ABSTRACT
Exercise training in patients with chronic stable heart failure (HF) is a recommended and broadly accepted treatment strategy that is an integral part of an evidence-based management involving pharmacological and non-pharmacological therapies. There is ample scientific evidence that exercise training in HF with reduced (HFrEF) and with preserved ejection fraction (HFpEF) improves exercise capacity, HF symptoms and quality of life. This is due to an improvement of central hemodynamics, endothelial function, neurohumoral activation, skeletal muscle structure and function as well as a decrease in inflammatory markers. The largest randomized, controlled HF-ACTION study (Heart Failure-A Controlled Trial Investigating Outcomes of exercise TraiNing) demonstrated that exercise training results in a modest improvement of all-cause mortality and hospitalizations in HFrEF, depending on adequate compliance. Outcome data in HFpEF are lacking. Besides compliance, efficacy of exercise training is dependent on the intensity and type of exercise. Resistance and high intensity endurance training in addition to a standard aerobic exercise seem to be superior in improving the clinical status of HF patients. In the future, individualized exercise programs will help to improve long-term adherence to exercise training.
Subject(s)
Exercise Therapy/methods , Heart Failure/therapy , Physical Conditioning, Human/methods , Quality of Life , Chronic Disease , Evidence-Based Medicine , HumansABSTRACT
Observation of 39 patients who had undergone surgery for hyperthyroidism with or without endocrine ophthalmopathy between 1965 and 1972 indicate that this type of therapy involves no higher risk than do medication of radiological measures as far as the course of ophthalmic changes is concerned. Examination of the basal and the TRH-stimulated TSH concentrations i.s. argues against any primarily pituitary cause for progressive ophthalmopathy after surgery. In addition, it elucidates the almost inevitable postoperative development of preclinical hypothyroidism while the clinical condition is still euthyroid, and indicates the necessity of constant postoperative hormone substitution.
