Exercise in heart failure

Shah, Parin

Abstract

Introduction
In ambulatory patients with chronic stable heart failure, the cardinal symptom of exercise intolerance is not fully resolved despite optimal medical treatment. Identifying other treatments to improve exercise intolerance may improve quality of life.
Methods
I investigated 2 treatments that may improve exercise intolerance in patients with heart failure. First, I conducted a review of oxygen supplementation in cardiovascular disease and then investigated the exercise capacity of 46 patients (mean age 75 years, 63% male and median N-terminal pro-B type natriuretic peptide 1432 (interquartile range: 543-2378 ng/l)) with heart failure and normal ejection fraction (HeFNEF), using different oxygen supplementation (21%, 28% and 40%). Second, I conducted a literature review on the acute effects of water immersion (WI) and swimming in patients with heart failure and reduced ejection fraction (HeFREF) and then investigated the haemodynamic and echocardiographic changes during warm WI in 17 patients with HeFREF (NYHA I and II; mean age 67 years, 88% male and mean left ventricular ejection fraction 33%) and 10 normal subjects.
Results
In patients with HeFREF, high doses of oxygen have negative haemodynamics effects however low doses may improve exercise tolerance. In patients with HeFNEF, increasing oxygen supplementation during exertion leads to a small increase in exercise time. In patients with HeFREF, although exercise in water appears to be safe, the studies conducted have been small, very heterogeneous and inconclusive. In patients with HeFREF, warm WI causes an acute increase in cardiac output and a fall in systemic vascular resistance.
Conclusion
Warm WI is well tolerated; however, whether swimming can be recommended as alternative to other forms of exercise or rehabilitation in patients with HeFREF needs further studies. In patients with HeFNEF, a disproportionate increase in left atrial pressure on exercise contributes to symptoms. However extra-cardiac mechanisms may also contribute to impaired exercise tolerance. Studies should also focus on treatment of co morbidities.

Citation

Shah, P. Exercise in heart failure. (Thesis). Hull York Medical School, the University of Hull and the University of York. https://hull-repository.worktribe.com/output/4222393

• Thesis Type: Thesis
• Deposit Date: Jun 10, 2020
• Publicly Available Date: Feb 23, 2023
• Keywords: Medicine
• Public URL: https://hull-repository.worktribe.com/output/4222393
• Additional Information: Hull York Medical School, The University of Hull and the University of York
• Award Date: Nov 1, 2018