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PubMedDate not supplied

Exercise training in chronic obstructive pulmonary disease.

Exercise and activity limitation are characteristic features of chronic obstructive pulmonary disease (COPD). Exercise intolerance may result from ventilatory limitation, cardiovascular impairment, and/or skeletal muscle dysfunction. Exercise training, a core component of pulmonary rehabilitation, improves the exercise capacity (endurance and, to a lesser degree, maximal work capacity) of patients with COPD in spite of the irreversible abnormalities in lung function. Dyspnea and health-related quality of life also improve following pulmonary rehabilitation. The clinical benefits of exercise rehabilitation last up to 2 years following 8 to 12 weeks of training. Existing evidence-based guidelines recommend that exercise training/pulmonary rehabilitation be included routinely in the management of patients with moderate to severe COPD. Exercise training/ pulmonary rehabilitation may be undertaken in an inpatient, outpatient, or home-based setting, depending on the individual needs of the patient and available resources. The type and intensity of training and muscle groups trained determine the expected outcomes of exercise training. Both high- and low-intensity exercise lead to increased exercise endurance, but only high-intensity training also leads to physiologic gains in aerobic fitness. The rationale for and outcomes of lower- and upper-limb training, as well as ventilatory muscle training, are reviewed, and the potential for anabolic hormone supplementation to optimize the benefits of exercise training is discussed.

Exercise Therapy↗

PubMed2006

Effects of exercise training on pathological cardiac hypertrophy related gene expression and apoptosis.

This study determined whether exercise training prevents pathological hypertrophy in the left ventricle by modulation of myocardial and apoptosis-associated genes. We used spontaneously hypertensive rats (n=15, non-exercise SHR), exercise-trained SHR (n=15, treadmill exercise for 12 weeks), and sedentary Wistar-Kyoto (WKY) rats (n=15). Exercise-trained SHR expressed adaptive changes such as reduced body weight, heart rate, blood pressures, left ventricle wall thickness, lipid profiles, and homocysteine level. The mRNA expression of angiotensin converting enzyme, endothelin-1, and brain natriuretic peptides in the heart was lower in the exercise-trained SHR and in the WKY than in the non-exercise SHR, whereas mRNA expression of caveolin-3 and eNOS in the heart was higher. Bcl-2 protein was higher in the exercise-trained SHR than in the WKY and the non-exercise SHR. In contrast, Bax protein levels were lower in the exercise-trained SHR and in the WKY than in the non-exercise SHR. Furthermore, the levels of the active forms of caspase-3 (20 kDa) were lower in the exercise-trained SHR and in the WKY than in the non-exercise SHR. These findings suggest that exercise training prevents pathological hypertrophy in the left ventricle by modulation of myocardial genes and that it interferes with a signal transduction pathway of apoptosis secondary to the pathological cardiac hypertrophy.

Animals↗

PubMed2000

Exercise training in chronic obstructive pulmonary disease.

Exercise limitation is a common and disturbing manifestation of COPD. The exercise intolerance is often caused by multiple interrelated anatomic and physiologic disturbances. Importantly, exercise tolerance can be improved despite the presence of fixed structural abnormalities in the lung. Exercise training, undertaken alone or in the context of comprehensive PR, improves exercise endurance and, to a lesser degree, the maximal tolerated workload of patients with COPD. Pulmonary rehabilitation also improves dyspnea and QOL. Exercise training and PR should be considered for all patients lacking contraindications who experience exercise intolerance despite optimal medical therapy. Lower-extremity training should be included routinely in the exercise prescription. The choice of type and intensity of training should be based primarily on the patient's individual baseline functional status, symptoms, needs, and long-term goals. When tolerated, high-intensity (continuous or interval) training may lead to greater improvements in aerobic fitness than low-intensity training but is not absolutely necessary to achieve gains in exercise endurance. Upper-extremity training should be undertaken when possible. Ventilatory muscle training should be considered for patients who continue to experience exercise limitation and breathlessness despite medical therapy and general exercise reconditioning. Exercise tolerance may improve following exercise training because of gains in aerobic fitness or peripheral muscle strength; enhanced mechanical skill and efficiency of exercise; improvements in respiratory muscle function, breathing pattern, or lung hyperinflation; as well as reduction in anxiety, fear, and dyspnea associated with exercise. Gains made in exercise tolerance can last up to 2 years following a limited duration (6-12 week) rehabilitation program.

