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Referências sobre treinamento de força para hipertensos e cardiopatas


Resistance exercise training in patients with heart failure.

Volaklis KA, Tokmakidis SP.

Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece.

The utility, safety and physiological adaptations of resistance exercise training in patients with chronic heart failure (CHF) are reviewed and recommendations based on current research are presented. Patients with CHF have a poor clinical status and impaired exercise capacity due to both cardiac limitations and peripheral maladaptations of the skeletal musculature. Because muscle atrophy has been demonstrated to be a hallmark of CHF, the main principle of exercise programmes in such patients is to train the peripheral muscles effectively without producing great cardiovascular stress. For this reason, new modes of training as well as new training methods have been applied. Dynamic resistance training, based on the principles of interval training, has recently been established as a safe and effective mode of exercise in patients with CHF. Patients perform dynamic strength exercises slowly, on specific machines at an intensity usually in the range of 50-60% of one repetition maximum; work phases are of short duration (< or =60 seconds) and should be followed by an adequate recovery period (work/recovery ratio >1 : 2). Patients with a low cardiac reserve can use small free weights (0.5, 1 or 3 kg), elastic bands with 8-10 repetitions, or they can perform resistance exercises in a segmental fashion. Based on recent scientific evidence, the application of specific resistance exercise programmes is safe and induces significant histochemical, metabolic and functional adaptations in skeletal muscles, contributing to the treatment of muscle weakness and specific myopathy occurring in the majority of CHF patients. Increased exercise tolerance and peak oxygen consumption (V-dotO(2peak)), changes in muscle composition, increases in muscle mass, alterations in skeletal muscle metabolism, improvement in muscular strength and endurance have also been reported in the literature after resistance exercise alone or in combination with aerobic exercise. According to new scientific evidence, appropriate dynamic resistance exercise should be recommended as a safe and effective alternative training mode (supplementary to conventional aerobic exercise) in order to counteract peripheral maladaptation and improve muscle strength, which is necessary for recreational and daily living activities, and thus quality of life, of patients with stable, CHF.

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PMID: 16336010 [PubMed - indexed for MEDLINE]

 
2: Clin Invest Med. 2006 Jun;29(3):166-9.
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Resistance exercise in chronic heart failure--landmark studies and implications for practice.

Meyer K.

Swiss Health Observatory and University of Bern, Switzerland. meyer.katharina@bluewin.ch

In patients with chronic congestive heart failure (CHF), there is a need for complementary strength training to maintain and/or increase muscle mass and strength. The challenge is how to stress peripheral muscles intensively without creating cardiovascular overload. Since the late 1990s, an increasing number of research and clinical experiments have been conducted on resistance exercise in CHF. As a result, data are now available for both acute responses during resistance exercise as well as muscular and cardiovascular adaptation to resistance training programs, based on different training methods. Study results demonstrated that dynamic resistance exercise is well tolerated in chronic stable CHF when: 1) initial contraction intensity is low, 2) small muscle groups are involved, 3) work phases are kept short, 4) a small number of repetitions per set is performed, and 5) work/rest ratio is > or = 1:2. With tolerance, contraction intensity can be increased. With resistance training programs lasting 12 weeks, maximal strength could be improved by 15 to 50%. Improvements in maximum exercise time and peak VO2 were between 10 and 18%, in relation to baseline values. In terms of these results, no differences were reported between combined resistance/ aerobic training and resistance training alone. Thus, resistance exercise can be assumed as safe as aerobic exercise in clinically stable CHF.

PMID: 17058436 [PubMed - indexed for MEDLINE]
 
3: Heart Fail Rev. 2008 Feb;13(1):69-79.
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Resistance exercise: training adaptations and developing a safe exercise prescription.

Braith RW, Beck DT.

Center for Exercise Science, College of Health and Human Performance and the College of Medicine, University of Florida, P.O. Box 118206, Gainesville, FL 32611, USA. rbraith@hhp.ufl.edu

The safety and efficacy of resistance exercise training (RT) in patients with chronic heart failure (CHF) are critically reviewed. Evidence-based recommendations for designing safe RT programs are also presented to help clinicians and rehabilitation professionals formulate exercise prescriptions for their patients. To the extent possible, the separate and independent effects of RT on patients with CHF are discussed. Clinical prognosis (i.e. risk stratification) and exercise capacity in patients with CHF are determined by the mitigating effects of both central hemodynamics and peripheral pathophysiology. Despite the well-described skeletal muscle wasting and myopathy in heart failure, aerobic exercise remains by far the most prescribed training modality in patients with CHF. This article presents evidence that improvement of skeletal muscle phenotype (muscle mass, fiber morphology, and histochemistry) should be a fundamental goal of rehabilitation in patients with CHF. Moreover, RT may be the preferred exercise modality when targeting the periphery for muscle phenotype adaptation.

