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R E S E A R C H  R E P O R T S

Moderate Exercise May Be Best for
Congestive Heart Failure

Lead P&S Researcher: Demetrios Georgiou

Moderate exercise, rather than traditional bedrest, may be the best therapy for patients with congestive heart failure (CHF), according to the results of the first long-term study to show a sustained improvement in both functional capacity and quality of life for these patients. The study, co-authored by Dr. Demetrios Georgiou, assistant clinical professor of medicine, appeared in the March 1999 issue of Circulation.

The results demonstrate that patients with CHF who were enrolled in a 14-month exercise program not only lived longer and had a lower cardiac mortality rate, but also had fewer hospital readmissions than did the control group after 40 months of follow-up.

Ninety-nine patients with stable CHF (88 men, 11 women) were randomized into an exercise and a non-exercise group. Stable disease was defined as patients without malignant ventricular arrhythmias, no fluid in the lungs, and no heart attack within three months of entering the study. Fifty patients exercised three times a week for two months on a stationary bicycle, then twice weekly for 12 months. Each exercise session consisted of a 20-minute warm-up of stretching exercise followed by 40 minutes of cycling, under the supervision of a cardiologist.

Almost three times as many patients in the control group were rehospitalized for CHF during the study compared with the exercise group (14 vs. five patients). While 20 patients in the control group died of their condition, only nine in the exercise group did. In addition, six patients in the control group experienced sudden cardiac death compared to one in the exercise group. Patients in the exercise group also reported a higher quality of life.

Laboratory analysis reiterated the benefits of exercise training, as patients in the exercise group scored higher than those in the control group. Results in the thallium stress tests, which measure blood circulation within the heart muscle, and the oxygen uptake tests, which measure exercise capacity, improved with exercise training. Moreover, levels of catecholamines, adrenaline-like substances that can cause heart failure to worsen, decreased in patients who exercised.

"These results clearly indicate that moderate exercise training improves functional capacity and that this benefit translates into a favorable outcome for patients with stable CHF," notes Dr. Georgiou. "In the past, physical activity has not been recommended for CHF patients, even though it has been shown to be beneficial for patients with other cardiovascular disease, such as heart attacks. Now, based on the results of our long-term study, as well as other recent studies, exercise training may well be the best medicine for patients with stable CHF."

While the results of the study are encouraging, Dr. Georgiou cautions that even stable CHF patients should contact their physicians before starting an exercise program. Cardiac monitoring is essential for the initial four to eight weeks.

Dr. Georgiou collaborated on the research with scientists from the Istituto Cardiologico Ancona, Italy.

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