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Educating About Exercise

In most cases, patients should be encouraged to be as active as possible, but should be cautioned not to over-exert themselves.

Exercise has been shown to benefit heart failure patients in numerous ways:

  • Improve functional work capacity [6]

  • Increase LV stroke volume at rest and during exercise [5]

  • Decrease LV end diastolic diameter and volume [5]

  • Reduce total peripheral resistance (TPR) at rest and during exercise. [5]

  • Significantly improve quality of life [7][8][9][10][11][12][13][14]

  • Benefit skeletal muscle physiology, endothelial function as well as perceived QoL [16]

  • Reduce anxiety [15]

  • Reduce afterload and cardiomegaly [5]

 

 

Most low impact exercises are adequate:

  • Walking

  • Cycling

  • Climbing stairs

  • Ergometer (rowing)

     

Sexual activity is perfectly alright, although some patients may need to "tone down" their sexual practices due to physical limitations. Discussing sexual activity with your patient is a good way to relieve some of their anxiety, as patients are often concerned with whether it is still safe for them to have sex. [1]

 

 

Exercise and Gender

  • Despite the well known benefits of exercise, only 34.4% of males and 14.3% of female patients reported exercising in a study by [16]

  • Other studies have shown that women participate in fewer, and withdraw earlier from exercise rehabilitation programs than men [17]

1.

Why do only half as many female HF patients exercise than male HF patients, when the they benfit equally both physically and psychologically?

 

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1. Grady KL, Dracup K, Kennedy G, Moser DK, Piano M, Stevenson LW, Young JB. Team Management of Patients With Heart Failure. Circulation. 2000;102:2443-2456.

5. Hambrecht R, Gielen S, Linke A, Fiehn E, Yu J, Walther C, Scoene N, Schuler G. Effects of Exercise Training on Left Ventricular Function and Peripheral Resistance in Patients With Chronic Heart Failure. JAMA. 2000;283(23):3095-3101.

6. Demopoulos L, Bijou R, Fergus I, Jones M, Strom J, Lejemtel TH. Exercise training in patients with severe congestive heart failure: enhancing peak aerobic capacity while minimizing the increase in ventricular wall stress. J Am Coll Cardiol. 1997;29:597-603.

7. Tyni-Lenne´R, Gordon A, Sylve´n C.Impr oved quality of life in chronic heart failure patients following local endurance training with leg muscles.J Card Fail 1996;2:111 –7.

8. Kavanagh T, Myers MG, Baigrie RS, Mertens DJ.Quality of life and cardiorespiratory function in chronic heart failure: effects of 12 months aerobic training.Heart 1996;76:42 –9.

9. Tyni-Lenne´R, Gordon A, Jansson E, Bermann G, Sylve´n C. Skeletal muscle endurance training improves peripheral oxidative capacity, exercise tolerance, and health related quality of life in women with chronic congestive heart failure secondary to either ischemic cardiomyopathy or idiopathic dilated cardiomyopathy.Am J Cardiol 1997;80:1025 –9.

10. Wielinga RP, Erdman RAM, Huisveld IA, et al.Effects of exercise training on quality of life in patients with chronic heart failure.J Psychosom Res 1998;45:459 –64.

11. Willenheimer R, Erhardt L, Cline C, Rydberg E, Israelsson B. Exercise training in heart failure improves quality of life and exercise capacity.Eur Heart J 1998;19:774 –81.

12. Belardinella R, Georgiou D, Gianci G, Purcaro A.Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome.Cir culation 1999;99:1173 –82.

13. Quittan M, Sturm B, Wiesinger GF, Pacher R, Fialka-Moser V.Quality of life in patients with chronic heart failure: a randomized controlled trial of changes induced by a regular exercise program.Scand J Rehabil Med 1999;31:223 –8.

14. Koch M, Douard H, Broustet JP. The benefit of graded physical exercise in chronic heart failure. Chest 1992;101(5 Suppl): 231S-5S.

15. Kostis JB, Rosen RC, Cosgrove NM, Shindler DM, Wilson AC.Nonpharmacologic therapy improves functional and emotional status in congestive heart failure.Chest 1994;106:996 – 1001.

16. Friedman MM. Gender differences in the health related quality of life of older adults with heart failure. Heart & Lung. 2003;32(5):320-327.

17. Cannistra LB, O’Malley CJ, Balady GJ. Comparison of outcome of cardiac rehabilitation in black women and white women. Am J Cardiol 1995;75:890-3.

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