JOE FRANCO
PERSONAL TRAINER
Monday March 8,1999 6:28 PM ET
NEW YORK, Mar 08 (Reuters Health) -- Moderate amounts of regular exercise can help patients with congestive heart failure, leading to a better quality of life and perhaps even a reduced risk of dying, according to researchers.
``Moderate physical activity should be prescribed along with appropriate drug therapy for patients with congestive heart failure who are stable,'' concludes study lead author Dr. Romualdo Belardinelli of the G.M. Lancisi Institute Cardiac Rehabilitation Laboratory in Ancona, Italy. The findings are published in the March 9th issue of Circulation: Journal of the American Heart Association.
Congestive heart failure (CHF) is defined as a decline in the heart's ability to pump blood efficiently. CHF can lead to fatigue and shortness of breath, and may also raise risks for heart attack.
In a related American Heart Association statement, study co-author Dr. Demetrios Georgiou of Columbia University in New York City explained that ``although physical activity has been an important component of rehabilitation for many heart attack survivors, it was not recommended for those with CHF.''
Traditionally, patients with heart failure were advised to rest. ``However, recent studies in the last decade, including one of our own, have suggested that moderate exercise, rather than bed rest, may be the better medicine,'' Georgiou said.
In their latest study, the investigators assigned 99 CHF patients to a year of either no exercise or regular moderate exercise. Exercise sessions were conducted twice weekly and consisted of stretching followed by 40 minutes on an exercycle.
Based on their findings, the authors conclude that ''long-term moderate exercise training improves functional capacity'' and quality of life for patients with stable CHF. They report that patients who exercised had a 63% lower mortality rate and a 71% lower risk for hospital readmission for heart failure compared with sedentary patients. Patients placed on exercise programs also reported significant increases in quality of life during therapy when compared with non-exercisers, who reported no such improvement.
All of these benefits ``were observed immediately after 2 months of physical activity and were maintained at 1 year,'' the investigators add.
They stress, however, that exercise still cannot be recommended for patients with unstable, difficult-to-treat CHF. Experts remain concerned that the cardiovascular stress of strenuous physical activity could trigger heart attack or other cardiac events in this group of high-risk patients.
And Georgiou says patients with stable disease should always consult with their doctor before embarking on any exercise regimen. ``During the first four to eight weeks,'' he explained, ``patients must be monitored to make sure there are no problems.''
The American Heart Association notes that CHF ``is the only form of heart disease that is increasing in the population.''
SOURCE: Circulation: Journal of the American Heart Association 1999;99.
NEW YORK, Apr 02,1999 (Reuters Health) -- A supervised program of regular exercise improves fitness and helps to relieve depression and anxiety in patients recovering from a heart attack, report UK researchers.
Heart attack patients who participated in a supervised aerobic exercise program for a year showed improved cardiovascular health, enjoyed a better quality of life, and returned to their jobs sooner than patients who did not exercise regularly, the research team writes in the journal Heart.
Investigators at the Action Heart, Cardiac Rehabilitation Centre in Dudley, West Midlands, UK, observed 124 patients over a 5-year period. The patients, all of whom had had a heart attack between 1984 and 1988, were given stress tests after their heart attacks and divided into two groups: those who had a good prognosis for recovery and those with a poor prognosis.
Half the patients in each group began a year-long rehabilitation program that included regular walking, cycling, and muscular endurance exercises three times a week. The other half did not participate in any formal rehabilitation exercise program, and were used as ``controls'' to determine the effect of exercise in those with a good prognosis as well as those with a poor outlook.
Immediately after the initial exercise stress test, there were no significant differences between patients with a good or poor prognosis and the controls.
However, between the fourth month and the end of the first year, there were ``statistically significant differences in cardiorespiratory fitness within both the good and poor prognosis exercise groups compared with their matched controls,'' write the study authors, led by Dr. L.D. Dugmore.
``The improvement in cardiorespiratory fitness in the poor prognosis patients with regular exercise is particularly encouraging, illustrating the effectiveness of low/moderate intensity aerobic training in higher risk groups,'' Dugmore and colleagues add.
The group that exercised also suffered from less depression, tension, and anxiety. And almost twice as many of the exercisers had returned to work full-time, and earlier than the patients who did not exercise.
Finally, the researchers found that almost three times as many of the non-exercisers had another heart attack compared with the regular exercisers. The non-exercisers also visited their doctors more often, and required more drugs.
``Returning to active employment should improve the patient's own self-confidence and positively influence the cost-effectiveness/benefit of providing cardiac rehabilitation services,'' the investigators write.
Dugmore's team concludes that the study results ``clearly identify benefits for patients undertaking comprehensive exercise rehabilitation.'' They recommend early exercise testing to help determine ``the safest and most effective forms of treatment for their ischaemic heart disease.'' SOURCE: Heart 1999;81:359-366.