Breathing Exercises↗

PubMed1998

Exercise training restores decreased cellular immune functions in obese Zucker rats.

This study investigated whether exercise training had a beneficial effect on the decreased mitogen response and improved a decreased expression of glucose transporter 1 (GLUT-1) in splenocytes from obese Zucker rats. Experimental groups were lean and sedentary and exercise-trained obese Zucker rats. Exercise training, running on a motor-driven treadmill for 5 days/wk for 40 wk, did not induce a significant decrease in body weight in obese Zucker rats. The plasma insulin concentration, showing a significant increase compared with lean Zucker rats, was unaffected by exercise training. However, the plasma triglyceride concentration in obese Zucker rats was significantly depressed by exercise training, whereas it was still higher than that in lean Zucker rats. In addition, natural killer cell activity and concanavalin A-induced mitogenesis of splenic lymphocytes of obese Zucker rats were significantly restored. In these splenic lymphocytes, glucose uptake was significantly lower compared with that in lean Zucker rats, which was also improved by exercise training. Although the expression of GLUT-1, the major glucose transporter in immune cells, was depressed in splenic lymphocytes of obese Zucker rats, exercise training induced a significant improvement. These results suggest that exercise training has a beneficial effect on the decreased cellular immune functions in obese Zucker rats, which is associated, in part, with the improvement in GLUT-1 expression.

Animals↗

PubMed1991

Group- vs home-based exercise training in healthy older men and women. A community-based clinical trial.

OBJECTIVE: --To determine the effectiveness of group- vs home-based exercise training of higher and lower intensities among healthy, sedentary older adults. DESIGN: --Year-long randomized, controlled trial comparing (1) higher-intensity group-based exercise training; (2) higher-intensity home-based exercise training; (3) lower-intensity home-based exercise training; or (4) assessment-only control. SETTING: --General community located in northern California. PARTICIPANTS: --One hundred sixty women and 197 men 50 to 65 years of age who were sedentary and free of cardiovascular disease. One out of nine persons contacted through a community random-digit-dial telephone survey and citywide promotion were randomized. INTERVENTIONS: --For higher-intensity exercise training, three 40-minute endurance training sessions per week were prescribed at 73% to 88% of peak treadmill heart rate. For lower-intensity exercise training, five 30-minute endurance training sessions per week were prescribed at 60% to 73% of peak treadmill heart rate. MAIN OUTCOME MEASURES: --Treadmill exercise test performance, exercise participation rates, and heart disease risk factors. RESULTS: --Compared with controls, subjects in all three exercise training conditions showed significant improvements in treadmill exercise test performance at 6 and 12 months (P less than .03). Lower-intensity exercise training achieved changes comparable with those of higher-intensity exercise training. Twelve-month exercise adherence rates were better for the two home-based exercise training conditions relative to the group-based exercise training condition (P less than .0005). There were no significant training-induced changes in lipid levels, weight, or blood pressure. CONCLUSIONS: --We conclude that (1) this community-based exercise training program improved fitness but not heart disease risk factors among sedentary, healthy older adults; (2) home-based exercise was as effective as group exercise in producing these changes; (3) lower-intensity exercise training was as effective as higher-intensity exercise training in the home setting; and (4) the exercise programs were relatively safe.

Aged↗

PubMed2005

The role of exercise training for patients with heart failure.

