Körperliche Aktivität bei älteren Patienten mit chronischer Herzinsuffizienz

Zusammenfassung

Bereits ab dem 30. Lebensjahr nimmt die maximale körperliche Leistungfähigkeit kontinuierlich mit steigendem Lebensalter ab - um etwa 10 % pro Lebensdekade. Als Konsequenz dieser Entwicklung leiden ältere Menschen > 65 Jahre in besonderem Maße unter einer Einschränkung der körperlichen Leistungsfähigkeit als Folge der kardialen, vaskulären und muskulären Alterserscheinungen. Diese natürlichen altersbedingten Veränderungen machen alte Menschen besonders anfällig für die zentral-kardialen und peripheren Alteration, die eine chronische Herzinsuffizienz (CHI) mit sich bringt. Die Funktionseinschränkungen unterscheiden sich dabei nicht qualitativ grundsätzlich von den altersbedingten Veränderungen - sie überlagern sich diesen oft unmerklich.

Durch körperliche Aktivität kann ein bedeutender Anteil der Funktionseinschränkung von Vasomotorik, Skelettmuskelfunktion und kardialer Leistungsreserve wiedergewonnen werden. Bisher existieren noch keine systematischen Vergleichsstudien zur Altersabhängigkeit der Trainingseffekte, kleinere Beobachtungsstudien und Subgruppenanalysen legen jedoch den Schluss nahe, dass der trainingsbedingte Gewinn an Leistungsfähigkeit im Alter proportional dem (niedrigeren) Ausgangswert nicht geringer als bei jüngeren Patienten ausfällt. Im Vordergrund körperlicher Aktivität im Alter steht dabei die Erhaltung von Muskelkraft und Muskelmasse sowie die Übung der motorischen Koordination. Ziel ist letztlich die Reduktion der CHI-bedingten Morbidität: Immerhin sind aktuell 79 % der wegen CHI hospitalisierten Patienten älter als 65 Jahre.

Summary

Maximal exercise capacity undergoes a steady decline after the age of 30 by approximately 10 % per decade. As a consequence of this development older people > 65 years of age suffer from the exercise limitation caused by age-associated cardiac, vascular and skeletal muscle changes. These physiologic alterations make older people especially vulnerable for the cardiovascular and peripheral alterations associated with chronic heart failure (CHF). These changes are not phenomenologically differerent from age-associated changes.

Physical activity plays an important role for regaining a considerable part of vasomotor function, skeletal muscle contractility, and cardiac reserve. Up to now there are no prospective trials comparing the effects of physical training between older and younger patients with CHF. However, smaller observational studies indicate that elderly patients benefit equally well from training interventions with regard to functional improvements in proportion to their lower baseline values.

In an aging population training aims at maintaining skeletal muscle force and muscle mass as well as locomotor coordination. Ultimately, the goal is to reduce the subsantial morbidity among elderly CHF patients which constitute 79 % of all hospital admissions for heart failure.

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