The effect of resistance training on left ventricular function and structure of patients with chronic heart failure.

INTRODUCTION: Resistance training (RT) has been shown to improve chronic heart failure (CHF) patients' functional ability and quality of life. Despite these benefits RT has not always been recommend as a form of exercise principally because of a concern for acceleration of the left ventricular (LV) remodeling process. This study investigated the effects of 8 weeks RT on the LV structure and function of patients with CHF. METHOD: Fifteen men who suffered from CHF were divided into either a RT program or non-training control group. Before and after 8 weeks of training patients underwent resting echocardiography to assess their end-diastolic and end-systolic dimensions (EDD and ESD, respectively), ejection fraction (EF), fractional shortening (FS) and stroke volume (SV). RESULTS: A repeated measured ANOVA showed that 8 weeks of RT had no significant effect on the LV measurements (group x time, p>0.05). Post training comparison, however, revealed that the EF and FS of the training group was significantly higher than in the control group (40.9+/-10.5% vs. 30.3+/-4.6%, p=0.029 and 25.0+/-7.0% vs. 17.4+/-3.1%, p=0.020 respectively). CONCLUSION: RT is a suitable method of training for CHF patients since it does not cause a reduction of LV contractility function or enhance myocardial deterioration as measured by EF and FS.

Resistance training for chronic heart failure patients on beta blocker medications.

BACKGROUND: Resistance training increases the skeletal muscle strength and functional ability of chronic heart failure patients. However, there is limited data regarding the effect of resistance training on the hemodynamic responses and peak oxygen consumption (peak VO(2)) of chronic heart failure patients treated with beta-blocker. This study examined the effect of resistance training on hemodynamics, peak aerobic capacity, muscle strength and quality of life of chronic heart failure patients on beta-blockers medication. METHODS: Fifteen men diagnosed with chronic heart failure were matched to either a resistance training program or non-training control group. At baseline and after 8 weeks of resistance training patients performed both Balke incremental and maximal strength tests and completed quality of life questionnaires. RESULTS: The resistance training group demonstrated a significant increase of walking time and peak VO(2) by 11.7% (p=0.002) and approximately 19% (p<0.05), respectively. Peak VO(2) was significantly correlated with both walking time (r=0.54, p=0.038) and change in total weight lifted (r=0.55, p=0.034). Quality of life significantly increased by 87% (p=0.030). The improvement in quality of life was correlated with post training peak VO(2) (r=0.58, p=0.025) and total weight lifted during the post maximal strength test (r=-0.52, p=0.047). CONCLUSIONS: The benefits from resistance training for chronic heart failure patients on beta-blocker medication included an increased aerobic and exercise capacity, skeletal muscle strength and most importantly, an improvement in the quality of life, which is the main goal of cardiac rehabilitation programs. Furthermore, with appropriate supervision, it is recommended that resistance exercise be added to the exercise rehabilitation program of these patients when possible.

The physiological responses of chronic heart failure patients to maximal strength test and a balke incremental test.

It has been demonstrated that resistance exercises may improve chronic heart failure (CHF) patients' functional ability and quality of life, however, physicians do not recommend this form of exercise because of a concern for reported increases in afterload and blood pressure (BP) during the exercise. This study compared the heart rate (HR), BP and rate pressure product (RPP) of CHF patients for a Balke incremental test and a maximal strength test (MS). Fifteen men diagnosed with CHF participated in the study. All subjects performed both a Balke incremental test and MS test for eight different resistance exercises. The subjects' HR and BP were monitored during the incremental test and immediately after each resistance exercise. HR, systolic BP and RPP were significantly lower during the MS test than during both the peak Balke incremental test and during exercise at 80% of peak VO2 (p < 0.05). No significant RPP differences were found between upper and lower body resistance exercises (p > 0.05). The physiological responses in this study were less severe during a MS test than those reported during an incremental Balke treadmill test. Also the finding suggests that MS tests may be an acceptable method to assess the maximal strength of patients with moderate heart failure. Key PointsThe physiological responses of CHF patients to maximal strength test were less severe than those reported during a walking incremental test.There were similar hemodynamic responses during upper and lower resistance exercises.Maximal strength test appears to be an acceptable method to assess the maximal strength of patients with moderate CHF.

Perceived exertion as an exercise intensity indicator in chronic heart failure patients on Beta-blockers.

The Rating of Perceived Exertion (RPE) has been used as a supplementary tool for prescription of exercise training intensity for healthy and special populations. Despite the wide use of the RPE scale, there is an inconsistency regarding the accuracy of that scale for chronic heart failure (CHF) patients treated with beta-blockers. The study examined the correlation between RPE and heart rate (HR), percentage of maximal HR (%MHR), ventilation (VE) and oxygen consumption (VO2) during graded treadmill testing and examined the RPE scale as a guideline for training intensity for CHF patients treated with beta-blockers. Fourteen men age 57.7 ± 10.2 yrs diagnosed with CHF and treated with beta-blockers participated in the study. During a Balke treadmill test the subjects RPE, HR, VE and VO2 ml·kg(-1)·min(-1) were monitored. Low to moderate significant correlations were found between RPE and HR, %MHR, VE and VO2 ml·kg(-1)·min(-1) (r = 0.44, 0.43, 0.55 and 0.69 respectively, all p < 0.001). Some subjects exhibited clinical symptoms (e.g. fall of systolic blood pressure, ST depression/elevation) despite relatively low RPE. The RPE may be used to indicate the level of exercise intensity; however it may not represent the HR responses in CHF patients on beta-blocker medication. Therefore, it is recommended to monitor the HR in combination with RPE when prescribing exercise intensity for CHF patients on beta blocker medication. Key PointsRPE correlated with HR, VE and VO2 in CHF patients on beta blockers.There was a large RPE inter-individual variability during graded treadmill tests.RPE can be used as an exercise intensity indicator for patients on beta-blockers, however, it must be taken with caution.