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PMID: 17932746 [PubMed - indexed for MEDLINE]

 
4: Med Sci Sports Exerc. 2001 Apr;33(4):525-31.
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Exercise training in heart failure: recommendations based on current research.

Meyer K.

Swiss Cardiovascular Center Bern, University Clinic, Bern, Switzerland. katharina.meyer@insel.ch

A review of methods used for exercise training in stable chronic heart failure patients (CHF) shows a lack of standardization to guide prescription. Previous recommendations have been adopted from fitness training or rehabilitation studies. A model for use in CHF patients requires specific guidelines which respect the various manifestations of this illness. Pathology and exercise tolerance of patients with CHF allow only a few selected activities to be performed, such as walking and cycle ergometer training. Although the steady state method has usually been applied for aerobic exercise, the interval method has been shown to cause greater exercise stimuli to peripheral muscle than that obtained during steady state training methods without inducing greater cardiovascular stress. There is no consensus at present as to an optimal parameter for measuring intensity. An intensity of 40-80% peak oxygen consumption (VO(2)) has been applied successfully. A heart rate reserve of 60-80% or 75% of peak heart rate was used as a guide to exercise intensity without consideration of the impaired force-frequency relationship in myocardial performance. Because intensity, duration, and frequency of exercise are closely interrelated, initial exercise should be kept at 40-50% peak VO(2) with exercise duration of > 3-5 min x session performed several times daily. Progression should be followed in this order: duration, then frequency, then intensity. Resistance training can be recommended when small muscle groups are involved, using short bouts of work phases and small numbers of repetitions. To increase respiratory muscle strength and endurance, resistive inspiratory muscle training at intensity 25--35% maximum inspiratory pressure, and performed 20-30 min x d(-1), is recommended. On the basis of currently available research, supervised inpatient training programs should be preferred. Future research should be performed with respect on statistically sufficient, randomized, and controlled long-term studies that compare different training modes, intensities, frequency/duration ratios, and rates of progression.

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PMID: 11283426 [PubMed - indexed for MEDLINE]

 
5: J Cardiopulm Rehabil. 2003 Jan-Feb;23(1):10-6.
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Exercise training for heart failure patients improves respiratory muscle endurance, exercise tolerance, breathlessness, and quality of life.

McConnell TR, Mandak JS, Sykes JS, Fesniak H, Dasgupta H.

Department of Cardiology, Geisinger Medical Center, Danville, PA 17822-2160, USA. tmcconnell@geisinger.edu

PURPOSE: Increased respiratory muscle endurance and peak oxygen consumption (VO(2peak)) induced by respiratory muscle training support the relationship between respiratory muscle function and exercise capacity in patients with heart failure. This raises the question whether exercise-training results in increased respiratory muscle function contributing to an increased exercise tolerance, a decreased perception of breathlessness, and an improved quality of life. METHODS: Prospective cohort analysis was completed on 24 patients with New York Heart Association (NYHA) Class III heart failure [18 men, 6 women; aged = 64 (SD 7.9) years; percent ejection fraction (%EF) = 24.0 (SD 7.8)]. Maximal sustainable ventilatory capacity (MSVC), submaximal and peak exercise responses, perception of breathlessness, and quality of life were measured before (baseline) and after (end of study) 12 weeks of exercise training. RESULTS: As a result of exercise training, VO(2peak) (P=.01) and MSVC (P<.001) increased, with MSVC contributing to a larger proportion of the variability for VO(2peak) at study completion (r=0.57 vs 0.42). Although stroke volume did not increase beyond exercise at 25 W and did not change with exercise training, ventilation decreased during exercise (P<.05), perception of breathing difficulty (P<.05) was reduced, and quality of life was enhanced (P=.008). CONCLUSIONS: Despite no increase in cardiac output and stroke volume, respiratory muscle endurance improved with exercise training, contributing to increased exercise capacity, decreased breathlessness, and decreased perception of breathlessness. Practical implications can include less frequent rest periods and fatigue, greater confidence, maintenance of independence, and enhanced quality of life.

