Exercise in Heart Failure: The Added Pressure Is Worth the Payoff

      Exercise occupies a central place in guideline-endorsed approaches to the primary and secondary prevention of cardiovascular disease. Among those patients with established cardiovascular disease, exercise plays a key role in ameliorating symptoms, preserving functional capacity, and potentially modifying disease trajectory.
      • O'Connor C.M.
      • Whellan D.J.
      • Lee K.L.
      • Keteyian S.J.
      • Cooper L.S.
      • Ellis S.J.
      • et al.
      Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial.
      • Piercy K.L.
      • Troiano R.P.
      • Ballard R.M.
      • Carlson S.A.
      • Fulton J.E.
      • Galuska D.A.
      • et al.
      The physical activity guidelines for Americans.
      • Fihn S.D.
      • Gardin J.M.
      • Abrams J.
      • Berra K.
      • Blankenship J.C.
      • Dallas A.P.
      • et al.
      2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
      Exercise training accordingly has earned class I recommendations in the treatment of heart failure,
      • Ponikowski P.
      • Voors A.A.
      • Anker S.D.
      • Bueno H.
      • Cleland J.G.F.
      • Coats A.J.S.
      • et al.
      2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
      ,
      • Yancy C.W.
      • Jessup M.
      • Bozkurt B.
      • Butler J.
      • Casey Jr., D.E.
      • Drazner M.H.
      • et al.
      2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.
      and structured, supervised exercise as offered by cardiac rehabilitation programs has been shown to provide a host of benefits including reductions in heart failure admissions and improvements in both quality of life and long-term survival.
      • O'Connor C.M.
      • Whellan D.J.
      • Lee K.L.
      • Keteyian S.J.
      • Cooper L.S.
      • Ellis S.J.
      • et al.
      Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial.
      ,
      • Long L.
      • Mordi I.R.
      • Bridges C.
      • Sagar V.A.
      • Davies E.J.
      • Coats A.J.
      • et al.
      Exercise-based cardiac rehabilitation for adults with heart failure.
      In recent years, there has been growing interest in optimizing the exercise prescription for the cardiovascular patient to maximize the health gain and reduce any attendant risks.
      • Bobenko A.
      • Bartels I.
      • Munch M.
      • Trippel T.
      • Lindhorst R.
      • Nolte K.
      • et al.
      Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction.
      This interest has led to an increasing range of exercise permutations across axes including exercise modality, intensity, and duration,
      • Ellingsen O.
      • Halle M.
      • Conraads V.
      • Stoylen A.
      • Dalen H.
      • Delagardelle C.
      • et al.
      High-intensity interval training in patients with heart failure with reduced ejection fraction.
      ,
      • Haykowsky M.J.
      • Liang Y.
      • Pechter D.
      • Jones L.W.
      • McAlister F.A.
      • Clark A.M.
      A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: the benefit depends on the type of training performed.
      with particular interest paid to the balance of resistance (RT) versus aerobic training (AT).
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      References

        • O'Connor C.M.
        • Whellan D.J.
        • Lee K.L.
        • Keteyian S.J.
        • Cooper L.S.
        • Ellis S.J.
        • et al.
        Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial.
        JAMA. 2009; 301: 1439-1450
        • Piercy K.L.
        • Troiano R.P.
        • Ballard R.M.
        • Carlson S.A.
        • Fulton J.E.
        • Galuska D.A.
        • et al.
        The physical activity guidelines for Americans.
        JAMA. 2018; 320: 2020-2028
        • Fihn S.D.
        • Gardin J.M.
        • Abrams J.
        • Berra K.
        • Blankenship J.C.
        • Dallas A.P.
        • et al.
        2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.
        J Am Coll Cardiol. 2012; 60: e44-e164
        • Ponikowski P.
        • Voors A.A.
        • Anker S.D.
        • Bueno H.
        • Cleland J.G.F.
        • Coats A.J.S.
        • et al.
        2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
        Eur Heart J. 2016; 37: 2129-2200
        • Yancy C.W.
        • Jessup M.
        • Bozkurt B.
        • Butler J.
        • Casey Jr., D.E.
        • Drazner M.H.
        • et al.
        2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.
        Circulation. 2013; 128: 1810-1852
        • Long L.
        • Mordi I.R.
        • Bridges C.
        • Sagar V.A.
        • Davies E.J.
        • Coats A.J.
        • et al.
        Exercise-based cardiac rehabilitation for adults with heart failure.
        Cochrane Database Syst Rev. 2019; : CD003331
        • Bobenko A.
        • Bartels I.
