Heart Failure Phenotype Associated With Physical Inactivity And Low Fitness: Heart Failure With Preserved Ejection Fraction Vs Heart Failure With Reduced Ejection Fraction
Brinker et al.19 examined a subset of patients at the Cooper Center who underwent fitness testing for screening purposes and received echocardiographic testing. They observed that lower fitness was associated with a higher prevalence of diastolic dysfunction and abnormal left ventricle remodelling, which represent important intermediate phenotypes in the natural history of heart failure with preserved ejection fraction . These data suggested that low fitness associated risk of HF is more likely to be in HFpEF than in HFrEF. Accordingly, a recent work20 in 2017 from an individuallevel pooled analysis of three large cohort studies confirmed a strong and dosedependent association of physical activity with HFpEF but not with HFrEF. Adequately designed randomized prevention trials are needed to further evaluate these evidences.
Association Between Changes In Physical Activity And Heart Failure Risk
Pandey et al.,14 evaluating Cooper Center Longitudinal Study and Centers for Medicare & Medicaid Services data, demonstrated that individuals who increased their fitness levels had a lower rate of HF hospitalization. Furthermore, longitudinal changes in cardiorespiratory fitness, but not body mass index, were found to be associated with HF risk.13 Moreover, in young adults evaluated in the CARDIA Study,17 the decline in cardiorespiratory fitness over followup was a significant predictor of subclinical systolic dysfunction and elevated diastolic filling pressure in middle age independent of baseline cardiorespiratory fitness levels. These data were confirmed in HFpEF: low cardiorespiratory fitness could be not only considered as an early stage marker but also a target for prevention, owing to the impact of exercise training on risk factor profile, on left ventricle structure and function, on myocardial strain pattern, and on vascular stiffness.19 It was calculated that 1 MET improvement in physical activity was associated with 17% reduction of HFpEF risk at a later age21 and that daily dynamic exercise for > 30 min four or five times weekly over the course of a lifetime preserves left ventricle diastolic function.22
The Best Exercises For Heart Failure
Your heart is your bodyâs most important muscle. Like all of the others, it needs exercise. Thatâs true even when you have heart failure.
In most cases, light to moderate exercise isnât going to make your condition worse. In fact, itâs not only safe, itâs the best medicine, says Suzanne Steinbaum, DO, an American Heart Association Go Red for Women volunteer medical expert and cardiologist in New York City.
It slows your heart rate, opens your arteries, and improves the way your heart works, she says. This means less shortness of breath and less time spent in the hospital — and possibly a longer life.
Exercise can help you do the activities you love, Steinbaum adds.
The key is to do it smartly to keep your ticker as strong as it can be. Ask your doctor which activities are safe for you and how much you should do, says Brittany Ferri, MS, OTR/L, an occupational therapist in Rochester, NY.
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What Are Treatment Options
If you take your dog in for treatment there are many different options depending on your pets particular diagnosis. Your dog will get a treatment plan from a veterinary cardiologist.
The most common treatments for congestive heart failure in dogs available are:
- Oxygen therapy
- Symptomatic support and care
- Removal of fluids, from the chest or from the abdomen
With quality care, many dogs do well with medications and treatment. Treatment, however, is about keeping your dog in a good quality of life, not about keeping your emotions intact.
There is no cure for heart disease. As an owner, you have to be aware of your dogs feelings and abilities and be prepared for when it comes time for humane euthanasia if necessary.
Walking Has Numerous Heart Benefits
Walking is one of the best and easiest forms of exercise for people with congestive heart failure . Years ago, healthcare providers advised patients to avoid working out, but that’s no longer the case. A 2018 study showed that regular, moderate-intensity walking can also prevent heart failure in people with heart disease.
Walking has numerous benefits for patients with heart failure, but as with all new exercise programs, you should check with your healthcare provider for guidelines on any precautions you should take.
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With Heart Failure Present: Exercise Improvement With Training Provides Benefits In Heart Failure
Exercise in HF patients was historically proscribed and the concept of reducing physical activity to avoid exerciseinduced symptoms and haemodynamic overload for the diseased ventricle dominated the textbooks.25 Indeed, there was a consensus in the 1970s that patients with all stages of HF should be advised to refrain from physical activity with bed rest prescription.26 In 1988, the comprehensive seminal paper of Sullivan et al.27 about exercise training in 12 HF patients demonstrated for the first time that ambulatory HF patients can significantly improve their exercise tolerance. This study is the cornerstone for three decades of subsequent research, changing deeply the scientific approach to the relationship between exercise and HF. Recently, Doukky et al.28 demonstrated that in patients with symptomatic chronic HF, physical inactivity is associated with nearly twice allcause and cardiac mortality, and even modest exercise was associated with survival benefit. The authors calculated the propensity scores of spending > 4 h/day watching television, showing that increasing sedentary time was associated with a stepwise increase in the risk of allcause death in HF patients.