Heart failure (HF) is characterized by dyspnea and fatigue leading to exercise intolerance. HF patients have been advised to avoid exercise because of concerns about detrimental cardiac effects. However, in many studies on the effects of exercise training HF patients have demonstrated beneficial outcomes. Furthermore, exercise training has been found to be safe. Recent studies have demonstrated that exercise training might reduce morbidity and mortality. Although these data are promising, confirmation is required from a large clinical trial powered to examine the effects of exercise training on mortality and morbidity. The "Heart Failure - A Controlled Trial Investigating Outcomes of Exercise TraiNing" (HF-ACTION) trial, a large randomized controlled clinical trial, will answer that question. Standardized guidelines for exercise training HF patients have not been established. Exercise training should be individualized according to the results of the exercise test. Ideally, the exercise program should be initiated in the setting of a supervised program followed by a home-based program. Each patient should have a tailored activity program based on a prescription for the frequency of each session, the intensity, duration of each session, and modalities to be used. Exercise training should involve aerobic exercise. Resistance exercise and interval training might be an acceptable method for HF patients; however, more studies are required for these types of exercise programs.

Exercise Therapy↗

PubMed1984

Effects of high- and low-intensity exercise training on aerobic capacity and blood lipids.

Sixteen non-obese, non-smoking males, ages 20-30 yr, were assigned to one of two training groups, exercising on a cycle ergometer 3 d/wk for 18 wk: high-intensity (H; N = 7; 80-85% Vo2max, 25 min/session) or low-intensity (L; N = 9; 45% VO2max, 50/min/session). Data were obtained at 3-wk intervals for Vo2max, body weight, percent body fat, and 12-h fasting blood levels of cholesterol (CHOL), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). The average post-training increase in VO2max for group H (0.56 l X min-1, 8.5 ml X min-1 X kg-1) was not significantly (P greater than 0.05) greater than for group L (0.45 l X min-1, 6.5 ml X min-1 X kg-1). Significant reductions in percent body fat occurred in both groups, amounting to an average fat loss of approximately 1.35 kg. No statistically significant changes in CHOL, TG, HDL-C, LDL-C, CHOL/HDL-C, or HDL-C/LDL-C occurred in either group. However, changes in HDL-C after 18 wk of training were inversely correlated (r = -0.57, P less than 0.05) with pre-training levels. We conclude that 1) the minimum exercise training-intensity threshold for improving aerobic capacity is at least 45% Vo2max; 2) 18 wk of high- or low-intensity exercise training is ineffective in significantly altering CHOL, TG, HDL-C, LDL-C, CHOL/HDL-C, and HDL-C/LDL-C in young male subjects with low blood lipid levels, and 3) exercise training-induced changes in HDL-C are dependent upon initial pre-training levels.

Adult↗

PubMed2006

Low-intensity exercise training improves survival in Dahl salt hypertension.

PURPOSE: The present study examined whether exercise training could increase survival in a rodent model of salt-sensitive hypertension. METHODS: Male, inbred Dahl salt-sensitive rats arriving at 8 wk of age were randomly divided into a sedentary control group (N = 5) or an exercise-trained group (N = 8). Exercise training consisted of running 20 m.min(-1), 0% incline, 60 min.d(-1), 5 d.wk(-1) on a motorized driven treadmill. On arrival, animals were fed a low-salt diet (0.12% NaCl) during a 1-wk acclimatization period. At the end of this period, all rats were then fed a high-salt diet (7.8% NaCl) for the remainder of the study. Arterial systolic blood pressure (SBP) was measured via the tail-cuff method. RESULTS: Systolic blood pressure (SBP) measured on the low salt diet was similar between groups. After 2 wk of a high-salt diet, SBP was similarly significantly elevated in both control and exercise groups relative to the low salt diet. Kaplan-Meier analysis showed that exercise training increased survival (P < 0.02) with an approximate 30% increase in the mean days survived with exercise training (P < 0.02). CONCLUSION: These data suggest that exercise training is an important intervention for salt-sensitive hypertension and that the enhanced survival observed with exercise training appears to be independent of training-induced SBP lowering effects.

