[Training and educational measures in severe chronic heart failure. Experiences and application to general practice].
OBJECTIVE
Prognosis and course of severe left ventricular dysfunction have been shown to be influenced positively by exercise training. Yet, physicians have been reluctant to include exercise into therapeutic concepts due to widespread uncertainty about the acceptable intensity of cardiac stress. Standardized exercise programs with proven safety may promote acceptance of this approach.


METHODS
25 patients with severe heart failure were enrolled in a PC-controlled interval exercise training on cycle ergometer, lasting 21 minutes five times a week for a 4-week inpatient period. After discharge patients performed incremental daily walking for 3 months. Associated educational measures concerned life-style changing and self-controls.


RESULTS
None of the patients had to interrupt the training because of side effects. 3 weeks and 3 months after starting exercise training there was an increase of peak VO2 from 13.4 +/- 2.8 to 14.5 +/- 3.8 (p < 0.05) and 15.3 +/- 3.2 ml/kg/min (p < 0.01), respectively, and an increase of ventilatory anaerobic threshold (VAT) from 9.3 +/- 1.9 to 10.0 +/- 2.3 (p < 0.05) and 11.3 +/- 2.2 ml/kg/min (p < 0.001), respectively. The improved aerobic capacity corresponded to a 9.3% increase in the results of the 6-minute walk test in the 4th week (n.s.). During out-patient period, the walking could be increased from 37 to 58 minutes daily. The physical quality of life was significantly improved after 3 months. There was no hospital admission due to heart failure.


CONCLUSIONS
Exercise training in the therapy of severe heart failure is safe and increases the aerobic capacity. Associated educational measures may be able to minimize the danger of wrong exercise techniques and to reduce the rate of hospital readmissions.
Bertram
Rolf
R
Gollwitzer-Meier-Klinik Herforder Strasse 43 32545 Bad Oeynhausen. rbertram@gollwitzer-meier-klinik.de
Cordes
Carsten
C
Schmidt
Stefan
S
Lorig
Karin
K
Delille
Gabriele
G
Mertens
Hans-Martin
HM
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015444:Exercise; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000534:rehabilitation*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011788:Quality of Life