Chronic Heart Failure & Exercise Rehabilitation

Morgan Walker, B.S., ACSM EP-C

Patients with chronic heart failure (CHF) suffer from a condition in which the heart is unable to pump sufficient blood to accommodate metabolic requirements of organs and tissues.1 CHF can result from systolic dysfunction of the left ventricle (LV) which decreases ejection fraction (volume of blood per minute pumped into circulation by the LV) or diastolic LV dysfunction that increases resistance to filling the LV1.  There is high risk when exercising this type of client, but in the correct circumstances, it preserves quality of life. Proper education on the condition and its FITT principle is paramount in a safe and effective program for the CHF sufferer.  

Patients with CHF present two key signs and symptoms1:

1. Exercise intolerance- manifested by fatigue and dyspnea (shortness of breath)
2. Fluid retention- evidenced by peripheral edema and/or acute weight gain

Each of these present their own issues when paired with exercise.  It is extremely important for the exercise physiologist to discern between what is normal, and what is dangerous and be able to stop exercise before exacerbation of the condition.

Once the risk-reward ratio for the patient has been considered to indicate exercise, cardiorespiratory endurance training is the obvious first strategy for managing CHF.1 Range of motion and resistance training for those with stable CHF can also be incorporated at a safe progression once exercise tolerance is improved. See table below for the CHF FITT principle.

Adapted Table from p 2711

Exercise	Frequency	Intensity	Time	Type
Aerobic	4-5 sessions/wk	11-14 on RPE scale 60-75% HRR	40+ min, using interval training as needed	Treadmill, leg ergometer, arm ergometer
Resistance	1-2 session/wk	11-14 on RPE scale	1x12-15 reps per muscle group	Fixed machines, bands, dumbbells
Range of motion	Pre and post session	Static stretching, safe intensity for client	5-10 total minutes pre and post session, 10-30 second intervals devoted to large muscle groups and joints	Facilitated, passive

RPE: rate of perceived exertion, HRR: heart rate reserve

Despite a safe exercise program, CHF is a condition that must be predominately managed with prescription drugs. Ensuring that the client has taken all doses as prescribed before, during and after exercise is one of the obligations of the exercise physiologist. If the client is not compliant with medications, it could be life threatening; exercise should cease immediately and the proper intervention should be sought. Constant monitoring of vitals and condition signs and symptoms are important for the health of these clients. Electrocardiogram may be helpful in routine supervision of the condition.  

References

1Ehrman J., Gordon P., Visich P. & Keteyian S. Clinical Exercise Physiology-3rd edition. 2013.