News Release

Physical Activity Recommended For "Stable" Congestive Heart Failure

Peer-Reviewed Publication

American Heart Association

DALLAS, March 9 -- Moderate physical activity -- not bed rest -- may be the best medicine for individuals who suffer from "stable" congestive heart failure, according to a new study in today's Circulation: Journal of the American Heart Association.

The study conducted by researchers in Italy and the United States found that individuals with congestive heart failure (CHF) who participated in a 14-month exercise program lived longer and required fewer hospitalizations after about four years of follow-up than those with the disease who did not exercise.

Lead author of the study, Romualdo Belardinelli, M.D., director of the G.M. Lancisi Institute Cardiac Rehabilitation Laboratory in Ancona, Italy, says, "Moderate physical activity should be prescribed along with appropriate drug therapy for patients with congestive heart failure who are stable." Stable patients include those without rapid heartbeats, called malignant ventricular arrhythmias, in addition to those without fluid in the lungs and without recent heart attacks (less than three months).

The hearts of individuals with CHF no longer pump blood efficiently throughout the body. People with CHF typically have difficulty breathing, particularly during exercise, due to fluid accumulation in the lungs and in other tissues. CHF is the only form of heart disease that is increasing in the population.

According to co-investigator Demetrios Georgiou, M.D., assistant clinical professor of medicine at Columbia University College of Physicians and Surgeons, New York, "Although physical activity has been an important component of rehabilitation for many heart attack survivors, it was not recommended for those with CHF. However, recent studies in the last decade, including one of our own, have suggested that moderate exercise, rather than bed rest, may be the better medicine."

In the study, 99 patients were divided into two groups. Fifty patients exercised three times a week for the first eight weeks and then twice a week during a 14-month program. The 49 patients in the "control" group did not engage in an exercise training program. Both groups were monitored for an average of 40 months after the 14-month training.

The individuals who exercised had fewer hospital readmissions for heart failure and a lower risk of cardiac death (heart failure, heart attack and malignant arrhythmias). Five of the patients in the exercise group were hospitalized for CHF during the study period, compared with 14 in the control group. Nine of the patients in the exercise group died of CHF during the study period, compared with 20 in the control group who died, researchers report. Six patients had sudden cardiac death; five were in the control group and one was in the exercise group.

Exercising patients reported they had a higher quality of life, as reflected by higher scores on a questionnaire, than the control group.

Those in the exercise group also had higher scores than the control group in two other tests. One test, called the thallium stress test, measures the circulation of blood within the heart muscle and the other shows an increase in exercise capacity.

"Exercise reduces the adverse effects of catecholamines, adrenaline-like substances that can worsen heart failure," suggests Georgiou. "Exercise also improves the circulation of blood to the heart muscle as well as the function of skeletal muscles, which is impaired in individuals with heart failure."

Despite these encouraging results, Georgiou says that even stable patients must contact their physicians before exercising. "During the first four to eight weeks, patients must be monitored to make sure there are no problems. We do not recommend the program for unstable patients."

In an accompanying editorial that calls the report "heartening," Andrew J. S. Coats, M.D., Viscouni Royston professor of clinical cardiology at the Imperial College School of Medicine at Royal Brumpton Hospital, London, says the study substantially adds to the growing body of evidence that CHF patients benefit from moderate physical activity. "The excellent work of Belardinelli and colleagues gives us an incentive to put exercise rehabilitation for heart failure to the test."

Co-authors are Giovanni Cianci, M.D., and Augusto Purcaro, M.D., both at the G.M. Lancisi Institute's Cardiac Rehabilitation Laboratory.

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Media advisory: Dr. Georgiou can be reached by phone at 212-475-8066. (Please do not publish number.)



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