        • Munch M.
        • Trippel T.
        • Lindhorst R.
        • Nolte K.
        • et al.
        Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction.
        ESC Heart Fail. 2018; 5: 53-62
        • Ellingsen O.
        • Halle M.
        • Conraads V.
        • Stoylen A.
        • Dalen H.
        • Delagardelle C.
        • et al.
        High-intensity interval training in patients with heart failure with reduced ejection fraction.
        Circulation. 2017; 135: 839-849
        • Haykowsky M.J.
        • Liang Y.
        • Pechter D.
        • Jones L.W.
        • McAlister F.A.
        • Clark A.M.
        A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: the benefit depends on the type of training performed.
        J Am Coll Cardiol. 2007; 49: 2329-2336
        • Lan N.
        • Lam K.
        • Naylor L.
        • Green D.
        • Minaee N.
        • Dias P.
        • et al.
        The impact of distinct exercise training modalities on echocardiographic measurements in patients with heart failure and reduced ejection fraction.
        J Am Soc Echocardiogr. 2020; 33: 148-156
        • Maiorana A.J.
        • Naylor L.H.
        • Exterkate A.
        • Swart A.
        • Thijssen D.H.
        • Lam K.
        • et al.
        The impact of exercise training on conduit artery wall thickness and remodeling in chronic heart failure patients.
        Hypertension. 2011; 57: 56-62
        • Mancini D.M.
        • Eisen H.
        • Kussmaul W.
        • Mull R.
        • Edmunds Jr., L.H.
        • Wilson J.R.
        Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure.
        Circulation. 1991; 83: 778-786
        • Levine B.D.
        • Baggish A.L.
        • Kovacs R.J.
        • Link M.S.
        • Maron M.S.
        • Mitchell J.H.
        Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 1: classification of sports: dynamic, static, and impact: a scientific statement from the American Heart Association and American College of Cardiology.
        J Am Coll Cardiol. 2015; 66: 2350-2355
        • Green H.J.
        • Jones L.L.
        • Painter D.C.
        Effects of short-term training on cardiac function during prolonged exercise.
        Med Sci Sports Exerc. 1990; 22: 488-493
        • Mtinangi B.L.
        • Hainsworth R.
        Effects of moderate exercise training on plasma volume, baroreceptor sensitivity and orthostatic tolerance in healthy subjects.
        Exp Physiol. 1999; 84: 121-130
        • Pollock M.L.
        • Franklin B.A.
        • Balady G.J.
        • Chaitman B.L.
        • Fleg J.L.
        • Fletcher B.
        • et al.
        AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: an advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; Position paper endorsed by the American College of Sports Medicine.
        Circulation. 2000; 101: 828-833
        • Morganroth J.
        • Maron B.J.
        • Henry W.L.
        • Epstein S.E.
        Comparative left ventricular dimensions in trained athletes.
        Ann Intern Med. 1975; 82: 521-524
        • Baggish A.L.
        • Wood M.J.
        Athlete's heart and cardiovascular care of the athlete: scientific and clinical update.
        Circulation. 2011; 123: 2723-2735
        • Wasfy M.M.
        • Weiner R.B.
        • Wang F.
        • Berkstresser B.
        • Lewis G.D.
        • DeLuca J.R.
        • et al.
        Endurance exercise-induced cardiac remodeling: not all sports are created equal.
        J Am Soc Echocardiogr. 2015; 28: 1434-1440
        • Baggish A.L.
        • Wang F.
        • Weiner R.B.
        • Elinoff J.M.
        • Tournoux F.
        • Boland A.
        • et al.
        Training-specific changes in cardiac structure and function: a prospective and longitudinal assessment of competitive athletes.
        J Appl Physiol (1985). 2008; 104: 1121-1128
        • Arbab-Zadeh A.
        • Perhonen M.
        • Howden E.
        • Peshock R.M.
        • Zhang R.
        • Adams-Huet B.
        • et al.
        Cardiac remodeling in response to 1 year of intensive endurance training.
        Circulation. 2014; 130: 2152-2161
        • Boraita A.
        • Sanchez-Testal M.V.
        • Diaz-Gonzalez L.
        • Heras M.E.
        • Alcocer-Ayuga M.
        • de la Rosa A.
        • et al.
        Apparent ventricular dysfunction in elite young athletes: another form of cardiac adaptation of the athlete's heart.
        J Am Soc Echocardiogr. 2019; 32: 987-996
        • Perry R.
        • Swan A.L.
        • Hecker T.
        • De Pasquale C.G.
        • Selvanayagam J.B.