Animals↗

PubMed2001

Effect of mild exercise training on glucose effectiveness in healthy men.

OBJECTIVE: To detect whether mild exercise training improves glucose effectiveness (S(G)), which is the ability of hyperglycemia to promote glucose disposal at basal insulin, in healthy men. RESEARCH DESIGN AND METHODS: Eight healthy men (18-25 years of age) underwent ergometer training at lactate threshold (LT) intensity for 60 min/day for 5 days/week for 6 weeks. An insulin-modified intravenous glucose tolerance test was performed before as well as at 16 h and 1 week after the last training session. S(G) and insulin sensitivity (S(I)) were estimated using a minimal-model approach. RESULTS: After the exercise training, VO(2max) and VO(2) at LT increased by 5 and 34%, respectively (P < 0.05). The mild exercise training improves S(G) measured 16 h after the last training session, from 0.018 +/- 0.002 to 0.024 +/- 0.001 min(-1) (P < 0.05). The elevated S(G) after exercise training tends to be maintained regardless of detraining for 1 week (0.023 +/- 0.002 min(-1), P = 0.09). S(I) measured at 16 h after the last training session significantly increased (pre-exercise training, 13.9 +/- 2.2; 16 h, 18.3 +/- 2.4, x10(-5). min(-1). pmol/l(-1), P < 0.05) and still remained elevated 1 week after stopping the training regimen (18.6 +/- 2.2, x10(-5). min(-1). pmol/l(-1), P < 0.05). CONCLUSIONS: Mild exercise training at LT improves S(G) in healthy men with no change in the body composition. Improving not only S(I) but also S(G) through mild exercise training is thus considered to be an effective method for preventing glucose intolerance.

Adult↗

PubMed2006

Coimmunoprecipitation of FAT/CD36 and CPT I in skeletal muscle increases proportionally with fat oxidation after endurance exercise training.

Although the increase in fatty acid oxidation after endurance exercise training has been linked with improvements in insulin sensitivity and overall metabolic health, the mechanisms responsible for increasing fatty acid oxidation after exercise training are not completely understood. The primary aim of this study was to determine the effect of adding endurance exercise training to a weight loss program on fat oxidation and the colocalization of the fatty acid translocase FAT/CD36 with carnitine palmitoyltransferase I (CPT I) in human skeletal muscle. We measured postabsorptive fat oxidation and acquired a muscle sample from abdominally obese women before and after 12% body weight loss through either dietary intervention with endurance exercise training (EX + DIET) or dietary intervention without endurance exercise training (DIET). Immunoprecipitation techniques were used on these muscle samples to determine whether the association between FAT/CD36 and CPT I is altered after DIET and/or EX + DIET. FAT/CD36 was found to coimmunoprecipitate with CPT I, and the amount of FAT/CD36 that coimmunoprecipitated with CPT I increased by approximately 25% after EX + DIET (P < 0.005) but was unchanged after DIET. In addition, the increase in the amount of FAT/CD36 that coimmunoprecipitated with CPT I in EX + DIET was strongly correlated with the increase in whole body fat oxidation (R2 = 0.857, P < 0.003). In conclusion, the findings from this study indicate that exercise training alters the localization of FAT/CD36 and increases its association with CPT I, which may help augment fat oxidation.

Adult↗

PubMed1991

Oxygen-assisted exercise training in adult cystic fibrosis patients with pulmonary limitation to exercise.

