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.