How Heart Failure Patients Can Safely Exercise
Follow this expert advice to get the physical activity you need to help with heart failure recovery.
Physical activity is important for everyone, even people living with heart failure.
Research, including a review of more than 30 trials published in January 2015 in the journal Open Heart, has shown that heart failure patients who follow an exercise-based cardiac rehabilitation program are less likely to be hospitalized, and report a better quality of life than those who do not.
We know exercise helps chronic heart failure patients, says David Taylor, MD, a cardiologist at the Cleveland Clinic in Ohio. While these studies werent designed to show if the patients actually lived longer, staying out of the hospital is incredibly important, as is improved symptoms.
Most patients will be referred to a cardiac rehab program by their doctors, where their heart rate, ECG, blood pressure, and other physical responses can be monitored while you exercise. This is a great place to start an exercise program, especially for patients with heart problems, says Amy Beitel, a physical therapist in the department of rehabilitation sciences at the Medical University of South Carolina in Charleston.
It also provides extra motivation for patients to work out. If you have a scheduled time and youre sort of forced to go, youre much more likely to go than if you have a bicycle in your basement, Dr. Taylor says
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Best Exercises For Congestive Heart Failure
Heart failure refers to a situation where your heart functions abnormally and fails to pump the required blood necessary for the body. Due to lack of flow of blood and oxygen to several tissues and organs, performing different routine activities become difficult. However, with simple lifestyle changes, it is possible to turn the severe condition of heart failure into a success story.
Exercise In Heart Failure Patient:
Some examples of aerobic exercises are walking, jogging, running, aerobic dancing, cycling, stepping, cross country skiing, swimming, arm cycle ergometry, rowing, chair aerobics, etc. Resistance training can be done with the use of dumbbells, cuff and hand weights, elastic bands, barbells, hand-held blades, Pilates table, punching bags, inflated balls, stability balls, variable resistance exercise machines etc. Please check my article on how to prescribe exercise to know more about different ways to determine resistance.
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Warming Up And Cool Down
It is essential for every person to spend at least a few minutes to do warming up as well as cool down before and after you start/wind up each session of the activity. This helps you to avoid any injury and stress to your heart.
Warming up for 5 minutes allows our body and our heart to adjust with increasing demands of our physical activities. Furthermore, it stretches muscles and tendons for avoiding any cramp. Cooling down on the other side lets our blood pressure, heart rate and other functions performed by our body to return to the normal resting levels and to bring down the adrenaline level in a gradual way.
Congestive Heart Failure: Prevention Treatment And Research
Congestive heart failure is a serious condition in which the heart doesnt pump blood as efficiently as it should. Despite its name, heart failure doesnt mean that the heart has literally failed or is about to stop working. Rather, it means that the heart muscle has become less able to contract over time or has a mechanical problem that limits its ability to fill with blood. As a result, it cant keep up with the bodys demand, and blood returns to the heart faster than it can be pumped outit becomes congested, or backed up. This pumping problem means that not enough oxygen-rich blood can get to the bodys other organs.
The body tries to compensate in different ways. The heart beats faster to take less time for refilling after it contractsbut over the long run, less blood circulates, and the extra effort can cause heart palpitations. The heart also enlarges a bit to make room for the blood. The lungs fill with fluid, causing shortness of breath. The kidneys, when they dont receive enough blood, begin to retain water and sodium, which can lead to kidney failure. With or without treatment, heart failure is often and typically progressive, meaning it gradually gets worse.
More than 5 million people in the United States have congestive heart failure. Its the most common diagnosis in hospitalized patients over age 65. One in nine deaths has heart failure as a contributing cause.
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Benefits Of Exercise Training
In contrast to the former belief, exercise training in HF patients has proven to be safe and has no adverse effect on left ventricular remodelling .
Exercise capacity and quality of life
With regard to benefit on exercise capacity, a meta-analysis of 29 randomised controlled trials including 848 patients revealed a mean improvement of VO2peak of 2.16 ml/kg/min . Although modest in absolute terms, this means an increase of 13% which translates into a considerably better quality of life . VO2peak is a strong and independent prognosticator in HF, and even small changes in VO2peak are associated with significantly improved outcomes . In addition to VO2peak, exercise training has positive effects on health-related quality of life. A meta-analysis of 13 RCT demonstrated that exercise training results in a clinically important improvement in the Minnesota Living with Heart Failure Questionnaire .
Hospitalisations and mortality
The HF-ACTION trial randomised 2,331 patients suffering from HF with reduced ejection fraction either to three months of supervised aerobic exercise training at moderate intensity or to usual care . This study showed in an intention-to-treat analysis that exercise training was associated with an 11% lower adjusted risk for all-cause mortality or all-cause hospitalisation and a 15% lower adjusted risk for cardiovascular mortality or HF hospitalisation.