Exercise training has been considered suitable only in cystic fibrosis (CF) patients with mild to moderate pulmonary dysfunction without progressive hypoxaemia during exercise. We trained 16 CF patients, all with advanced lung disease (mean standardized forced expiratory volume in 1 s (FEV1), 30% pred.), with a ventilatory limitation to exercise and a progressive hypoxaemia and hypercapnia at low maximal exercise capacity, Wmax (mean Wmax, 50% pred). Exercise training was performed on a cycle ergometer twice a day for 20 min at approximately 75% of the maximal predicted heart rate for at least 3 weeks. Supplemental oxygen was administered to reach a haemoglobin oxygen saturation of 90% during training. Patients considered malnourished because of a Quetelet Index of less than 20 kg m-2 received hyperalimentation orally or by duodenal tube (total 3500-4000 kcal day-1). Evaluation directly after the training period showed a statistically significant improvement in Wmax, maximal oxygen consumption, maximal minute ventilation, pulse, PaCO2 at rest, FEV1 and body weight. None of the pretraining variables was able to predict the outcome of the training programme in the individual patient. We detected no adverse effects of the programme. This study shows that oxygen-assisted exercise training in combination with correction of the nutritional status is safe and beneficial in CF patients with severe lung disease.

Adult↗

PubMed2003

Mechanisms of exercise training in patients with heart failure.

BACKGROUND: The reduction of exercise capacity because of fatigue and dyspnea in patients with heart failure can be improved with exercise training. We sought to examine the mechanisms of exercise training as an adjunctive treatment strategy for patients with heart failure. METHODS: We reviewed the published data on the possible mechanisms of effect of exercise training in heart failure. RESULTS: Symptoms of heart failure may be explained on the basis of abnormal skeletal muscle perfusion and structure and endothelial function. Exercise training has been shown to engender changes in muscle structure and biochemistry and vascular function, although effects on cardiac function have not been detected uniformly and may require longer training periods. CONCLUSIONS: A suitable, long-term program of exercise training may reverse unfavorable interactions among the heart, vessels, and skeletal muscles. These improvements may be preserved with an ongoing maintenance program.

Endothelium, Vascular↗

PubMed1982

Interactions between dietary obesity and exercise-training on carbohydrate metabolism.

The present study addressed the important question of whether exercise-training could reduce insulin levels in exercise-trained rats made obese by a diet composed of palatable foods. Female rats were divided in exercise-trained or in sedentary groups which receive either a palatable high-energy diet or merely a standard laboratory chow. The high-energy diet was composed of supermarket foods including chocolate chips cookies, pop-corn, bologna, etc. Exercise-training program consisted of forced swimming, 6 d per week, 2 h per d, in water maintained at 36 degrees C. At the end of both fattening and exercise-training program, the animals were subjected to an intravenous glucose tolerance test. The results showed that high-energy diet and exercise-training had opposite effects on both glucose tolerance and insulin secretion: the former impaired glucose tolerance and increased insulin levels, whereas the latter leads to opposite adaptations. In addition, some abnormalities in insulin metabolism persisted in rats simultaneously assigned to exercise-training and high-energy diet. Thus, the present results also suggested that physical training alone could not reduce plasma insulin under control levels, and that a change in energy balance is possibly necessary to achieve this purpose.

Adipose Tissue↗

PubMed2005

Prior exercise training improves the outcome of acute myocardial infarction in the rat. Heart structure, function, and gene expression.

