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Many clinicians hesitate to advise exercise for patients with heart failure, given that the disease involves shortness of breath, fatigue, and discomfort during exertion. But clinicians would be wise to recommend mild to moderate exercise for patients in whom the disease is well controlled, said Ileana Piña, MD, at the 11th Annual Scientific Meeting of the Heart Failure Society of America, September 16–19 in Washington, D.C.
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A growing body of research indicates that carefully managed, slowly ramped-up workouts benefit heart failure patients in multiple ways—chiefly by enhancing these patients' exercise capacity and duration, with an accompanying boost in quality of life, says Piña, a professor of medicine at Case Western Reserve University in Cleveland, Ohio.
Physicians should, of course, consider energy-draining effects of some medications and only recommend exercise if medication is keeping symptoms in check.
They should also advise patients to cease activity when symptoms flare, and to otherwise approach exercise with pragmatism, Pina notes.
"Discuss with them when to fit exercise into their daily routine at a time of day when they have the most energy," she advises.
What sort of exercise works best in heart failure? Piña won't yet provide any specific recommendations. She and her colleagues are seeking that sort of information from an ongoing study they're conducting—Heart Failure: A Controlled Trial Investigating Outcomes of exercise traiNing (HF-ACTION), a 5-year, 50-site study involving 3,000 patients with heart failure.
In the meantime, Piña advises her heart failure patients to aim for thrice weekly workouts, incorporating aerobic exercise to bolster cardiac endurance and resistance training to build muscle mass (though no past studies have examined the latter in heart failure). Based on research to date, workouts should last 20 to 30 minutes with additional warm-up and cool-down periods, and patients should supplement workouts with walking on non-training days.1
Piña offers general tips to share with patients on ways to save energy for workouts:
Footnotes
To find out more about the multi-site study, Heart Failure: A Controlled Trial Investigating Outcomes of exercise traiNing (HF-ACTION), visit www.hfaction.org/about/index.html.
Further information on heart failure and exercise is available from the American Heart Association at www.americanheart.org/presenter.jhtml?identifier=1543.
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