Differentiated approach to prescription of physical activity in patients with left ventricular dysfunction
Authors:
H. Svačinová 1; J. Siegelová 1; P. Dobšák 1; B. Fišer 2; L. Mífková 1; V. Chludilová 1
Authors‘ workplace:
Klinika funkční diagnostiky a rehabilitace Lékařské fakulty MU a FN u sv. Anny, Brno, přednostka prof. MUDr. Jarmila Siegelová, DrSc.
1; Fyziologický ústav Lékařské fakulty MU Brno, přednosta prof. MUDr. Bohumil Fišer, CSc.
2
Published in:
Vnitř Lék 2008; 54(1): 53-61
Category:
Review
Overview
Correctly indicated physical exercise performed and controlled on a regular basis is an inseparable part of treatment and rehabilitation of patients with left ventricular dysfunction. In order to guarantee the best effect and safety of physical exercise, it is necessary to adopt a differential approach to its prescription to patients with different degrees of functional damage. In addition, a number of conditions should be fulfilled, among which, in the first place, the determination of functional classification of patients used in practice and described in the relevant literature (NYHA, AMA, Goldman, Weber). Physical exercise cannot be differentiated only with respect to the degree of dysfunction; other conditioning factors should be taken into consideration, too, among which the relative contraindication of physical strain, somatic condition, physical exercise anamnesis and others (i.e. sex, age, motivation, etc.), causing a high degree of patient heterogeneity. Also described are additional conditions for differentiation and correct application of physical training, which involve the selection of suitable types of exercise and their energetic demands, adequate intensity, frequency and duration; it is also important to determine the available effective and safe methods, programmes and means of training. The article contains examples of the above conditions, as well as classification of physical exercise into functional classes NYHA I–IV. In conclusion, the authors point out the necessity of differentiation of physical training and of cooperation of the cardiologist with the physiotherapist in its indication, implementation and monitoring.
Keywords:
left ventricular dysfunction – heart failure – rehabilitation – physical training – physical exercise programme – functional classification – differentiation of physical exercise
Sources
1. Fletcher GF, Balady GJ, Ezra A et al. Exercise Standards for Testing and Training. A Statement for Healthcare Professionals From the American Heart Association. Circulation 2001; 104: 1694-1740.
2. Chaloupka V, Siegelová J, Špinarová L et al. Rehabilitace u nemocných s kardiovaskulárním onemocněním. Cor Vasa 2006; 48: Kardio K127-K145.
3. Jančík J, Svačinová H, Dobšák P et al. Kombinovaný trénink u nemocných se systolickou dysfunkcí levé komory srdeční. Vnitř Lék 2003; 49: 280-284.
4. Jonsdottir S, Andersen KK, Sigurdsson SB et al. The effect of physical training in chronic heart failure. Eur J Heart Failure 2006; 8: 97-101.
5. McKelvie RS, Teo KK et al. Effect of exercise training in patients with heart failure: the exercise rehabilitation trial (EXERT). Am Heart J 2002; 144: 23-30.
6. Meyer K, Westbrook S, Schwaibold M et al. Aerobic Capacity and Functional Classification of Patients with Severe Left-Ventricular Dysfunction. Cardiology 1996; 87: 443-449.
7. Meyer K. Exercise training in heart failure: recommendations based on current research. Med Sci Sports Exerc 2001; 33: 525-531.
8. Pollock ML, Schmidt DH et al. Heart Disease and Rehabilitation. 3rd ed. Champaign: Human Kinetics 1995.
9. Senden PJ, Sabelis LW, Zonderland ML. The effect of physical training on workload, upper leg muscle function and muscle areas in patients with chronic heart failure. Int J Cardiology 2005; 100: 293-300.
10. Špinarová L, Toman J, Kára T et al. Tělesný trénink u nemocných s chronickým srdečním selháním: hemodynamika, působky. Vnitř Lék 2001; 47: 67-73.
11. Štejfa M, Špinarová L, Toman J et al. Rehabilitace u nemocných s chronickým srdečním selháním. Závěrečná zpráva grantového úkolu č. 3007-3 1998; IGA MZ ČR.
12. Toman J, Špinarová L, Kára T et al. Tělesný trénink u nemocných s chronickým srdečním selháním: funkční zdatnost a úloha periferie. Vnitř Lék 2001; 47: 74-80.
13. Widimský J et al. Srdeční selhání. Praha: Triton 2001.
14. Wielenga RP et al. The role of exercise training in chronic heart failure. Heart 1997; 78: 431-436.
15. Willenheimer R, Erhardt L, Cline C. Exercise training in heart failure improves quality of life and exercise capacity. Eur Heart J 1998; 19: 774-781.
16. Working Group on Cardiac Rehabilitation. Recommendations for exercise training in chronic heart failure patients. Eur Heart J 2001; 22: 125 -35.
