Physical training in patients with stable chronic heart failure: effects on cardiorespiratory fitness and ultrastructural abnormalities of leg muscles
R Hambrecht,
J Niebauer,
E Fiehn,
B Kalberer,
B Offner,
K Hauer,
U Riede,
G Schlierf,
W Kubler,
and
G Schuler
St. Vincentius-Krankenhauser Karlsruhe, Abteilung III-Kardiologie, Germany.
OBJECTIVES. The present study was designed to evaluate the effect of an ambulatory training program on ultrastructural morphology and the oxidative capacity of skeletal muscle and its relation to central and peripheral hemodynamic variables in patients with chronic heart failure. BACKGROUND. Clinical evidence supports the hypothesis that exercise intolerance in patients with chronic heart failure is not only a consequence of low cardiac output, but is also a result of alterations in oxidative metabolism of skeletal muscle. METHODS. Twenty-two patients were prospectively randomized either to a training group (mean [+/-SD] ejection fraction 26 +/- 9%, n = 12) participating in an ambulatory training program or to a physically inactive control group (ejection fraction 27 +/- 10%, n = 10). At baseline and after 6 months, patients underwent symptom-limited bicycle exercise testing, and central and peripheral hemodynamic variables were measured. Percutaneous needle biopsy samples of the vastus lateralis muscle were obtained at baseline and after 6 months. The ultrastructure of skeletal muscle was analyzed by ultrastructural morphometry. RESULTS. After 6 months, patients in the training group achieved an increase in oxygen uptake at the ventilatory threshold of 23% (from 0.86 +/- 0.2 to 1.07 +/- 0.2 liters/min, p < 0.01 vs. control group) and at peak exercise of 31% (from 1.49 +/- 0.4 to 1.95 +/- 0.4 liters/min, p < 0.01 vs. control group). There was no significant change in oxygen uptake at the ventilatory threshold and at peak exercise in the control group. The total volume density of mitochondria and volume density of cytochrome c oxidase-positive mitochondria increased significantly by 19% (from 4.7 +/- 1.5 to 5.6 +/- 1.5 vol%, p < 0.05 vs. control group) and by 41% (from 2.2 +/- 1.0 to 3.1 +/- 1.0 vol%, p < 0.05 vs. control group) after 6 months of regular physical exercise. Cardiac output at rest and at submaximal exercise remained unchanged but increased during maximal symptom-limited exercise from 11.9 +/- 4.0 to 14.1 +/- 3.3 liters/min in the training group (p < 0.05 vs. baseline; p = NS vs. control group). Peak leg oxygen consumption increased significantly by 45% (from 510 +/- 172 to 740 +/- 254 ml/min, p < 0.01 vs. control group). Changes in cytochrome c oxidase-positive mitochondria were significantly related to changes in oxygen uptake at the ventilatory threshold (r = 0.82, p < 0.0001) and at peak exercise (r = 0.87, p < 0.0001). CONCLUSIONS. Regular physical training increases maximal exercise tolerance and delays anaerobic metabolism during submaximal exercise in patients with stable chronic heart failure. Improved functional capacity is closely linked to an exercise-induced increase in the oxidative capacity of skeletal muscle.
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[Abstract]
[Full Text]
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O. M. HIJAZI, M. RAMANATHAN, A. S. ESTRERA, R. M. PESHOCK, and C. C. W. HSIA
Fixed Maximal Stroke Index in Patients after Pneumonectomy
Am. J. Respir. Crit. Care Med.,
May 1, 1997;
157(5):
1623 - 1629.
[Abstract]
[Full Text]
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P. Dubach, J. Myers, G. Dziekan, U. Goebbels, W. Reinhart, P. Vogt, R. Ratti, P. Muller, R. Miettunen, and P. Buser
Effect of Exercise Training on Myocardial Remodeling in Patients With Reduced Left Ventricular Function After Myocardial Infarction : Application of Magnetic Resonance Imaging
Circulation,
April 15, 1997;
95(8):
2060 - 2067.
[Abstract]
[Full Text]
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L. Demopoulos, M. Yeh, M. Gentilucci, M. Testa, R. Bijou, S. D. Katz, D. Mancini, M. Jones, and T. H. LeJemtel
Nonselective ß-Adrenergic Blockade With Carvedilol Does Not Hinder the Benefits of Exercise Training in Patients With Congestive Heart Failure
Circulation,
April 1, 1997;
95(7):
1764 - 1767.
[Abstract]
[Full Text]
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C. C. Lang, D. B. Chomsky, G. Rayos, T. K. Yeoh, and J. R. Wilson
Skeletal muscle mass and exercise performance in stable ambulatory patients with heart failure
J Appl Physiol,
January 1, 1997;
82(1):
257 - 261.
[Abstract]
[Full Text]
[PDF]
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J. R. Wilson, J. Groves, and G. Rayos
Circulatory Status and Response to Cardiac Rehabilitation in Patients With Heart Failure
Circulation,
October 1, 1996;
94(7):
1567 - 1572.
[Abstract]
[Full Text]
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G. F. Fletcher, G. Balady, S. N. Blair, J. Blumenthal, C. Caspersen, B. Chaitman, S. Epstein, E. S. S. Froelicher, V. F. Froelicher, I. L. Pina, et al.
Statement on Exercise: Benefits and Recommendations for Physical Activity Programs for All Americans: A Statement for Health Professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association
Circulation,
August 15, 1996;
94(4):
857 - 862.
[Full Text]
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