It is said that exercise is good medicine, but is exercise a good medicine for heart failure?Can people with heart failure exercise?
Exercise certainly increases the workload on the heart, and it has been previously thought that people with heart failure (HF) are risky to participate in exercise and are often discouraged from engaging in physical activity. Contrary to these concerns, however, multiple studies have demonstrated the safety and benefits of exercise and physical activity in people with heart failure, as well as the harmful effects of prolonged bed rest and immobilization.
The HF-Action trial, the largest study of exercise training in patients with heart failure with reduced ejection fraction (HFREF), demonstrated that regular aerobic exercise was well tolerated and safe, and improved quality of life (QoL), with a non-statistically significant downward trend in all-cause mortality and hospitalizationIn a risk factor-adjusted analysis, exercise training reduced cardiovascular disease deaths and hospitalizations by 15% (HR, 0.).85 [95% ci, 0.74-0.99]; p = 0.03）；Post-hoc analysis found that exercise training could significantly improve New York cardiac function grading, and 30% of patients in the exercise** group had a 1-level improvement in New York cardiac function rating. The HF-Action trial further confirmed the benefits and safety of exercise in multiple subgroups, with clear benefits and safety of exercise regardless of age, HF level**, HF severity, ethnicity, and gender.
Meta-analyses have further demonstrated the safety and efficacy of exercise in patients with heart failure, whether it is heart failure with reduced ejection fraction or heart failure with preserved ejection fraction, which can significantly improve the quality of life and reduce the rehospitalization rate of patients with reduced ejection fraction.
Figure: Exercise can improve the condition of heart failure patients from various aspects such as heart, lungs, muscles, blood vessels, nerves, kidneys, metabolism, and inflammation. Exercise is not only a good medicine, but also a precise targeted drug for various organs, which can accurately act on every link that affects circulation and metabolism.
hfPatient exercise intolerance** and reversibility
Exercise intolerance, chronic fatigue, and inability to perform activities are the main manifestations of HF and are associated with poor quality of life and poor prognosis. Patients with better motor performance have lower mortality and hospitalization rates, and are independent of left ventricular function.
The causes of exercise intolerance in HF patients are multifactorial, including central cardiac and peripheral mechanisms. There is evidence of cardiac output insufficiency and high filling pressure in HF patients, resulting in motor muscle hypoperfusion, early onset of anaerobic metabolism, and muscle fatigue. Skeletal muscle dysfunction is characterized by impaired peripheral oxygen extraction and alterations in fiber composition, contractile efficiency, and metabolism. Other factors include endothelial dysfunction, obesity, increased sympathetic activity, vasoconstriction, and elevated levels of inflammatory cytokines.
There may be differences in the pathophysiology of exercise tolerance between HFPEF and HFREF patients. In patients with HFPEF, chronotropic dysfunction of the heart may be a key cause of exercise restriction.
Pilot studies in HF patients have shown that exercise** can reverse or reduce neurohormonal and inflammatory activation and ventricular remodeling. Exercise** has also been associated with improved vascular motility and endothelial function, skeletal muscle morphological characteristics and function, ventricular filling pressure, exercise performance, and quality of life in patients with HF.
In summary, whether it is heart failure with reduced ejection fraction or heart failure with preserved ejection fraction, exercise** has obvious benefits and is safe.