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PMID: 12576906 [PubMed - indexed for MEDLINE]

 
6: J Appl Physiol. 2001 Jun;90(6):2341-50.
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Randomized trial of progressive resistance training to counteract the myopathy of chronic heart failure.

Pu CT, Johnson MT, Forman DE, Hausdorff JM, Roubenoff R, Foldvari M, Fielding RA, Singh MA.

Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer United States Department of Agriculture, Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA.

Chronic heart failure (CHF) is characterized by a skeletal muscle myopathy not optimally addressed by current treatment paradigms or aerobic exercise. Sixteen older women with CHF were compared with 80 age-matched peers without CHF and randomized to progressive resistance training or control stretching exercises for 10 wk. Women with CHF had significantly lower muscle strength (P < 0.0001) but comparable aerobic capacity to women without CHF. Exercise training was well tolerated and resulted in no changes in resting cardiac indexes in CHF patients. Strength improved by an average of 43.4 +/- 8.8% in resistance trainers vs. -1.7 +/- 2.8% in controls (P = 0.001), muscle endurance by 299 +/- 66% vs. 1 +/- 3% (P = 0.001), and 6-min walk distance by 49 +/- 14 m (13%) vs. -3 +/- 19 m (-3%) (P = 0.03). Increases in type I fiber area (9.5 +/- 16%) and citrate synthase activity (35 +/- 21%) in skeletal muscle were independently predictive of improved 6-min walk distance (r2 = 0.78; P = 0.0024). High-intensity progressive resistance training improves impaired skeletal muscle characteristics and overall exercise performance in older women with CHF. These gains are largely explained by skeletal muscle and not resting cardiac adaptations.

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PMID: 11356801 [PubMed - indexed for MEDLINE]

 
7: Eur J Cardiovasc Prev Rehabil. 2004 Aug;11(4):352-61.
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Recommendations for resistance exercise in cardiac rehabilitation. Recommendations of the German Federation for Cardiovascular Prevention and Rehabilitation.

Bjarnason-Wehrens B, Mayer-Berger W, Meister ER, Baum K, Hambrecht R, Gielen S; German Federation for Cardiovascular Prevention and Rehabilitation.

Institute for Cardiology and Sports Medicine, German Sport University, Cologne; Klinik Roderbirken, Leichlingen, Germany. bjarnason@dshs-koeln.de

Aerobic endurance training has been an integral component of the international recommendations for cardiac rehabilitation for more than 30 years. Notwithstanding, only in recent years have recommendations for a dynamic resistance-training program been cautiously put forward. The perceived increased risk of cardiovascular complications related to blood pressure elevations are the primary concern with resistance training in cardiac patients; recent studies however have demonstrated that this need not be a contraindication in all cardiac patients. While blood pressure certainly may rise excessively during resistance training, the actual rise depends on a variety of controllable factors including magnitude of the isometric component, the load intensity, the amount of muscle mass involved as well as the number of repetitions and/or the load duration. Intra-arterial blood pressure measurements in cardiac patients have demonstrated that that during low-intensity resistance training [40-60% maximum voluntary contraction (MVC)] with 15-20 repetitions, only modest elevations in blood pressure are revealed, similar to those seen during moderate endurance training. When properly implemented by an experienced exercise therapist, in specific patient groups an individually tailored, medically supervised dynamic resistance training program carries no inherent higher risk for the patient than aerobic endurance training. As an adjunct to endurance training, in selected patients, resistance training can increase muscle strength and endurance, as well as positively influence cardiovascular risk factors, metabolism, cardiovascular function, psychosocial well-being and quality of life. According to present data, resistance training is however not recommended for all patient groups. The appropriate training method and correct performance are highly dependent on each patient's clinical status, cardiac stress tolerance and possible comorbidities. Most studies have used middle-aged men of average normal aerobic performance capacity and with good left-ventricular (LV) function. Data are lacking for high-risk groups, women and older patients. With the current knowledge it is reasonable to include resistance training without any restraints as part of cardiac rehabilitation programs for coronary artery disease (CAD) patients with good cardiac performance capacity (i.e., revascularised and with good myocardial function). As patients with myocardial ischaemia and/or poor left ventricular function may develop wall motion disturbances and/or severe ventricular arrhythmias during resistance exercise, the following criteria are suggested for resistance training: moderate-to-good LV function, good cardiac performance capacity [>5-6 metabolic equivalents of oxygen consumption (METS)=1.4 watt/kg body weight], no symptoms of angina pectoris or ST segment depression under continued maintenance of the medical therapy. Based on available data, this article presents recommendations for risk stratification in cardiac rehabilitation programs with respect to the implementation of dynamic resistance training. Additional recommendations for specific patient groups and detailed directions showing how to structure and implement such therapy programs are presented as well.

