All concepts, explanations, trials, and studies have been
re-written in plain English and may contain errors. I am
not a doctor
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Exercise Is Recommended for Heart Failure Patients

March 4, 2003 - The American Heart Association now
recommends exercise for heart failure patients. The
current statement follows up on the 2001 guidelines.
The AHA Committee on Exercise, Rehabilitation and
Prevention writes the guidelines.
	The committee reviewed medical literature
which showed that exercise training in CHF patients
improves endothelial function, hormonal overactivity
and oxygen use. These changes improve exercise
capacity and quality of life.
	HOWEVER, the exercise regimen must be
individualized for each heart failure patient and
cannot rely on heart rate as a measure of intensity.
Instead, gas exchange measurements like Vo2max and
peak Vo2, or functional ability should be used, as
well as the Borg scale of perceived exertion. This
is why exercise testing by your doctor is so
important BEFORE starting an exercise program.
	"The Borg scale allows you to ask the patient
how much total work they feel like they're doing
(during exercise) ... it is pretty darn accurate if
people understand the instructions," the head of the
committee, Dr. Pia, explained. "It's not how short of
breath you are and it's not how much your legs work
... it's how hard you think you are working."
	She and her associates recommend that patients
achieve a Borg score "somewhere between 13 and 15 - on
the moderate side."
	Because patients are uncomfortable when they
first start a program, they need to start with LOW
INTENSITY exercise and work up to higher intensity
workouts. A professional cardiac rehab program is very
helpful in this.
	In the official statement, both aerobic
training AND resistance exercise are recommended. A
rapid surge of adrenaline is not good for heart
failure patients and when people stop exercising,
adrenaline goes up, leaving a patient vulnerable to
irregular heart rhythms. That's why a cool-down period
after exercise is also recommended.
	The recommendations are based on a review of
more than 100 studies but the studies are all small.
So the National Institutes of Health are funding the
ACTION trial (A Congestive heart failure Trial
Investigating Outcomes of exercise Training). This is
a randomized study of about 3,000 heart failure patients.
Participants will do a formal exercise program, then
continue exercising at home.

Circulation 2003;107:1210-1225