© 2002 European Society of Cardiology
Recovery of cardiac autonomic responsiveness with low-intensity physical training in patients with chronic heart failure
a Divisione di Cardiologia, Istituto Scientifico Ospedale San Luca, Istituto Auxologico Italiano IRCCS via Spagnoletto, 3-20147 Milan, Italy
b Università degli Studi di Milano Milan, Italy
* Corresponding author. Tel.: +39-02-582161; fax: +39-02-5821-6712. E-mail address: malfi{at}auxologico.it
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Abstract |
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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 pVO2; 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, pVO2 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.
Key Words: Heart failure • Cardiac rehabilitation • Autonomic nervous system • Power spectrum
Received March 14, 2001; Revised June 21, 2001; Accepted September 7, 2001
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