OBJECTIVES: The aim of this research was to investigate the structural, functional, and molecular features of the remodeling heart in prior swim-trained infarcted rats. BACKGROUND: Physical exercise training is a known protective factor against cardiovascular morbidity and mortality. The structural and molecular aspects underlying this protection in the remodeling heart have not been investigated. METHODS: After seven weeks of swimming exercise training, rats underwent surgical ligation of the left coronary artery followed by a four-week sedentary period. Untrained control rats underwent the same surgical protocol. Left ventricular function was assessed by echocardiography four weeks after infarction, and hearts were sampled for histological and molecular analysis. Ribonucleic acid from the surviving left ventricle was analyzed by complementary deoxyribonucleic acid arrays followed by Northern blotting or quantitative reverse transcription polymerase chain reaction of selected messenger ribonucleic acids (mRNAs). RESULTS: Scar area was 1.6-fold smaller (p = 0.0002), arteriolar density was 1.7-fold higher (p = 0.0002), and left ventricular shortening fraction was 1.9-fold higher (p = 0.003) in the exercise-trained compared with sedentary hearts. Eleven genes whose expression level varied by at least +/-1.5-fold distinguished the prior exercised rats from their sedentary counterparts. Compared with sedentary, the exercised hearts displayed 9- and 2.4-times lower levels of atrial natriuretic peptide and aldolase mRNA (p = 0.03 and 0.04, respectively), and a 2.7- and 1.9-fold higher abundance of cytochrome c-oxidase and fatty acid binding protein, respectively (p < 0.03, each). CONCLUSIONS: Swimming exercise training before acute myocardial infarction reduces scar size, increases arteriole density, and manifests adaptation of stress- and energy-metabolism-related genes that may contribute to the improved heart function observed during remodeling.

Adenosine Triphosphatases↗

PubMed2006

Effect of aerobic exercise training on renal responses to sodium in hypertensives.

INTRODUCTION: Aerobic exercise training has been shown to improve cardiovascular function and lower blood pressure (BP) in older adults. The exact mechanism(s) by which aerobic exercise training elicits these changes are unknown; however, it is possible that changes in renal hemodynamics may play a role. PURPOSE: The present study was undertaken to examine the effect of aerobic exercise training on renal hemodynamics in older hypertensive individuals. METHODS: Renal plasma flow (RPF) and glomerular filtration rate (GFR) were determined by plasma and urinary clearances of 131I-hippuran and 99mTc-DTPA after 8 d of low (20 mEq) and high (200 mEq) Na+ diets in 31 older (63 +/- 1 yr), hypertensive (152 +/- 2/88 +/- 1 mm Hg) individuals at baseline and following 6 months of aerobic exercise training (at 75% VO2max, three times a week, 40 min per session). RESULTS: Following 6 months of aerobic exercise training, a significant increase was seen in maximal aerobic capacity (VO2max: 18.3 +/- 0.7 vs 20.7 +/- 0.7 mL.kg.min(-1), P = 0.017) as well as a significant decrease in resting systolic (152 +/- 2 vs 145 +/- 2 mm Hg, P = 0.037) and mean arterial (109 +/- 1 vs 105 +/- 1 mm Hg, P = 0.021) BP. No significant (P < 0.05) effects were seen of aerobic exercise training on RPF (208.8 +/- 12.2 vs 197.1 +/- 13.1 mL.min(-1).1.73 m(-2)), GFR (68.9 +/- 3.6 vs 69.0 +/- 3.9 mL.min(-1).1.73 m(-2)), or filtration fraction (35.3 +/- 2.3 vs 37.1 +/- 2.4%) on the low Na+ diet or RPF (210.6 +/- 12.8 vs 212.1 +/- 11.7 mL.min(-1).1.73 m(-2)), GFR (72.9 +/- 4.1 vs 77.3 +/- 4.3 mL.min(-1).1.73 m(-2)), or filtration fraction (37.1 +/- 2.5 vs 37.7 +/- 3.0%) on the high Na+ diet. CONCLUSIONS: Our results suggest that changes in renal hemodynamics do not contribute to the reduction in resting BP in older hypertensive persons.

Analysis of Variance↗

PubMed2001

The effect of exercise training on beta-adrenergic stimulation of fat metabolism in obese men.

