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Dtsch Med Wochenschr 2011; 136(16): 836-840
DOI: 10.1055/s-0031-1275814
Übersicht | Review article
Kardiologie
© Georg Thieme Verlag KG Stuttgart · New York

Körperliches Training bei Herzinsuffizienz: Effektivität jenseits der medikamentösen Therapie?

Exercise in heart failure – additional effect to medication?R. Seebach1 , D. Hensler2 , J. W. Christle1 , A. Preßler1 , M. Halle1
  • 1Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München
  • 2Zentrum für Interdisziplinäre Intensivmedizin, Berufsgenossenschaftliche Unfallklinik Murnau
Further Information

Publication History

eingereicht: 3.2.2011

akzeptiert: 17.3.2011

Publication Date:
12 April 2011 (online)

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Zusammenfassung

Körperliche Aktivität galt bis vor 20 Jahren noch weitgehend als Kontraindikation bei chronischer Herzinsuffizienz – eine Annahme, die heutzutage als überholt angesehen werden muss. Regelmäßiges körperliches Training wurde in zahlreichen Studien als sicher bewertet und hat neben medikamentösen und apparativen Verfahren inzwischen einen bedeutsamen Stellenwert in der Therapie der systolischen Herzinsuffizienz. Training steigert signifikant kardiorespiratorische Belastbarkeit und die Lebensqualität, reduziert krankheitsspezifische Begleitsymptome wie Dyspnoe und Ermüdung und senkt die Hospitalisierungsrate. Auch gibt es Hinweise für eine trainingsinduzierte Verbesserung der linksventrikulären Auswurffraktion und eine Senkung der Mortalität. Ein optimales Training für stabile Patienten aller NYHA-Stadien beinhaltet sowohl Ausdauer- als auch Kraftelemente und sollte unter fachkundiger Aufsicht individuell dosiert durchgeführt werden.

Abstract

Twenty years ago chronic heart failure was considered a contraindication for regular physical activity. Many believed exercise to be counterproductive to recovery and perhaps harmful to chronic heart failure patients. However, in recent years numerous studies have proven the feasibility and safety of exercise training in heart failure patients. Exercise now plays a pivotal role in the treatment of systolic heart failure in addition to medical or device-related therapy. Regular exercise has been shown to increase exercise capacity and quality of life, as well as reduce symptoms and lower hospitalization rates. It also has the potential to increase left ventricular ejection fraction and reduce mortality. An individual tailored regular exercise program including endurance and resistance training is recommended for all stable heart failure patients.

Schlüsselwörter

chronische Herzinsuffizienz - körperliches Training - kardiorespiratorische Belastbarkeit - linksventrikuläre Auswurffraktion

Keywords

chronic heart failure - aerobic endurance training - exercise capacity - ejection fraction - cardiac rehabilitation

