Recommendations for exercise training in chronic heart failure patients.

The treatment of heart failure has changed dramatically during the years. The radical shift in concept is illustrated by the change from sympathomimetic drugs to beta-blocking agents, representing a striking example of how medical management of heart failure has evolved in an unanticipated fashion. Exercise and physical activity is another treatment area being completely readdressed and revised in this setting. Prior to the late 1980s, cardiac enlargement, decreased left ventricular systolic function and heart failure were considered absolute or relative contraindications to exercise training. Previous treatment strategies involved restriction of physical activity and bed rest for all stages and forms of heart failure. During acute exacerbation of the disease, rest was considered to be beneficial by causing increased renal blood flow, enhanced urine output, and pharmacological diuresis. Once stable, patients were advised to avoid exercise fearing a further decline in cardiac function. However, prolonged rest or inactivity can lead to skeletal muscle atrophy, further reduction in exercise tolerance, venous thrombosis, pulmonary embolism, decubitus, and exacerbation of symptoms. The concept of exercise training in patients with heart failure developed in the 1980s, following a period of intense evaluation of the safety and efficacy of exercise rehabilitation in patients with stable coronary artery disease and based on a better understanding of peripheral adaptation in heart failure. Initial studies among coronary patients with significant left ventricular dysfunction reported a significant improvement in exercise capacity without major detrimental effects. Research over the past 10 years expanded our understanding and knowledge about the role of exercise training in patients with left ventricular dysfunction and heart failure.