Exercise Training in Patients with Heart Failure: From Pathophysiology to Exercise Prescription

Reviews in Cardiovascular Medicine

Elio Venturini¹  Gabriella Iannuzzo²  Gianluigi Cuomo³  Carlo Vigorito³  Andrea D’Angelo³  Rita Pezzella³  Alessandro Parlato³  Giuseppe Cudemo³  Francesco Giallauria³  Pasquale Merone³  Anna Di Lorenzo³  Anna Tramontano³  Francesca Paola Iannone³  Crescenzo Testa³  Antonello D’Andrea⁴  Mario Pacileo⁴ 

[1] Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Cecina Civil Hospital, 57023 LI Cecina, Italy;Department of Clinical Medicine and Surgery, “Federico II" University of Naples, 80131 Naples, Italy;Department of Translational Medical Sciences, “Federico II" University of Naples, 80131 Naples, Italy;Division of Cardiology/UTIC, “Umberto I" Hospital, Nocera Inferiore (ASL Salerno), 84014 Nocera Inferiore (SA), Italy;

关键词: heart failure;    preserved ejection fraction;    exercise training;    cardiac rehabilitation;    continuous training;    interval training;    strength training;    respiratory training;    inspiratory muscle training;    functional electrical stimulation;    mortality;    elderly;    frailty;    covid-19;   

DOI  :  10.31083/j.rcm2304144

来源: DOAJ

【 摘 要 】

Heart failure (HF) is a chronic, progressive, and inexorable syndrome affecting worldwide billion of patients (equally distributed among men and women), with prevalence estimate of 1–3% in developed countries. HF leads to enormous direct and indirect costs, and because of ageing population, the total number of HF patients keep rising, approximately 10% in patients >65 years old. Exercise training (ET) is widely recognized as an evidence-based adjunct treatment modality for patients with HF, and growing evidence is emerging among elderly patients with HF. We used relevant data from literature search (PubMed, Medline, EMBASE) highlighting the epidemiology of HF; focusing on central and peripheral mechanisms underlying the beneficial effect of ET in HF patients; and on frail HF elderly patients undergoing ET. Since many Countries ordered a lockdown in early stages pandemic trying to limit infections, COVID-19 pandemic, and its limitation to exercise-based cardiac rehabilitation operativity was also discussed. ET exerts both central and peripheral adaptations that clinically translate into anti-remodeling effects, increased functional capacity and reduced morbidity and mortality. Ideally, ET programs should be prescribed in a patient-tailored approach, particularly in frail elderly patients with HF. In conclusion, given the complexity of HF syndrome, combining, and tailoring different ET modalities is mandatory. A procedural algorithm according to patient’s baseline clinical characteristics [i.e., functional capacity, comorbidity, frailty status (muscle strength, balance, usual daily activities, hearing and vision impairment, sarcopenia, and inability to actively exercise), logistics, individual preferences and goals] has been proposed. Increasing long-term adherence and reaching the frailest patients are challenging goals for future initiatives in the field.

【 授权许可】

Unknown