Kernaussagen
Innerhalb der letzten 15 Jahre hat sich körperliches Ausdauertraining von einer
kontrovers diskutierten symptomatisch orientierten Begleitbehandlung zu einer
etablierten leitlinienorientierten adjuvanten Therapiestrategie entwickelt, die
auf die Belastungstoleranz, CHI-Progression und wahrscheinlich auch die CHI-Mortalität
dokumentierte positive Effekte hat.
Wichtigste Wirkungsmechanismen von Ausdauertraining bei CHI sind:
-
Verbesserung der Endothelfunktion mit Abnahme des peripheren Widerstandes,
-
Verbesserung der kardialen Funktion durch die damit verbundene Nachlastsenkung,
-
Reduktion von oxidativem Stress und lokaler Inflammation im Skelettmuskel,
-
Verbesserung des oxidativen Skelettmuskelmetabolismus,
-
Umkehr der krankheitsbedingten Muskelatrophie und des Muskelkatabolismus.
Literatur
- 1
Coats A JS, Adamopoulos S, Meyer T E, Conway J, Sleight P.
Effects of physical training in chronic heart failure.
Lancet.
1990;
335
63-66
- 2
Franciosa J A, Park M, Levine T B.
Lack of correlation between exercise capacity and indexes of resting left ventricular
performance in heart failure.
Am J Cardiol.
1981;
47
33-39
- 3
Cohn J N, Levine T B, Francis G S, Goldsmith S.
Neurohumoral control mechanisms in congestive heart failure.
Am Heart J.
1981;
102 (3 Pt 2)
509-514
- 4
Levine B, Kalman J, Mayer L, Fillit H M, Packer M.
Elevated circulating levels of tumor necrosis factor in severe chronic heart
failure.
N Engl J Med.
1990;
323
236-241
- 5
Coats A JS.
The muscle hypothesis of chronic heart failure.
J Mol Cell Cardiol.
1996;
28
2255-2262
- 6
Jonsdottir S, Andersen K K, Sigurdsson A F, Sigurdsson S B.
The effect of physical training in chronic heart failure.
Eur J Heart Fail.
2006;
8
97-101
- 7
Jette M, Heller R, Landry F, Blümchen G.
Randomized 4-week exercise program in patients with impaired left ventricular
function.
Circulation.
1991;
84
1561-1567
- 8
Coats A JS, Adamopoulos S, Radaelli A. et al .
Controlled trial of physical training in chronic heart failure: Exercise performance,
hemodynamics, ventilation, and autonomic function.
Circulation.
1992;
85
2119-2131
- 9
Belardinelli R, Georgiou D, Cianci G, Berman N, Ginzton L, Purcaro A.
Exercise training improves left ventricular diastolic fillining in patients
with dilated cardiomyopathy.
Circulation.
1995;
91
2775-2784
- 10
Hambrecht R, Niebauer J, Fiehn E. et al .
Physical training in patients with stable chronic heart failure: Effects on
cardiorespiratory fitness and ultrastructural abnormalities of leg muscle.
J Am Coll Cardiol.
1995;
25
1239-1249
- 11
Kiilavuori K, Toivonen L, Näveri H, Leinonen H.
Reversal of autonomic derangements by physical training in chronic heart failure
assessed by heart rate variability.
Eur Heart J.
1995;
16
490-495
- 12
Kiilavuori K, Sovijärvi A, Näveri H, Ikonen T, Leinonen H.
Effect of physical training on exercise capacity and gas exchange in patients
with chronic heart failure.
Chest.
1996;
110
985-991
- 13
Keteyian S J, Levine A B, Brawner C A. et al .
Exercise training in patients with heart failure.
Ann Intern Med.
1996;
124
1051-1057
- 14
Meyer K, Schwaibold M, Westbrook S. et al .
Effects of exercise training and activity restriction on 6-minute walking test
performance in patients with chronic heart failure.
Am Heart J.
1997;
133
447-453
- 15
Dubach P, Myers J, Dzienkan G. et al .
Effect of high intensity exercise training on central hemodynamic response to
exercise in men with reduced left ventricular function.
J Am Coll Cardiol.
1997;
29
1591-1598
- 16
Belardinelli R, Georgiou D, Cianci G, Purcaro A.
Randomized, controlled trial of long-term moderate exercise training in chronic
heart failure.
Circulation.
1999;
99
1173-1182
- 17
Hambrecht R, Gielen S, Linke A. et al .
Effects of exercise training on left ventricular function and peripheral resistance
in patients with chronic heart failure. A randomised trial.
JAMA.
2000;
283
3095-3101
- 18
Dubach P, Myers J, Dziekan G. et al .