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PMID: 15292771 [PubMed - indexed for MEDLINE]

 
8: J Card Fail. 2004 Feb;10(1):21-30.
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Moderate-intensity resistance exercise training in patients with chronic heart failure improves strength, endurance, heart rate variability, and forearm blood flow.

Selig SE, Carey MF, Menzies DG, Patterson J, Geerling RH, Williams AD, Bamroongsuk V, Toia D, Krum H, Hare DL.

Centre for Rehabilitation, Exercise and Sport Science, School of Human Movement, Recreation & Performance, Victoria University, PO Box 14428, Melbourne MC 8001, Australia.

BACKGROUND: Resistance exercise training was applied to patients with chronic heart failure (CHF) on the basis that it may partly reverse deficiencies in skeletal muscle strength and endurance, aerobic power (VO(2peak)), heart rate variability (HRV), and forearm blood flow (FBF) that are all putative factors in the syndrome. METHODS AND RESULTS: Thirty-nine CHF patients (New York Heart Association Functional Class=2.3+/-0.5; left ventricular ejection fraction 28%+/-7%; age 65+/-11 years; 33:6 male:female) underwent 2 identical series of tests, 1 week apart, for strength and endurance of the knee and elbow extensors and flexors, VO(2peak), HRV, FBF at rest, and FBF activated by forearm exercise or limb ischemia. Patients were then randomized to 3 months of resistance training (EX, n=19), consisting of mainly isokinetic (hydraulic) ergometry, interspersed with rest intervals, or continuance with usual care (CON, n=20), after which they underwent repeat endpoint testing. Combining all 4 movement patterns, strength increased for EX by 21+/-30% (mean+/-SD, P<.01) after training, whereas endurance improved 21+/-21% (P<.01). Corresponding data for CON remained almost unchanged (strength P<.005, endurance P<.003 EX versus CON). VO(2peak) improved in EX by 11+/-15% (P<.01), whereas it decreased by 10+/-18% (P<.05) in CON (P<.001 EX versus CON). The ratio of low-frequency to high-frequency spectral power fell after resistance training in EX by 44+/-53% (P<.01), but was unchanged in CON (P<.05 EX versus CON). FBF increased at rest by 20+/-32% (P<.01), and when stimulated by submaximal exercise (24+/-32%, P<.01) or limb ischemia (26+/-45%, P<.01) in EX, but not in CON (P<.01 EX versus CON). CONCLUSIONS: Moderate-intensity resistance exercise training in CHF patients produced favorable changes to skeletal muscle strength and endurance, VO(2peak), FBF, and HRV.

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PMID: 14966771 [PubMed - indexed for MEDLINE]

 
9: Int J Cardiol. 2005 Jul 20;102(3):493-9. Epub 2004 Sep 23.
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Resistance training for chronic heart failure patients on beta blocker medications.

Levinger I, Bronks R, Cody DV, Linton I, Davie A.

Southern Cross University, NSW, Australia. ilevin10@scu.edu.au

BACKGROUND: Resistance training increases the skeletal muscle strength and functional ability of chronic heart failure patients. However, there is limited data regarding the effect of resistance training on the hemodynamic responses and peak oxygen consumption (peak VO(2)) of chronic heart failure patients treated with beta-blocker. This study examined the effect of resistance training on hemodynamics, peak aerobic capacity, muscle strength and quality of life of chronic heart failure patients on beta-blockers medication. METHODS: Fifteen men diagnosed with chronic heart failure were matched to either a resistance training program or non-training control group. At baseline and after 8 weeks of resistance training patients performed both Balke incremental and maximal strength tests and completed quality of life questionnaires. RESULTS: The resistance training group demonstrated a significant increase of walking time and peak VO(2) by 11.7% (p=0.002) and approximately 19% (p<0.05), respectively. Peak VO(2) was significantly correlated with both walking time (r=0.54, p=0.038) and change in total weight lifted (r=0.55, p=0.034). Quality of life significantly increased by 87% (p=0.030). The improvement in quality of life was correlated with post training peak VO(2) (r=0.58, p=0.025) and total weight lifted during the post maximal strength test (r=-0.52, p=0.047). CONCLUSIONS: The benefits from resistance training for chronic heart failure patients on beta-blocker medication included an increased aerobic and exercise capacity, skeletal muscle strength and most importantly, an improvement in the quality of life, which is the main goal of cardiac rehabilitation programs. Furthermore, with appropriate supervision, it is recommended that resistance exercise be added to the exercise rehabilitation program of these patients when possible.

