage the heart. Research has since shown that exercise is both safe and beneficial for people with heart failure. Excessive rest should be avoided because it leads to further deconditioning and disability.
Challenges
Compared with the average person, people with chronic heart failure have a lower tolerance for exercise and take longer to recover. This is due to limitations within the heart itself (central limitations) and abnormalities in skeletal muscle (peripheral limitations). During exercise, people with chronic heart failure are often hindered by leg fatigue rather than by shortness of breath. Exercise should start slowly and incorporate rest periods as needed.
Exercise Benefits
People with chronic heart failure can improve cardiovascular endurance, muscular strength, muscular endurance and flexibility with regular exercise. Improved physical fitness facilitates independent living and makes it easier to accomplish activities of daily living. Avoiding a sedentary lifestyle can prevent development of other diseases such as diabetes and certain cancers. Exercise also helps people with chronic heart failure to live longer, avoid hospitalizations and improve quality of life.
Mechanism
In people with chronic heart failure, cardiovascular improvements with exercise are usually due to peripheral changes rather than central changes. Although exercise may not change the heart's ability to contract or relax, it does improve blood vessel dilation, distribution of blood flow and the ability of the muscles to use oxygen. These changes help to reduce muscular fatigue and improve functional ability.
Considerations
People with chronic heart failure often have implanted cardiodefibrilators (ICDs) that are set to electrically shock the heart at a certain heart rate. It is important to keep exercise heart rate at least 10 percent below this threshold at all times. Intensity should be gauged using rating of perceived exertion (RPE) rather than using heart rate. With RPE, the person exercising subjectively rates their intensity level on a scale from 6 to 20. This is beneficial for people with chronic heart failure because they tire more easily and may have an abnormal heart rate response to exercise.
Programming
Exercise for people with chronic heart failure should include aerobic and flexibility training daily with resistance training two to three times per week. Pool walking in waist-high or chest-high water can benefit people whose legs fatigue easily. For people who are very deconditioned, resistance training using body weight, such as chair stands or wall push-ups, may be preferable to using an external weight. Resistance training should be done in a slow and controlled manner, with proper breathing technique to avoid excessive increases blood pressure.
References
- "ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities"; American College of Sports Medicine; 2009
- Circulation Journal: Heart Disease and Stroke Statistics 2009 Update. A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
