CORRESPONDENCE: LETTER TO THE EDITOR
Exercise in Chronic Heart Failure: Does it Need to Be "Anti-Remodeling"?
Viviane Conraads, MD, PhD*,
Paul Beckers, MSc and
Christiaan J. Vrints, MD, PhD
* Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium (Email: Viviane.Conraads{at}uza.be).
From their analysis, Haykowsky et al. (1) conclude that combined aerobic and strength training provides no anti-remodeling benefit in patients with chronic heart failure (CHF). The fact that the latter studies all date from the last 5 years is not highlighted. Systematic prescription of beta-blockers in recent trials might have obscured additional anti-remodeling effects of combined exercise training.
The relevance attributed to the 3% increase in left ventricular ejection fraction in the accompanying editorial is surprising (2). Patients treated with cardiac resynchronization therapy (CRT) would typically be classified as nonresponders based on this modest improvement. Furthermore, increased blood pressure is called upon by Haykowsky et al. (1) to explain the lack of anti-remodeling effects of combined exercise training. In fact, McKelvie et al. (3) showed a lower rate–pressure product when patients with CHF performed leg press versus aerobic cycling at comparable exercise intensity. Finally, Rubin (2) mentions being unaware of exercise training studies in CRT-treated patients. We recently showed that the combination of endurance training with CRT is highly effective in terms of exercise capacity (4).
Endurance training in patients with CHF concentrates on peak exercise capacity and apparently also provides modest anti-remodeling effects (1). However, disabled CHF patients are also likely to benefit from dynamic resistive exercise. To a large extent, quality of life in this population depends on engagement in daily life activity, which does not demand peak aerobic performance. Pulling, pushing, and lifting require skeletal muscle mass and strength of both upper and lower limbs. To rule out dynamic resistive exercise for patients with CHF on the basis of "no known" anti-remodeling effect and without the demonstration of harm would limit initiatives to adequately assess the possible value of this particular training modality.
 |
References
|
|---|
- Haykowsky MJ, Liang Y, Pechter D, et al. 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.[Abstract/Free Full Text]
- Rubin SA. Exercise training in heart failureContradictory or conventional?. J Am Coll Cardiol 2007;49:2337-2340.[Free Full Text]
- McKelvie RS, McCartney N, Tomlinson C, Bauer R, MacDougall JD. Comparison of hemodynamic responses to cycling and resistance exercise in congestive heart failure secondary to ischemic cardiomyopathy Am J Cardiol 1995;76:977-979.[CrossRef][ISI][Medline]
- Conraads VM, Vanderheyden M, Paelinck B, et al. The effect of endurance training on exercise capacity following cardiac resynchronization therapy in chronic heart failure: a pilot trial Eur J Cardiovasc Prev Rehabil 2007;14:99-106.[CrossRef][ISI][Medline]
Related Article
-
Reply
- Mark J. Haykowsky, Yuanyuan Liang, David Pechter, Lee W. Jones, Finlay A. McAlister, and Alexander M. Clark
J. Am. Coll. Cardiol. 2007 50: 2356.
[Full Text]
[PDF]
Top
References