The role of exercise therapy in patients with impaired ventricular function and chronic heart failure

Physical training as a part of a comprehensive cardiac care program is accepted as an effective therapeutic modality. The physiological and psychological benefits of such a program have definitely been demonstrated in selected patients with coronary artery disease, but there is still some doubt about the influence of exercise therapy on morbidity and mortality. Recently, exercise training has also been instituted as part of the therapeutic regimen of groups of coronary patients who have impaired cardiac function or who suffer from chronic heart failure. If patients have been selected properly, taking into account absolute and relative contraindications, no deteriorating effect as a consequence of training has been observed in a follow-up period of 14 months. In some selected patients, an increased ejection fraction was found during the training. The results of our preliminary studies are reported and discussed, as is a special training method based on arm ergometry and applied to patients with impaired ventricular function. Clinicians are often concerned with the quality of life of their patients who have chronic cardiac conditions. In our experience, exercise therapy has beneficial effects on various psychological factors and determinants of the "quality of survival" in these patients. It still remains to be demonstrated whether a prolonged and effective exercise therapy can preserve or maintain patterns of an adaptive mechanism to exercise in patients with left ventricular dysfunction or chronic heart failure, or both.