Effect of exercise training on myocardial remodeling in patients with reduced
left ventricular function after myocardial infarcation.
Circulation.
1997;
95
2060-2067
- 19
Giannuzzi P, Temporelli P, Corrà U, Gattone M, Giordano P, Tavazzi L.
Attenuation of unfavorable remodeling by exercise training in postinfarction
patients with left ventricular dysfunction. Results of the Exercise in Left
Ventricular Dysfunction (ELVD) Trial.
Circulation.
1997;
96
1790-1797
- 20
Lipkin D P, Jones D A, Round J M, Poole-Wilson P A.
Abnormalities of skeletal muscle in patients with chronic heart failure.
Int J Cardiol.
1988;
18
187-195
- 21
Lipkin D P, Canepa-Anson R, Stephens M R, Poole-Wilson P A.
Factors determining symptoms in heart failure: comparison of fast and slow exercise
tests.
Br Heart J.
1986;
55
439-445
- 22
McParland C, Krishnan B, Wang Y, Gallagher G C.
Respiratory muscle weakness and dyspnea in chronic heart failure.
Am Rev Respir Dis.
1992;
146
467-472
- 23
Mancini D M, Henson D, LaMacna J, Levine S.
Respiratory muscle function and dyspnea in patients with chronic congestice
heart failure.
Circulation.
1992;
86
909-918
- 24
Hammond M D, Bauer K A, Sharp J T, Rocha R D.
Respiratory muscle strength in congestive heart failure.
Chest.
1990;
98
1091-1094
- 25
Mortara A, Bernardi L, Pinna G D. et al .
Alterations of breathing in chronic heart failure: clinical relevance of arterial
oxygen saturation instability.
Clin Sci (Lond).
1996;
91 (Suppl. 72-4)
72-74
- 26
Mortara A, Sleight P, Pinna G D. et al .
Abnormal awake respiratory patterns are common in chronic heart failure and
may prevent evaluation of autonomic tone by measures of heart rate variability.
Circulation.
1997;
96
246-252
- 27
Mortara A, Sleight P, Pinna G D. et al .
Association between hemodynamic impairment and Cheyne-Stokes respiration and
periodic breathing in chronic stable congestive heart failure secondary to ischemic
or idiopathic dilated cardiomyopathy.
Am J Cardiol.
1999;
84
900-904
- 28
Davey P, Meyer T, Coats A. et al .
Ventilation in chronic heart failure: effects of physical training.
Br Heart J.
1992;
68
473-477
- 29
Bernardi L, Spadacini G, Bellwon J, Hajric R, Roskamm H, Frey A W.
Effect of breathing rate on oxygen saturation and exercise performance in chronic
heart failure.
Lancet.
1998;
351
1308-1311
- 30
Hambrecht R, Fiehn E, Yu J. et al .
Effects of endurance training on mitochondrial ultrastructure and fiber type
distribution in skeletal muscle of patients with stable chronic heart failure.
J Am Coll Cardiol.
1997;
29
1067-1073
- 31
Adamopoulos S, Coats A JS, Brunotte F. et al .
Physical training improves skeletal muscle metabolism in patients with chronic
heart failure.
J Am Coll Cardiol.
1993;
21
1101-1106
- 32
Anker S D, Ponikowski P, Varney S. et al .
Wasting as independent risk factor for mortality in chronic heart failure.
Lancet.
1997;
349
1050-1053
- 33
Gielen S, Adams V, Möbius-Winkler S. et al .
Anti-inflammatory effects of exercise training in the skeletal muscle of patients
with chronic heart failure.
J Am Coll Cardiol.
2003;
42
861-868
- 34
Gielen S, Adams V, Linke A. et al .
Exercise training in chronic heart failure:correlation between reduced local
inflammation and improved oxidative capacity in the skeletal muscle.
Eur J Cardiovasc Prev Rehabil.
2005;
12
393-400
- 35
Linke A, Adams V, Schulze P C. et al .
Antioxidative Effects of Exercise Training in Patients With Chronic Heart Failure.
Increase in Radical Scavenger Enzyme Activity in Skeletal Muscle.
Circulation.
2005;
111
1763-1770
- 36
Adams V, Jiang H, Yu J. et al .
Apoptosis in skeletal myocytes of patients with chronic heart failure is associated
with exercise intolerance.
J Am Coll Cardiol.
1999;
33
959-965
- 37
Hambrecht R, Schulze P C, Linke A. et al .
Effects of exercise training on local expression of Insulin-like growth factor-1
in the skeletal muscle of patients with chronic heart failure.
Circulation.
2000;
102; 18 (Suppl. II)
413
- 38
Kubo S H, Rector T S, Williams R E, Heifritz S M, Bank A J.