Alternative Approaches To Exercise In Heart Failure Patients
Tai Chi training
Tai Chi is a form of lowintensity physical activity originating in China, with positive effects on balance control, flexibility, cardiovascular fitness, pain, fatigue, insomnia, and psychological wellbeing Pan et al.65 performed a metaanalysis to evaluate the effects of Tai Chi training on exercise capacity, QoL, and other clinical outcomes in patients with HF including 242 patients enrolled in four randomized clinical trials the metaanalysis results suggest Tai Chi training as a valuable and suggestive tool for improving QoL in patients with HF however, more data are needed to demonstrate improvement of other clinical and exercise parameters.
Muscle electrical stimulation
Exercise training is not recommended in unstable HF patients Groehs et al.66 investigated the effects of muscle functional electrical stimulation on muscle sympathetic nerve activity, muscle blood flow, and exercise tolerance in hospitalized patients for stabilization of HF functional electrical stimulation improves muscle sympathetic nerve activity, vasoconstriction, exercise tolerance, muscle strength, and QoL, suggesting this approach during hospitalization to treat decompensated HF.
The Nintendo Wii platform is the most tested exergame in adults the HFWii study is a randomized study to evaluate the effect of exergaming in patients with HF recruitment was expected to be completed by December 2016, and the study should close at the beginning of 2018.67
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What Will Happen Towards The End
Heart failure usually gets gradually worse over time. It may eventually reach a point where it becomes very severe and it’s unlikely the person will live much longer.
Palliative care will usually begin when heart failure reaches this stage.
This involves treatment to help you feel as comfortable as possible, as well as being offered psychological, spiritual and social support for both you and your family.
You can choose whether you want palliative care and where you’d like it to be provided.
Care can be provided:
When To Terminate The Exercise Session
Exercise is a beneficial treatment tool for CHF but it needs to have the right response. A clinician needs to terminate the exercise session if they see the following signs:
- A decrease in heart rate with an increase in workload
- A decrease in systolic BP of more than 10 mm of Hg with an increase in workload
- Diastolic BP increase more than 20 mm of HG with an increase in workload
- SpO2 measurement is below 80% with supplemental oxygen
- Patient requests to terminate the session
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How Do I Know If I’m Overdoing It
You may need to stop exercising if you have any of these signs:
- Shortness of breath
- Unable to talk or finish a sentence
- Shortness of breath that doesnt get better when you slow down or stop
- Feeling dizzy or lightheaded
- Chest pain, tightness, or pressure
- Pain in your shoulders, arms, neck, or jaw
- Skipped heart beats or uneven heart rate
- Feeling more tired or weak
- Major sweating, upset stomach, or vomiting
If you have any of these symptoms while you are active, slow down. If they do not get better, stop the activity. Call 911 if your chest pain or symptoms do not go away.
Walking 40 Minutes A Day Lowers Heart Failure Risk
A 2018 study showed that walking for at least 40 minutes several times per week at an average to fast pace is associated with a near 25% drop in heart failure risk.
Heart Failure Healthcare Provider Discussion Guide
Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.
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Exercise During Heart Failure: Cooling Down
The best way to cool down is to slowly decrease the intensity of the activity or exercise you are doing. For example, if you are walking, walk slowly for the last few minutes of your exercise session.
Never stop exercising suddenly and just sit, lie down, or stand still, unless you feel you have to. It can make you feel dizzy or lightheaded. End your activity program by doing about 5 minutes of stretching exercises.
Exercise During Heart Failure: Tips and Guidelines
Can You Exercise With Congestive Heart Failure
Heart failure or congestive heart failure indicates the condition of ones heart when it no longer is able to pump the blood properly. Since tissues and cells do not able to receive blood in adequate amount, most of your daily activities become very much difficult. However, even though congestive heart failure is a severe condition, cardiologists recommend patients to participate in various regular physical exercises to manage the condition and at the same time to make the necessary lifestyle changes to lead a healthy life.
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Kinds Of Exercise That Boost Heart Health
Being physically active is a major step toward good heart health. Its oneof your most effective tools for strengthening the heart muscle, keepingyour weight under control and warding off the artery damage from highcholesterol, high blood sugar and high blood pressure that can lead toheart attack or stroke.
Its also true that different types of exercise are needed to provide complete fitness. Aerobic exercise and resistance training are the most important for heart health, says Johns Hopkins exercise physiologist Kerry J. Stewart, Ed.D. Although flexibility doesnt contribute directly to heart health, its nevertheless important because it provides a good foundation for performing aerobic and strength exercises more effectively.
Heres how different types of exercise benefit you.
Can I Continue Working
If you’re well enough, you can keep working for as long as you feel able. With the right support, staying in work can make you feel better and give you financial security.
Talk to your employer as soon as you feel your heart failure is affecting your ability to do your job so you can find a solution that suits both of you. For example, it may be possible for you to work part-time.
The Disability Discrimination Act 1995 requires employers to make reasonable adjustments to working practices or premises to help a person with a disability.
Where possible, this might include changing or modifying tasks, altering work patterns, installing special equipment, allowing time off to attend appointments, or helping with travel to work.
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