Literatur

  • 1 Experience from controlled trials of physical training in chronic heart failure. Protocol and patient factors in effectiveness in the improvement in exercise tolerance. European Heart Failure Training Group.  Eur Heart J. 1998;  19 466-475
    Search in Google Scholar
  • 2 Belardinelli R, Georgiou D, Cianci G, Purcaro A. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome.  Circulation. 1999;  99 1173-1182
    Search in Google Scholar
  • 3 Bjarnason-Wehrens B, Schulz O, Gielen S. et al . Leitlinie körperliche Aktivität zur Sekundärprävention und Therapie kardiovaskulärer Erkrankungen.  Clin Res Cardiol. 2009;  4 1-44
    Search in Google Scholar
  • 4 Braith R W, Welsch M A, Feigenbaum M S, Kluess H A, Pepine C J. Neuroendocrine activation in heart failure is modified by endurance exercise training.  J Am Coll Cardiol. 1999;  34 1170-1175
    Search in Google Scholar
  • 5 Coats A J, Adamopoulos S, Radaelli A. et al . Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function.  Circulation. 1992;  85 2119-2131
    Search in Google Scholar
  • 6 Coletta A P, Cleland J G, Freemantle N, Clark A L. Clinical trials update from the European Society of Cardiology Heart Failure meeting: SHAPE, BRING-UP 2 VAS, COLA II, FOSIDIAL, BETACAR, CASINO and meta-analysis of cardiac resynchronisation therapy.  Eur J Heart Fail. 2004;  6 673-676
    Search in Google Scholar
  • 7 Davies E J, Moxham T, Rees K. et al . Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis.  Eur J Heart Fail. 2010;  12 706-715
    Search in Google Scholar
  • 8 Dickstein K, Cohen-Solal A, Filippatos G. et al . ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).  Eur Heart J. 2008;  29 2388-2342
    Search in Google Scholar
  • 9 Duscha B D, Kraus W E, Keteyian S J. et al . Capillary density of skeletal muscle: a contributing mechanism for exercise intolerance in class II-III chronic heart failure independent of other peripheral alterations.  J Am Coll Cardiol. 1999;  33 1956-1963
    Search in Google Scholar
  • 10 Flynn K E, Pina I L, Whellan D J. et al . Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial.  JAMA. 2009;  301 1451-1459
    Search in Google Scholar
  • 11 Giannuzzi P, Tavazzi L, Meyer K. et al . Recommendations for exercise training in chronic heart failure patients.  Eur Heart J. 2001;  22 125-135
    Search in Google Scholar
  • 12 Giannuzzi P, Temporelli P L, Corra U, Tavazzi L. Antiremodeling effect of long-term exercise training in patients with stable chronic heart failure: results of the Exercise in Left Ventricular Dysfunction and Chronic Heart Failure (ELVD-CHF) Trial.  Circulation. 2003;  108 554-559
    Search in Google Scholar
  • 13 Granger B B, Swedberg K, Ekman I. et al . Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial.  Lancet. 2005;  366 2005-2011
    Search in Google Scholar
  • 14 Haykowsky M J, Liang Y, Pechter D, Jones L W, McAlister F A, Clark A M. 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
    Search in Google Scholar
  • 15 Hunt S A, Abraham W T, Chin M H. et al . 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation.  J Am Coll Cardiol. 2009;  53 e1-e90
    Search in Google Scholar
  • 16 Keteyian S J, Pina I L, Hibner B A, Fleg J L. Clinical role of exercise training in the management of patients with chronic heart failure.  J Cardiopulm Rehabil Prev. 2010;  30 67-76
    Search in Google Scholar
  • 17 Löllgen H. Das Anstrengungsempfinden (RPE, Borg-Skala).  Dtsch Z Sportmed. 2004;  55 299-300
    Search in Google Scholar
  • 18 Mancini D M, Eisen H, Kussmaul W, Mull R, Edmunds Jr L H, Wilson J R. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure.  Circulation. 1991;  83 778-786
    Search in Google Scholar
  • 19 Mancini D M, Walter G, Reichek N. et al . Contribution of skeletal muscle atrophy to exercise intolerance and altered muscle metabolism in heart failure.  Circulation. 1992;  85 1364-1373
    Search in Google Scholar
  • 20 McKelvie R S. Exercise training in patients with heart failure: clinical outcomes, safety, and indications.  Heart Fail Rev. 2008;  13 3-11
    Search in Google Scholar
  • 21 McKelvie R S, Teo K K, McCartney N, Humen D, Montague T, Yusuf S. Effects of exercise training in patients with congestive heart failure: a critical review.  J Am Coll Cardiol. 1995;  25 789-796
    Search in Google Scholar
  • 22 McKelvie R S, Teo K K, Roberts R. et al . Effects of exercise training in patients with heart failure: the Exercise Rehabilitation Trial (EXERT).  Am Heart J. 2002;  144 23-30
    Search in Google Scholar
  • 23 Myers J, Doris W, Thomas S. et al . Effects of exercise training on left ventricular volumes and function in patients with nonischemic cardiomyopathy: Application of magnetic resonance myocardial tagging.  Am Heart J. 2002;  144 719-725
    Search in Google Scholar
  • 24 O’Connor C M, Whellan D J, Lee K L. et al . Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial.  JAMA. 2009;  301 1439-1450
    Search in Google Scholar
  • 25 Oka R K, De Marco T, Haskell W L. et al . Impact of a home-based walking and resistance training program on quality of life in patients with heart failure.  Am J Cardiol. 2000;  85 365-369
    Search in Google Scholar
  • 26 Piepoli M F, Davos C, Francis D P, Coats A J. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH).  BMJ. 2004;  328 189
    Search in Google Scholar
  • 27 Pina I L, Apstein C S, Balady G J. et al . Exercise and heart failure: A statement from the American Heart Association Committee on exercise, rehabilitation, and prevention.  Circulation. 2003;  107 1210-1225
    Search in Google Scholar
  • 28 Swedberg K, Cleland J, Dargie H. et al . Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology.  Eur Heart J. 2005;  26 1115-1140
    Search in Google Scholar
  • 29 van der Wal M H, Jaarsma T, van Veldhuisen D J. Non-compliance in patients with heart failure; how can we manage it?.  Eur J Heart Fail. 2005;  7 5-17
    Search in Google Scholar
  • 30 van der Wal M H, van Veldhuisen D J, Veeger N J, Rutten F H, Jaarsma T. Compliance with non-pharmacological recommendations and outcome in heart failure patients.  Eur Heart J. 2010;  31 1486-1493
    Search in Google Scholar
  • 31 van Tol B AF, Huijsmans R J, Kroon D W, Schothorst M, Kwakkel G. Effects of exercise training on cardiac performance, exercise capacity and quality of life in patients with heart failure: A meta-analysis.  Eur J Heart Fail. 2006;  8 841-850
    Search in Google Scholar
  • 32 Willenheimer R, Erhardt L, Cline C, Rydberg E, Israelsson B. Exercise training in heart failure improves quality of life and exercise capacity.  Eur Heart J. 1998;  19 774-781
    Search in Google Scholar
  • 33 Williams M A, Haskell W L, Ades P A. et al . Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism.  Circulation. 2007;  116 572-584
    Search in Google Scholar
  • 34 Wisloff U, Stoylen A, Loennechen J P. et al . Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study.  Circulation. 2007;  115 3086-3094
    Search in Google Scholar
  • 35 Yu C M, Fung J W, Zhang Q. et al . Tissue Doppler imaging is superior to strain rate imaging and postsystolic shortening on the prediction of reverse remodeling in both ischemic and nonischemic heart failure after cardiac resynchronization therapy.  Circulation. 2004;  110 66-73
    Search in Google Scholar

Univ.-Prof. Dr. med. Martin Halle

Technische Universität München
Medizinische Universitätsklinik
Präventive und Rehabilitative Sportmedizin

Connollystraße 32

80809 München

Email: halle@tum.de