Effects of Exercise Training on Left Ventricular Function and Peripheral Resistance in Patients With Chronic Heart Failure

TLDR

Exercise training improves work capacity in chronic heart failure by enhancing endothelial function and skeletal muscle aerobic metabolism, yet its impact on central hemodynamics remains unclear. The study aimed to assess how exercise training affects left ventricular function and hemodynamic responses during exercise in stable chronic heart failure patients. In a prospective randomized trial from 1994 to 1999, 73 men with an average ejection fraction of 0.27 underwent two weeks of in‑hospital ergometer training followed by six months of home‑based exercise, with ergospirometry, thermodilution, and echocardiography used to evaluate central hemodynamics and cardiac dimensions at baseline and after six months. Exercise training led to significant improvements in NYHA class, maximal ventilation, exercise time, and capacity, reduced resting heart rate, increased stroke volume, raised resting LV ejection fraction, lowered peak‑exercise total peripheral resistance, modestly decreased LV end‑diastolic diameter, and correlated changes in stroke volume and peripheral resistance. Published in JAMA, 2000.

Abstract

Exercise training in patients with chronic heart failure improves work capacity by enhancing endothelial function and skeletal muscle aerobic metabolism, but effects on central hemodynamic function are not well established.To evaluate the effects of exercise training on left ventricular (LV) function and hemodynamic response to exercise in patients with stable chronic heart failure.Prospective randomized trial conducted in 1994-1999.University department of cardiology/outpatient clinic in Germany.Consecutive sample of 73 men aged 70 years or younger with chronic heart failure (with LV ejection fraction of approximately 0.27).Patients were randomly assigned to 2 weeks of in-hospital ergometer exercise for 10 minutes 4 to 6 times per day, followed by 6 months of home-based ergometer exercise training for 20 minutes per day at 70% of peak oxygen uptake (n=36) or to no intervention (control group; n=37).Ergospirometry with measurement of central hemodynamics by thermodilution at rest and during exercise; echocardiographic determination of LV diameters and volumes, at baseline and 6-month follow-up, for the exercise training vs control groups.After 6 months, patients in the exercise training group had statistically significant improvements compared with controls in New York Heart Association functional class, maximal ventilation, exercise time, and exercise capacity as well as decreased resting heart rate and increased stroke volume at rest. In the exercise training group, an increase from baseline to 6-month follow-up was observed in mean (SD) resting LV ejection fraction (0.30 [0.08] vs 0.35 [0.09]; P=.003). Mean (SD) total peripheral resistance (TPR) during peak exercise was reduced by 157 (306) dyne/s/cm(-5) in the exercise training group vs an increase of 43 (148) dyne/s/cm(-5) in the control group (P=.003), with a concomitant increase in mean (SD) stroke volume of 14 (22) mL vs 1 (19) mL in the control group (P=.03). There was a small but significant reduction in mean (SD) LV end diastolic diameter of 4 (6) mm vs an increase of 1 (4) mm in the control group (P<.001). Changes from baseline in resting TPR for both groups were correlated with changes in stroke volume (r=-0.76; P<.001) and in LV end diastolic diameter (r=0.45; P<.001).In patients with stable chronic heart failure, exercise training is associated with reduction of peripheral resistance and results in small but significant improvements in stroke volume and reduction in cardiomegaly. JAMA. 2000.