OBJECTIVE: To investigate the in vivo effect of exercise training at high and low intensity on beta-adrenergic stimulated fat metabolism in obese men at rest. METHOD: Twenty-three obese, healthy subjects were randomly divided in a low-intensity exercise training program (40% VO(2max), n=7), a high-intensity exercise training program (70% VO(2max); n=8), or a non-exercising control group (n=8). The exercise training program lasted for 12 weeks with a training frequency of 3 times per week. Before and after the intervention body composition and maximal aerobic capacity were measured as well as fat metabolism at rest and during beta-adrenergic stimulation by isoprenaline. For comparison, six lean subjects served as a control group. They participated in a low-intensity exercise training program and underwent the same measurements as the obese subjects. RESULTS: Relative fat oxidation decreased significantly during infusion of an increasing dose of isoprenaline in the obese low-intensity and high-intensity exercise training groups as well as in the lean group (P<0.01). Exercise training failed to influence the effect of beta-adrenergic stimulation on relative fat oxidation in obese men at both intensities and in lean men. In addition, beta-adrenergic-mediated lipolysis did not seem to be different after low intensity exercise training in lean and obese men. Lipolysis might be increased after high-intensity exercise training in obese men. CONCLUSION: Low- and high-intensity exercise training in obese men failed to affect beta-adrenergic mediated relative fat oxidation in vivo. beta-Adrenergic-mediated lipolysis might be increased in obese men after HI exercise training only. The effect of low-intensity exercise training on beta-adrenergic-mediated fat metabolism was similar in lean and obese men. International Journal of Obesity (2001) 25, 16-23

Adrenergic beta-Agonists↗

PubMed2001

A new approach to monitoring exercise training.

The ability to monitor training is critical to the process of quantitating training periodization plans. To date, no method has proven successful in monitoring training during multiple types of exercise. High-intensity exercise training is particularly difficult to quantitate. In this study we evaluate the ability of the session rating of perceived exertion (RPE) method to quantitate training during non-steady state and prolonged exercise compared with an objective standard based on heart rate (HR). In a 2-part design, subjects performed steady state and interval cycle exercise or practiced basketball. Exercise bouts were quantitated using both the session RPE method and an objective HR method. During cycle exercise, the relationship between the exercise score derived using the session RPE method and the HR method was highly consistent, although the absolute score was significantly greater with the session RPE method. During basketball, there was a consistent relationship between the 2 methods of monitoring exercise, although the absolute score was also significantly greater with the session RPE method. Despite using different subjects in the 2 parts of the study, the regression relationships between the session RPE method and the HR method were nearly overlapping, suggesting the broad applicability of this method. We conclude that the session RPE method is a valid method of quantitating exercise training during a wide variety of types of exercise. As such, this technique may hold promise as a mode and intensity-independent method of quantitating exercise training and may provide a tool to allow the quantitative evaluation of training periodization plans.

Adult↗

PubMed2001

Exercise training in chronic heart failure: why, when and how.

The management of patients with chronic congestive heart failure has changed considerably during the last decade. Until recently, restriction of physical activity was recommended for patients with chronic heart failure. However, the knowledge that training influences largely the periphery rather than the heart itself has led to a dramatic change in the approach toward training in patients with chronic heart failure. Why to train patients with chronic heart failure: Training increases exercise tolerance by an average of 20% in chronic heart failure regardless of etiology (ischemic or non-ischemic cardiomyopathy) or severity of left ventricular dysfunction. Available data, while limited, demonstrate that increases in exercise capacity are paralleled by an improvement in quality of life. Studies have consistently demonstrated that training has no deleterious effect on central haemodynamics, left ventricular remodeling, systolic or diastolic function, or myocardial metabolism. At present, there are insufficient data to determine the effect of training on prognosis, but trials are currently underway to address this. When to train patients with chronic heart failure: Exercise training should be performed only with the patients that have been in a stable clinical condition for a period of at least 3-4 weeks. Clinical stability is defined as no change in symptoms, weight, drug regimen, or NYHA class over this period. How to train patients with chronic heart failure: Initially, the program should be supervised for a period of 2 to 4 weeks; home-based programs are usually appropriate thereafter. Activities that can be maintained for a lifetime should be encouraged, and the focus should be on aerobic-type activities. The intensity level should be targeted to about 50%-70% of peak VO2 and/or Borg ratings of 12-14 ("walk and talk").

Diastole↗