Exercise Training
In the past, HF patients have had rest prescribed as part of
their treatment plan. The individual
with HF often has dyspnea, fatigue and diminished exercise tolerance. In the last 20 years it has been found that
physical deconditioning may play a role in the progression of symptoms. Several studies, including the most recent
and largest study, the HF-ACTION trial, showed positive effects of exercise
training on exercise capacity, and quality of life with relatively few
complications during exercise (O’Connor et al., 2009, p. 3).
The 2013 ACCF/AHA Practice Guideline for the Management of Heart Failure, adds exercise training (or regular physical activity) as a class I recommendation for HF, recommended as safe and effective for patients with HF who are able to participate to improve functional status. CR is a newly added class IIa recommended intervention for HF, recommended as useful in clinically stable patients with HF to improve functional capacity, exercise duration, health-related quality of life, and mortality (Yancy et al., 2013, p. 1821).
Before beginning cardiac rehab, the HF patient should be clinically stable by the patient’s personal physician or cardiac rehab medical director. The cardiac rehab (CR) staff should assess the HF patient on each visit regarding changes in symptoms. These symptoms can include, but are not limited to:
• Weight gain ≥ 3 pounds since last visit or 5 pounds within a week
• Worsening dyspnea, on exertion or rest
• Excessive fatigue
• Increasing edema of legs or abdomen
• Productive cough
• Increased urination, especially at night
• Difficulty sleeping because of breathing problems
• Difficulty concentrating
• New or worsening angina or syncope
• Persistently elevated blood pressure, > 140/90 mm Hg
• Symptomatic low blood pressure, < 90/60 mm Hg
Any change in symptoms or disease progression should be communicated with the patient’s physician or the cardiac rehab medical director (Keteyian, Squires, Ades, & Thomas, 2014, p. 224).
References:
Keteyian, S. J., Squires, R. W., Ades, P. A., & Thomas, R. J. (2014). Incorporating patients with chronic heart failure into outpatient cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation & Prevention, 34, 223-232. http://dx.doi.org/10.1097/HCR.0000000000000073
O’Connor, C. M., Whellan, D. J., Lee, K. L., Keteyian, S. J., Cooper, L. S., Ellis, S. J., ... Pina, I. L. (2009, April 8). Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA: The Journal of the American Medical Association, 301 (14). http://dx.doi.org/10.1001/Jama.2009.454
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, Jr., D. E., Drazner, M. H., ... Wikoff, B. L. (2013). 2013 ACCF/AHA Guideline for the management of heart failure: executive summary [Practice Guideline]. Circulation. http://dx.doi.org/10.1161/CIR.0b013e31829e8807
The 2013 ACCF/AHA Practice Guideline for the Management of Heart Failure, adds exercise training (or regular physical activity) as a class I recommendation for HF, recommended as safe and effective for patients with HF who are able to participate to improve functional status. CR is a newly added class IIa recommended intervention for HF, recommended as useful in clinically stable patients with HF to improve functional capacity, exercise duration, health-related quality of life, and mortality (Yancy et al., 2013, p. 1821).
Before beginning cardiac rehab, the HF patient should be clinically stable by the patient’s personal physician or cardiac rehab medical director. The cardiac rehab (CR) staff should assess the HF patient on each visit regarding changes in symptoms. These symptoms can include, but are not limited to:
• Weight gain ≥ 3 pounds since last visit or 5 pounds within a week
• Worsening dyspnea, on exertion or rest
• Excessive fatigue
• Increasing edema of legs or abdomen
• Productive cough
• Increased urination, especially at night
• Difficulty sleeping because of breathing problems
• Difficulty concentrating
• New or worsening angina or syncope
• Persistently elevated blood pressure, > 140/90 mm Hg
• Symptomatic low blood pressure, < 90/60 mm Hg
Any change in symptoms or disease progression should be communicated with the patient’s physician or the cardiac rehab medical director (Keteyian, Squires, Ades, & Thomas, 2014, p. 224).
References:
Keteyian, S. J., Squires, R. W., Ades, P. A., & Thomas, R. J. (2014). Incorporating patients with chronic heart failure into outpatient cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation & Prevention, 34, 223-232. http://dx.doi.org/10.1097/HCR.0000000000000073
O’Connor, C. M., Whellan, D. J., Lee, K. L., Keteyian, S. J., Cooper, L. S., Ellis, S. J., ... Pina, I. L. (2009, April 8). Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA: The Journal of the American Medical Association, 301 (14). http://dx.doi.org/10.1001/Jama.2009.454
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, Jr., D. E., Drazner, M. H., ... Wikoff, B. L. (2013). 2013 ACCF/AHA Guideline for the management of heart failure: executive summary [Practice Guideline]. Circulation. http://dx.doi.org/10.1161/CIR.0b013e31829e8807