        • Joseph M.X.
        The spectrum of change in the elite athlete's heart.
        J Am Soc Echocardiogr. 2019; 32: 978-986
        • Gomes A.P.F.
        • Correia M.A.
        • Soares A.H.G.
        • Cucato G.G.
        • Lima A.
        • Cavalcante B.R.
        • et al.
        Effects of resistance training on cardiovascular function in patients with peripheral artery disease: a randomized controlled trial.
        J Strength Cond Res. 2018; 32: 1072-1080
        • Phillips B.E.
        • Williams J.P.
        • Greenhaff P.L.
        • Smith K.
        • Atherton P.J.
        Physiological adaptations to resistance exercise as a function of age.
        JCI Insight. 2017; 2
        • Arbab-Zadeh A.
        • Dijk E.
        • Prasad A.
        • Fu Q.
        • Torres P.
        • Zhang R.
        • et al.
        Effect of aging and physical activity on left ventricular compliance.
        Circulation. 2004; 110: 1799-1805
        • Pearson M.J.
        • Mungovan S.F.
        • Smart N.A.
        Effect of exercise on diastolic function in heart failure patients: a systematic review and meta-analysis.
        Heart Fail Rev. 2017; 22: 229-242
        • Sandri M.
        • Kozarez I.
        • Adams V.
        • Mangner N.
        • Hollriegel R.
        • Erbs S.
        • et al.
        Age-related effects of exercise training on diastolic function in heart failure with reduced ejection fraction: the Leipzig Exercise Intervention in Chronic Heart Failure and Aging (LEICA) Diastolic Dysfunction Study.
        Eur Heart J. 2012; 33: 1758-1768
        • Pathak R.K.
        • Elliott A.
        • Middeldorp M.E.
        • Meredith M.
        • Mehta A.B.
        • Mahajan R.
        • et al.
        Impact of CARDIOrespiratory FITness on Arrhythmia Recurrence in Obese Individuals with Atrial Fibrillation: the CARDIO-FIT Study.
        J Am Coll Cardiol. 2015; 66: 985-996
        • Benda N.M.
        • Seeger J.P.
        • Stevens G.G.
        • Hijmans-Kersten B.T.
        • van Dijk A.P.
        • Bellersen L.
        • et al.
        Effects of high-intensity interval training versus continuous training on physical fitness, cardiovascular function and quality of life in heart failure patients.
        PLoS One. 2015; 10: e0141256
        • Chrysohoou C.
        • Angelis A.
        • Tsitsinakis G.
        • Spetsioti S.
        • Nasis I.
        • Tsiachris D.
        • et al.
        Cardiovascular effects of high-intensity interval aerobic training combined with strength exercise in patients with chronic heart failure. A randomized phase III clinical trial.
        Int J Cardiol. 2015; 179: 269-274
        • Finocchiaro G.
        • Dhutia H.
        • D'Silva A.
        • Malhotra A.
        • Sheikh N.
        • Narain R.
        • et al.
        Role of Doppler diastolic parameters in differentiating physiological left ventricular hypertrophy from hypertrophic cardiomyopathy.
        J Am Soc Echocardiogr. 2018; 31: 606-613
        • Nagueh S.F.
        • Smiseth O.A.
        • Appleton C.P.
        • Byrd 3rd, B.F.
        • Dokainish H.
        • Edvardsen T.
        • et al.
        Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        J Am Soc Echocardiogr. 2016; 29: 277-314
        • Rivas-Gotz C.
        • Manolios M.
        • Thohan V.
        • Nagueh S.F.
        Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity.
        Am J Cardiol. 2003; 91: 780-784
        • Mitter S.S.
        • Shah S.J.
        • Thomas J.D.
        A test in context: E/A and E/e' to assess diastolic dysfunction and LV filling pressure.
        J Am Coll Cardiol. 2017; 69: 1451-1464
        • Convertino V.A.
        Blood volume: Its adaptation to endurance training.
        Med Sci Sports Exerc. 1991; 23: 1338-1348
        • Nagueh S.F.
        Left ventricular diastolic function: understanding pathophysiology, diagnosis, and prognosis with echocardiography.
        JACC Cardiovasc Imaging. 2019; https://doi.org/10.1016/j.jcmg.2018.10.038
        • Rudski L.G.
        • Gargani L.
        • Armstrong W.F.
        • Lancellotti P.
        • Lester S.J.
        • Grunig E.
        • et al.
        Stressing the cardiopulmonary vascular system: the role of echocardiography.
        J Am Soc Echocardiogr. 2018; 31: 527-550

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