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PMID: 16004896 [PubMed - indexed for MEDLINE]

 
10: Int J Cardiol. 2002 Apr;83(1):25-32.
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Effect of exercise training on skeletal muscle fibre characteristics in men with chronic heart failure. Correlation between skeletal muscle alterations, cytokines and exercise capacity.

Larsen AI, Lindal S, Aukrust P, Toft I, Aarsland T, Dickstein K.

Cardiology Division, Central Hospital in Rogaland, P.O. Box 8100, N4001 Stavanger, Norway. al-i-lar@online.no

BACKGROUND: In patients with congestive heart failure (CHF) there is a shift from aerobic type I muscle fibres to less aerobic type II fibres. Exercise training has been shown to have beneficial effects on exercise performance, peripheral pathology and the neurohumoral profile in stable patients with CHF. This study evaluated the effect of a 3 month exercise training program on skeletal muscle characteristics and the correlation of these to cytokines and exercise capacity in CHF patients. METHODS: Skeletal muscle biopsies for enzyme-histochemical analysis were performed in 15 CHF patients in New York Heart Association classes II-III, with a mean ejection fraction of 33+/-5% before and after a 12 week training period. The patients were trained for 30 min, five times a week at 80% of the peak heart rate achieved at baseline ergometer cycle test. Fifteen healthy men were used as controls. Plasma samples were examined by enzyme immunoassays for levels of pro-inflammatory cytokines. RESULTS: (a) At baseline we found muscle atrophy in five of the patients. The percent area of type I fibres (40.7+/-12.0 vs. 56.4+/-11.0%, P<0.05) and the thickness of type IIA (56.10+/-7.8 vs. 71.6+/-11.9 microm, P<0.001) and B-fibres (49.0+/-8.9 vs. 63.9+/-10.6 microm, P<0.001) were reduced, whereas the percent area of type IIA fibres (52.1+/-13.3 vs. 36.4+/-9.9%, P<0.05) was increased in heart failure patients compared to healthy controls. There was a modest correlation between fibre thickness and the level of interleukin 6 (r=-0.657, P=0.008). (b) After exercise training there was a reduction in muscle area examined by light-microscopy, measured as a percentage of field (-2.7, P=0.003) with an concomitant increase in interstitium. This reduction correlated to the increase in the 6-min walk test (r=-0.558, P=0.031). The thickness of type IIB fibres increased (+5.6 microm, P=0.068) and the area of type I fibres decreased (-6.1%, P=0.062). CONCLUSIONS: Patients with CHF have a relatively increased area of type IIA fibres and a relatively decreased area of type I fibres compared to healthy individuals. The thickness of type IIA and type IIB fibres is decreased compared to normal individuals. A modest negative correlation between the level of interleukin 6 and fibre thickness at baseline, suggests that inflammatory cytokines may be involved in the pathogenesis of the CHF related myopathy. A significant correlation between the reduction of muscle area, with increased interstitum, and the increase in the 6-min walk test may indicate that the improvement is due to increased capillary density permitting better flow reserve to exercising muscles.

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PMID: 11959380 [PubMed - indexed for MEDLINE]

 
11: Eur J Heart Fail. 2006 Jan;8(1):97-101. Epub 2005 Sep 27.
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The effect of physical training in chronic heart failure.

Jónsdóttir S, Andersen KK, Sigurosson AF, Sigurosson SB.

Landspitali-University Hospital, Department of Physical Therapy, Reykjavik, Iceland. solval@simnet.is

