Körperliches Training als Intervall- oder kontinuierliches Training bei chronischer Herzinsuffizienz zur Verbesserung der funktionellen Leistungskapazität, Hämodynamik und Lebensqualität – eine kontrollierte Studie

Abstract

We conducted a three-week randomized trial comparing the improvement of functional capacity by exercise training in chronic heart failure by the steady-state (EF 27.3%, n = 20) and the interval modus (EF 29.3%, n = 20) with a control group (EF = 26.6%, n = 10). Minimal EF was 10%, the lowest maximal oxygen consumption was 9.3 ml/kg/min and the lowest cardiac output was 1.9 l/min; 9 patients had been evaluated for HTX. VO2 at the anaerobic threshold and at maximal exercise increased in the continuous exercise group by 1.4 or 1.6 ml/kg/min, respectively, corresponding to an increase of 13.7% (p < 0.05) and 9.3% (p < 0.05). In the interval training group the increase was 1.3 and 1.5 ml/kg/min corresponding to 14% (p < 0.05) and 8.1% (p < 0.05). Continuous short-term exercise had no impact to central hemodynamics as pulmonary artery pressure (PA), capillary wedge pressure (pc), cardiac index (CI) or stroke volume index (SVI), whereas after interval training a significant increase at maximal exercise could be seen in CI (p < 0.05) and SVI (p < 0.01) with a concomitant drop in systemic peripheral resistance (p < 0.05) compared to the steady-state modus. Interval training was further characterized by a higher short-term but lower mean work load with a significantly smaller increase in lactate. Quality of life was improved according to the SF-36 questionnaire in both training groups but the psychologic sum factor was three times as high, increasing to 24.2% in the steady-state exercise group. It can be concluded that clinically stable patients with heart failure and even those already having been evaluated for cardiac transplantation profit from short-term physical training. Both training modalities seem equally suited to improve functional capacity. However interval training leads to more pronounced improvement in hemodynamics compared to the steady-state exercise, whereas the later had a greater impact on psychological well-being and quality of life. Patients with heart failure and severe peripheral deconditioning tolerate higher workloads with more peripheral stress by an interval training modus. Long-term training modalities need to be established to further improve and stabilize functional status.

Effect of Endurance Training on the Determinants of Peak Exercise Oxygen Consumption in Elderly Patients With Stable Compensated Heart Failure and Preserved Ejection Fraction

“…Taken together, studies performed in HFREF patients suggest that the increased peak VO 2 after 2 to 6 months of endurance exercise training is due to increased peak CO and/or A-VO 2 Diff. When present, increased peak CO was due primarily to increased peak heart rate as peak stroke volume was not significantly increased after training in any of these studies in HFREF patients 16, 17, 19-21, 40, 41 .…”

“…In HFREF patients, Hambrecht et al 19, 22 reported that 6 months of endurance exercise training increased peak exercise heart rate and CO. In contrast, Sullivan et al 16 and others 17, 39, 40 reported no significant change in peak stroke volume and CO after endurance exercise training in HFREF patients, and that increased peak A-VO 2 Diff measured invasively by direct oximetry was the major contributor to improved exercise capacity. Dubach et al 21 found that 2 months of high-intensity endurance training improved both peak exercise CO and A-VO 2 Diff in HFREF patients.…”

“…However, this requires measurement of VO 2 and its determinants during peak exercise which can be challenging in humans 9, 29 . As a result, a relatively small number of the training studies in HFREF patients have been able to examine this question 15-17, 19, 21, 22, 39, 40 , and to our knowledge this is the first to do so in elderly patients with stable compensated HFPEF.…”

Effects of exercise on cardiovascular performance in the elderly

“…Wisloff et al (2007) reported that high-intensity interval aerobic training was superior to continuous moderate intensity endurance exercise training for improving resting LV ejection fraction, peripheral vascular function, and skeletal muscle mitochondrial biogenesis in elderly men with HFREF. Nechwatal et al (2002) found that short-term high-intensity aerobic interval training significantly increased peak exercise stroke volume and CO and reduced systemic vascular resistance but there was no change in these outcomes after moderate intensity continuous endurance training in patients with HFREF.…”

Aerobic Interval Exercise Training Induces Greater Reduction in Cardiac Workload in the Recovery Period in Rats

“…In addition, several previous studies had reported that interval training at a relatively higher intensity could be used in both clinical practice and experiments, and that such exercise modality had greater beneficial effects on the heart 8,9 . Those characteristics suggest that intermittent training can be more appropriate to individuals with metabolic syndrome, dyslipidemia and other cardiovascular risk factors 10-12 . However, little is known about the acute and subacute differences obtained with that exercise modality as compared to traditional continuous training.…”