Exercise Capacity in Chronic Heart Failure

Abstract

of the primary prevention of cardiovascular (CV) disease. However, more emphasis needs to be placed on physicians identifying those at risk of HF who require intensified primary prevention practices and advanced therapies to prevent progression. In addition, this would need to include an assessment of exercise capacity, with each patient given a specific exercise prescription. 7 This could range from a conversation during an office visit to more advanced screening for high-risk individuals, with the selection of an exercise test to further assess functional capacity and the need for therapy. Physicians also need to be aware of the patient’s current level of conditioning, factors that predict safety in exercising, and proven methods to increase exercise adherence among patients. In the evaluation of HF, clinical assessment of dyspnea, fatigue, and exertional symptoms have been used for diagnosis and staging. 2 Exercise capacity has also been used to determine prognosis because it can be quantified objectively with a six-minute walk test, treadmill or cycle stress test, and cardiopulmonary exercise testing (CPET). 8–13 The limiting component in exercise capacity for those with HF is impaired Abstract Heart failure (HF) affects more than 5 million people and has an increasing incidence and cost burden. Patients note symptoms of dyspnea and fatigue that result in a decreased quality of life, which has not drastically improved over the past decades despite advances in therapies. The assessment of exercise capacity can provide information regarding patient diagnosis and prognosis, while doubling as a potential future therapy. Clinically, there is acceptance that exercise is safe in HF and can have a positive impact on morbidity and quality of life, although evidence for improvement in mortality is still lacking. Specific prescriptions for exercise training have not been developed because many variables and confounding factors have prevented research trials from demonstrating an ideal regimen. Physicians are becoming more aware of the indices and goals for HF patients in exercise testing and therapy to provide comprehensive cardiac care. It is further postulated that a combination of exercise training and pharmacologic therapy may eventually provide the most benefits to those suffering from HF.