BACKGROUND: Supervised cardiac rehabilitation programs have been offered to patients following myocardial infarct (MI), coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) for many years. However, limited information is available on the usefulness of rehabilitation programs in chronic heart failure (CHF). The aim of our study was to evaluate the outcome of supervised physical training on CHF patients by measuring both central and peripheral factors. METHODS: This was a prospective randomized study, including 43 patients with CHF, New York Heart Association (NYHA) class II or III, mean age 68 years. After initial measurements of VO2 peak, 6 min walk distance, muscle strength, plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), echocardiogram, measurements of pulmonary function and quality of life questionnaire, patients were randomized to either a training group (n = 21) or a control group (n = 22). The training group had supervised aerobic and resistance training program twice a week for five months. After the training program was completed, all measurements were repeated in both groups. RESULTS: No training related adverse events were reported. Significant improvement was found between groups in the six minute walk test (+37.1 m vs. +5.3 m, p = 0.01), work load on the bicycle exercise test (+6.1 W vs. +2.1 W, p = 0.03), time on the bicycle exercise test (+41 s vs. +0 s, p = 0.02) and quadriceps muscle strength test (+2.8 kg. vs. +0.2 kg., p = 0.003). Quality of life factors that reflect exercise tolerance and general health, improved significantly in the training group compared to the control group. No other significant changes were found between the two groups. CONCLUSION: Supervised physical training as used in this study appears safe for CHF patients in NYHA class II or III. The improvement in functional capacity observed in the training group seems to be related to peripheral factors rather than in central cardiovascular performance.

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PMID: 16194620 [PubMed - indexed for MEDLINE]

 
12: Clin Physiol Funct Imaging. 2007 Jul;27(4):225-30.
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Enhancement of isokinetic muscle strength with a combined training programme in chronic heart failure.

Degache F, Garet M, Calmels P, Costes F, Bathélémy JC, Roche F.

Service de Physiologie Clinique et de l'Exercice - Groupe PPEH, CHU Nord, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, France.

BACKGROUND: Patients with congestive heart failure (CHF) exhibit an impaired exercised tolerance that dramatically limits their functional capacity and alters their quality of life. DESIGN: The aim of this study was to compare the effects of two types of training programmes on isokinetic muscle strength and aerobic capacities in patients with CHF. METHODS: A group of 23 stable CHF patients included consecutively followed an exercise training programme, 3 days a week for 8 weeks. The first group (P1, n=11) exercised on a cycloergometer for 45 min at 65% of peak VO2. The second group (P2, n=12) followed a 45-min combined bicycle and quadricipital strength training. Strength training consisted of 10 series of 10 repetitions at 70% of maximal voluntary force. Incremental maximal cardiopulmonary exercise tests as well as an isokinetic quadricipital dynamometry evaluation were performed before and after training. RESULTS AND CONCLUSIONS: In P1, peak VO2 increased by 20% (22.3+/-4.9 versus 17.8+/-4.5 ml min(-1) kg(-1); P<0.05) without any significant change in isokinetic muscle strength. In P2, peak VO2 improved within the same range (20.5+/-2.8 versus 18.6+/-3.7 ml min(-1) kg(-1); P<0.01). This last rehabilitation programme significantly increased isokinetic muscle strength at each angular velocities (+10.5+/-13.5%, P<0.04; +5.6+/-7.0%, P<0.03; for 180 degrees s(-1) and 60 degrees s(-1) respectively). Only the combined endurance/strength training programme was associated with an improvement in both peak VO2 and peripheral muscle strength, two significant parameters of outcome and quality of life in CHF.

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PMID: 17564671 [PubMed - indexed for MEDLINE]

 
13: Eur Heart J. 1996 Jul;17(7):1048-55.
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High intensity knee extensor training, in patients with chronic heart failure. Major skeletal muscle improvement.

Magnusson G, Gordon A, Kaijser L, Sylvén C, Isberg B, Karpakka J, Saltin B.

Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.

Skeletal muscle adaptations to high intensity knee extensor strength and/or endurance training in patients with chronic heart failure were investigated. Eleven patients with chronic heart failure were randomized into two groups and exercised the m. quadriceps femoris 3 days/week for 8 weeks. After training, the maximal exercise intensity tolerated on the ergometer cycle was raised from 99 (32) to 114 (40) watts (W, P < 0.05) for all 11 patients. Peak dynamic knee extensor work rate showed the greatest increase after endurance training (40%, P < 0.01). Maximal dynamic and isometric strength were elevated by 40-45% (P < 0.05) after strength training. The cross-sectional area of m. quadriceps femoris was increased in the strength-trained legs (9%, P < 0.05), and the capillary per fibre ratio of m. vastus lateralis was raised by 47 and 58% in the endurance-trained legs (P < 0.05). The oxidative enzyme activity in m. vastus lateralis was significantly raised above 50% after endurance training, whereas glycolytic enzyme activity was unaltered. The peripheral skeletal musculature in patients with chronic heart failure adapts fairly quickly to high intensity knee extensor training. This results in a marked rise in local, and a small rise in total work capacity, indicating maintained plasticity of skeletal muscle in chronic heart failure patients.

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PMID: 8809523 [PubMed - indexed for MEDLINE]