More evidence for the benefit of exercise in heart failure

Heart failure, by far the most prevalent chronic cardiac condition, is also one of the most difficult to diagnose and treat. Its symptoms of breathlessness, exercise intolerance and fluid build-up in the abdomen and lungs are often mistaken for mere "old age" and left untreated. Now, however, another study from Leipzig, Germany, suggests that a moderate exercise programme four times daily for four weeks can improve the function of (endothelial) cells lining the circulatory system; endothelial dysfunction is a key event in the progression of atherosclerosis and heart failure. Each exercise session comprised a short warm-up routine followed by 10-20 minutes cycling under supervision. Fifty patients with stable heart failure were randomised to the exercise programme or to a control group; each of the four daily exercises was at 60-70% of maximal aerobic capacity.

Endothelial function was assessed by ultrasound measurement of arterial diameter, which is predominantly dependent on the release of nitric oxide from the endothelium and represents a well accepted predictor of outcome in heart failure. Results showed that in both young and older heart failure patients the four weeks exercise programme was effective in improving endothelial dysfunction, reflecting, says investigator Dr Marcus Sandri from the University of Leipzig, "the potential for rehabilitation in this patient group". No improvements were seen in the control group.

Dr Sandri also noted that the beneficial effect was seen as much in older subjects as in younger. "The effects of exercise were not diminished in our older heart failure patients," he says, "which suggests that exercise as a treatment might be just as effective in older patients as younger." Dr Sandri added that the study also measured the numbers of endothelial progenitor cells, which increased in number in those patients randomised to the exercise programme. Thus, while the effect of exercise appeared to improve arterial blood flow through vasodilation, it may also be that the increased number of progenitor cells had a regenerative effect on diseased endothelial tissue.

Although rest and palliative care have been traditionally prescribed for patients with heart failure, it has been seen in several recent studies that physical exercise training can improve functional capacity in patients with heart failure. The effects of exercise have been seen in improved exercise capacity, quality of life, and biomarkers of disease and even survival.

This latest study on the effect of exercise on endothelial function will be presented – along with the other two highlighted - at a session on "exercise training in coronary artery disease" on Friday 8 May at EuroPRevent 2009.