Show
Under a Creative Commons license Open access AbstractThe present review highlights current research on the importance of PA and fitness for patients with heart failure and recommendations with respect to heart failure phenotypes and special populations. Furthermore, the evidence for various exercise types and intensities/doses as an “exercise prescription”, are discussed. The strong association between heart failure and traditional risk factors, physical inactivity and low fitness, underlines the importance of regular PA and exercise for prevention and treatment of heart failure. This is illustrated by cardiac stiffness which typically accelerates in middle-life and could be reversed by aerobic exercise. In patients with HFpEF, regular PA counteracts many of the changes observed, both metabolic and functional. Indeed, exercise-based cardiac rehabilitation has received a class 1A recommendation in current guidelines [1], in order to improve functional capacity, quality of life and lower the risk of rehospitalization. An individually tailored plan based on risk stratification, clinical assessment and cardiopulmonary exercise testing is encouraged before initiation of exercise training in patients with heart failure. In general, a combination of aerobic exercise and resistance training protocols is recommended (Table 1) [2], preferably throughout life. More studies are needed, regarding the role of PA and exercise in specific populations, such as frail patients with heart failure. KeywordsHeart failure Prevention Risk factors Physical activity Cited by (0)© 2021 The Authors. Published by Elsevier B.V. Original Editor - Nadja Thöner Top Contributors - Nadja Thöner, Laura Ritchie, Wendy Walker, Kim Jackson, Lucinda hampton, Admin, Vidya Acharya, Uchechukwu Chukwuemeka, Tarina van der Stockt, Evan Thomas, Michelle Lee, Adam Vallely Farrell, Rucha Gadgil and Lauren Lopez Introduction[edit | edit source]Physical activity has a proportionally inverse effect on the CDV morbidity and mortality
Cardiovascular Disease[edit | edit source]The cardiovascular system consists of the heart and blood vessels. There is a wide array of problems that may arise within the cardiovascular system eg. endocarditis, rheumatic heart disease, abnormalities in the conduction system. Cardiovascular disease (CVD) or heart disease refer to the following 4 entities:
Early recognition of risk factors and primary prevention have significantly decreased the morbidity and mortality associated with CAD. Lifestyle modification with diet, exercise, and smoking cessation is crucial to reduce cardiovascular risk factors. Physical activity is very beneficial for CAD risk reduction. Even a little is better than nothing.
Physical Activity Effects on Cardiovascular Diseases[edit | edit source]The World Health Organization (WHO) states that substantial health benefits, for CVD risk reduction, can be achieved by moderate-intensity PA of at least 150 minutes a week, or vigorous-intensity PA of at least 75 minutes a week, or any combination of moderate and vigorous-intensity PA. It is also emphasises that any amount of PA leads to health benefits.[4]
PA Effect on Hypertension/Blood Pressure[edit | edit source]
Exercise in Coronary Artery Disease[edit | edit source]The evidence for the benefit of exercise in Coronary Artery Disease (CAD) is compelling, exercise is indicated in the primary and secondary prevention of CAD. The benefits of exercise are greater than the results of PCI (Percutaneous Coronary Intervention) techniques. A recent randomised controlled trial studying the feasibility, acceptance, and short-term clinical effectiveness of the Physical Activity Toward Health (PATHway) system for maintaining PA and physical fitness of patients with cardiovascular diseases (CVD) after completion of an ambulatory center-based CR program showed positive outcomes with their internet-based remote home-based cardiac rehabilitation program[13]. A study of men with stable CAD[14], over a two year period, regular exercise intervention outperformed PCI on all measures:
PA in Secondary Prevention of MI[edit | edit source]Guidelines on secondary prevention for patients following a myocardial infarct recommend[15]:
Although early mobilization using a cycle ergometer didn't increase physical activity as compared to standard physiotherapy sessions, a randomized controlled trial found Cycle Ergometer Use in the post-operative period following cardiac surgery to be a safe choice for patient rehabilitation[16][16][16] Exercise in Chronic Heart Failure[edit | edit source]The benefits of physical exercise in patients with Chronic Heart Failure (CHF) is established as well: exercise training in stable patients with mild to moderate CHF results in statistically significant improvements in maximum heart rate, maximum cardiac output, peak VO2, anaerobic threshold, 6 minute walk test and HRQL (quality of life questionnaire). The results of a cross-sectional study suggest that a single self-report activity question may identify inactive patients with high specificity, as determined by an accelerometer, thus implying that a single SR item might be useful in screening for physically inactive patients with Heart Failure[17]. Symptoms of Cardiovascular Events[edit | edit source]The classic symptoms of a cardiovascular event include;
Women may not experience the classic symptoms above. Instead, they are more likely to experience the following;
The American Heart Association designed a Healthy Heart Quiz: Are you able to recognise a Heart Attack? They have also produced a useful graphic on this topic. Prodromal Symptoms Increased long-term variability in systolic blood pressure was associated with a higher risk for cardiovascular events, mortality and disease.[20] LowExBP independently predicts fatal and non-fatal cardiovascular events and all-cause mortality.[21] Exercise Prescription[22][edit | edit source]The American College of Sports Medicine (ACSM) published guidelines which were based on their traditional exercise guidelines but adapted for the physiological differences in patients with CAD compared to healthy individuals. Patients with CAD should perform everyday physical activity as well as supervised exercise lessons. [23]
Frequency
Duration
Intensity Cardiovascular exercise in supervised programs should be of moderate intensity. Intensity can be determined using various methods;
Progression
Monitoring
Contraindications for Exercises[edit | edit source]Patients should exercise at a sub-symptom threshold to avoid provoking myocardial ischaemia, significant arrhythmias or symptoms of exercise intolerance. Patients at higher risk should exercise at lower levels of intensity. Absolute contraindications to exercise;[24]
Special Considerations[edit | edit source]Antihypertensive medication can influence exercise and should be considered by the therapist when prescribing exercise. [25]
Risk of Exercises[edit | edit source]Risk of Exercise for patients with coronary heart disease: acute myocardial infarction, cardiac arrest, and sudden death. A recent systematic review and meta-analysis of the cardiovascular health of field-based athletes suggests an elevated risk for CVD in some athletes, primarily football players[26]. Incidence in supervised cardiac rehabilitation programs are:
Over 80% of persons who reported cardiac arrest symptoms while exercising have been successfully resuscitated with prompt defibrillation [27]. Exercises and Medications[edit | edit source]Exercise response to cardiac medications [edit | edit source]Physical inactivity is an established risk factor for cardiovascular diseases.
Resources[edit | edit source]
References[edit | edit source]
What is the main relationship between physical activity and exercise?Physical activity refers to any movement produced by skeletal muscle which uses energy whereas physical fitness is measurable state such as strength or endurance. Exercise is planned physical activity with the goal of improving physical fitness and health.
Is there a relationship between physical fitness and exercise?Exercise is a subset of physical activity that is planned, structured, and repetitive and has as a final or an intermediate objective the improvement or maintenance of physical fitness. Physical fitness is a set of attributes that are either health- or skill-related.
What is the difference between cardiovascular fitness and physical fitness?Cardiovascular fitness is a health-related component of physical fitness that is brought about by sustained physical activity. A person's ability to deliver oxygen to the working muscles is affected by many physiological parameters, including heart rate, stroke volume, cardiac output, and maximal oxygen consumption.
What are the physical activities in cardiovascular fitness?Activities like walking, jogging, running, cycling, swimming, aerobics, rowing, stair climbing, hiking, cross country skiing and many types of dancing are “pure” aerobic activities. Sports such as soccer, basketball, squash and tennis may also improve your cardiovascular fitness.
|