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Recovery of cardiac autonomic responsiveness with low‐intensity physical training in patients with chronic heart failure
Author(s) -
Malfatto Gabriella,
Branzi Giovanna,
Riva Beatrice,
Sala Luca,
Leonetti Gastone,
Facchini Mario
Publication year - 2002
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/s1388-9842(01)00221-5
Subject(s) - medicine , heart failure , supine position , cardiology , pure autonomic failure , rehabilitation , ejection fraction , heart rate variability , heart rate , physical therapy , blood pressure , orthostatic vital signs
Background: A gradual worsening of autonomic control of cardiovascular function accompanies the progression of heart failure. Exercise training modulates autonomic balance, and may affect the prognosis of the disease. Aims: The sympathovagal balance was studied after 3 months of low‐intensity rehabilitation compared with conventional therapy in 45 patients with heart failure (52% ischemic, 48% idiopathic), of whom 30 underwent rehabilitation and 15 did not. In 11 rehabilitated patients we also studied the effects on autonomic profile of 6 additional months of home‐based training. Rehabilitated and non‐rehabilitated patients had similar NYHA class, ejection fraction, exercise pVO 2 ; 50% assumed carvedilol (39±5 mg/day). Methods and results: Autoregressive power spectral density of RR intervals variability were assessed during 10 min of: (1) supine rest and free breathing; (2) supine rest and breathing at 20 acts/min (‐ vagal stimulus); (3) standing (‐ sympathetic stimulus). During each period, the ratio LF/HF of the individual autospectrum indicated the sympathovagal balance. After 3 months of rehabilitation, pVO 2 increased (20%); LF/HF at rest was unchanged (8.7±1.2 vs. 9.2±1.2); it decreased with controlled breathing (−18%) and increased during standing (+79%) ( P <0.05). These changes were more evident after 6 months of home‐based training, when pVO2 was still high: LF/HF at rest was reduced (5.4±0.9 vs. 8.5±2.1), decreased during controlled breathing (−17%) and increased during standing (87%) ( P < 0.05). No changes in any variable were seen in non‐rehabilitated patients. Conclusions: A low intensity rehabilitation program restores autonomic tone and reactivity to vagal and sympathetic stimuli. Some of these effects are already evident after the initial hospital‐based phase.