[Drug therapy and adjuvant therapy in heart failure. Exercise training--more effective than digitalis?]

Physical training is known to have a favorable effect on the extracardiac causes of intolerance of exertion associated with cardiac insufficiency. Randomized studies have shown an improvement in the oxidative capacity of the skeletal muscles, to an attenuation of chronic inflammation, correction of endothelial dysfunction, and to normalization of the frequently pathological ventilation under effort. The result is an increase in the maximum oxygen uptake--depending on the study--of between 15% and 29% (average 2 ml/kg min). An old worry that physical training might lead to a worsening of hemodynamics was not confirmed. As a result of the positive effect of training on the neurohumoral system and the peripheral endothelial function the resistance of peripheral vessels was lowered and the burden on the left ventricle reduced. The results of initial long-term observational studies also reveal a reduction in mortality.