17. Weber KT, Janicki JS et al. CardioPulmonary EXercise Testing. Philadelphia: WB Saunders 1986.
18. Goldman L, Hashimoto B, Cook F et al. Comparative reproducibility and validity of systems assessing cardiovascular functional class: Advantages of a new specific activity scale. Circulation 1981; 64: 1227-1234.
19. The Criteria Committee of the New York Heart Association. Diseases of the Heart and Blood Vessels: Nomenclature and Criteria for Diagnosis. 7th ed. Boston: Little Brown 1973.
20. American Medical Association. Guides to the evaluation of permanent impairment. JAMA 1960; 172: 1049-1056.
21. International Society of Cardiology - ISC. Myocardial Infarction. How to prevent How to rehabilitate. Vienna: Scientific Council on Cardiac Rehabilitation 1971.
22. Lange Andersen K et al. Habitual Physical Activity and Health. Copenhagen: World Health Organization 1978.
23. Ainsworth BE et al. Compendium of Physical Activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32(Suppl 9): S498-S516.
24. Placheta Z, Siegelová J, Štejfa M et al. Zátěžová diagnostika v ambulantní a klinické praxi. Praha: Grada Publishing 1999.
25. European Heart Failure Training Group. Experience from controlled trials of physical training in chronic heart failure. Eur Heart J 1998, 19: 466-475.
26. Heyward VH. Advanced Fitness Assessment and Exercise Prescription. 5th ed. Champaign (IL): Human Kinetics 2006.
27. Myers J. How Should Peak Oxygen Uptake Be Expressed in Heart Failure? J Cardiopulm Rehabil 2002; 22: 89-92.
28. Persinger R, Foster C, Gibson M et al. Consistency of the Talk Test for Exercise Prescription. Med Sci Sports Exerc 2004; 36: 1632-1636.
29. Åstrand PO, Rodahl K. Textbook of Work Physiology. New York: McGraw-Hill 1977.
30. Wasserman K, Hansen JE, Sue DY et al. Principles of Exercise Testing and Interpretation. 4th ed. Philadelphia: Williams & Wilkins 2005.
31. Borg GA. Perceived exertion as an indicator of somatic stress. Scand J Rehab Med 1970; 2: 92-98.
32. Dvořák R. Základy kinezioterapie. Olomouc: Vydavatelství UP 2003.
33. Placheta Z, Siegelová J, Svačinová H et al. Zátěžové vyšetření a pohybová léčba ve vnitřním lékařství. Brno: Vydavatelství Masarykovy univerzity 2001.
34. Votava J et al. Ucelená rehabilitace osob se zdravotním postižením. Praha: Karolinum 2003.
35. Thow MK (ed). Exercise Leadership in Cardiac Rehabilitation. Chichester: John Wiley 2006.
36. Mífková L, Siegelová J, Vymazalová L et al. Intervalový a kontinuální trénink v kardiovaskulární rehabilitaci. Vnitř Lék 2006; 52: 44-50.
37. Jančík J, Siegelová J, Svačinová H et al. Combined Aerobic Training with Resistent Exercise in Chronic Heart Failure. Eur J Cardiovasc Prev Rehab 2004; 11 (Suppl): 65-65.
38. Dobšák P, Nováková M, Fišer B et al. Electrical Stimulation of Skeletal Muscles. An Alternative to Aerobic Exercise Training in Patients With Chronic Heart Failure? Int Heart J 2006; 47: 441-453.
39. Dobšák P, Nováková M, Siegelová J et al. Low-frequency electrical stimulation increases muscle strength and improves blood supply in patients with chronic heart failure. Circ J 2006; 70: 75-82.
40. Harris S, Le Maitre JP, Mackenzie G et al. A randomised study of home-based electrical stimulation of the legs and conventional bicycle exercise training for patients with chronic heart failure. Eur Heart J 2003; 24: 871-878.
41. Cider A, Schaufelberger M, Sunnerhagen KS et al. Hydrotherapy - a new approach to improve function in the older patient with chronic heart failure. Eur J Heart Failure 2003; 5: 527-535.
42. Cider A, Sunnerhagen KS, Schaufelberger M et al. Cardiorespiratory effects of warm water immersion in elderly patients with chronic heart failure. Clin Physiol Functional Imaging 2005; 25: 313-317.
43. ACSM‘s Guidelines for Exercise Capacity and Prescription. Baltimore: Williams & Wilkins 1995: 178-183.
44. Brusis OA, Weber H, Buchwalsky R et al. Handbuch der Koronargruppenbetreuung. Erlangen: Perimed Fachbuch 1980.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2008 Issue 1
Most read in this issue
- The use of galactomannan detection in diagnosing invasive aspergilosis in hemato-oncological patients
- Assessment of plasmatic cell proliferation and apoptosis indexes in the course of multiple myeloma
- Statin pharmacokinetics
- Recommendations of Czech Rheumatological Society for the treatment of rheumatoid arthritis. Efficacy and treatment strategies