Endothelium dependent vasodilitation is attenuated in patients with heart failure.
Circulation.
1994;
84
1589-1596
- 39
Hambrecht R, Fiehn E, Weigl C. et al .
Regular physical exercise corrects endothelial dysfunction and improves exercise
capacity in patients with chronic heart failure.
Circulation.
1998;
98
2709-2715
- 40
Sessa W C, Pritchard K, Seyedi N, Wang J, Hintze T H.
Chronic exercise in dogs increases coronary vascular nitric oxide production
and endothelial cell nitric oxide synthase gene expression.
Circ Res.
1994;
74
349-353
- 41
Hambrecht R, Adams V, Erbs S. et al .
Regular physical activity improves endothelial function in patients with coronary
artery disease by increasing phosphorylation of endothelial nitric oxide synthase.
Circulation.
2003;
107
3152-3158
- 42
Fukai T, Siefried M R, Fukai M, Cheng Y, Kojda G, Harrison D G.
Regulation of the vascular extracellular superoxide dismutase by nitric oxide
and exercise training.
J Clin Invest.
2000;
105
1631-1639
- 43
Braith R, Welsch M, Feigenbaum M, Kluess H A, Pepine C.
Neuroendocrine activation in heart failure is modified by endurance training.
J Am Coll Cardiol.
1999;
34
1170-1175
- 44 Eckberg D L, Sleight P.
Congestive heart failure. In: Eckberg DL, Sleight P (eds) Human baroreflexes in health and disease. Oxford,
UK; Clarendon 1992: 399-436
- 45
Wang W, Chen J S, Zucker I H.
Carotid sinus baroreceptor sensitivity in experimental heart failure.
Circulation.
1990;
81
1959-1966
- 46
Convertino V A, Adams W C.
Enhanced vagal baroreflex response during 24 h after acute exercise.
Am J Physiol.
1991;
260
R570-R575
- 47
Pietila M, Malminiemi K, Vesalainen R. et al .
Exercise training in chronic heart failure: beneficial effects on cardiac (11)C-hydroxyephedrine
PET, autonomic nervous control, and ventricular repolarization.
J Nucl Med.
2002;
43
773-779
- 48
Meyer K, Samek L, Schwaibold M. et al .
Physical response to different modes of interval exercise in patients with chronic
heart failure - application to exercise training.
Eur Heart J.
1996;
17
1040-1047
- 49 Gibbons R J, Balady G J, Bricker J T. et al .ACC/AHA 2002 guideline update for
exercise testing:A report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines (Committee on Exercise Testing). American
College of Cardiology, Web Site 2002
- 50
Vanhees L, Kornaat M, Defoor J. et al .
Effect of exercise training in patients with an implantable cardioverter defibrillator.
Eur Heart J.
2004;
25
1120-1126
- 51
Piepoli M, Flather M, Coats A JS.
Overview of studies of exercise training in chronic heart failure: the need
for a prospective randomized multicentre European trial.
Eur Heart J.
1998;
19
830-841
- 52
Demopoulos L, Bijou R, Fergus I, Jones M, Strom J, LeJemtel T H.
Exercise training in patients with severe congestive heart failure: Enhancing
peak aerobic capacity while minimizing the increase in ventricular wall stress.
JACC.
1997;
29
597-603
- 53
Belardinelli R, Georgiou D, Scocco V, Barstow T, Purcaro A.
Low intensity exercise training in patients with chronic heart failure.
J Am Coll Cardiol.
1995;
26
975-982
- 54
Elkayam U, Roth A, Weber L. et al .
Isometric exercise in patients with chronic advanced heart failure: hemodynamic
and and neurohumoral evaluation.
Circulation.
1985;
72
975-981
- 55
Reddy H K, Weber K T, Janicki J S, McElroy P A.
Hemodynamic, ventilatory and metabolic effects of light isometric exercise in
patients with chronic heart failure.
J Am Coll Cardiol.
1988;
12
353-358
- 56
Keren G, Katz S, Gage J, Strom J, Sonnenblick E H, LeJemtel T H.
Effect of isometric exercise on cardiac performance and mitral regurgitation
in patients with severe congestive heart failure.
Am Heart J.
1989;
118
973-979
- 57
McKelvie R S, McCartney N, Tomlinson C W, Bauer R, MacDougall J D.
Comparison of hemodynamic responses to cycling and resistance exercise in congestive
heart failure secondary to ischemic cardiomyopathy.
Am J Cardiol.
1995;
76
977-979
- 58
Meyer K, Hajric R, Westbrook S. et al .
Hemodynamic response during leg press exercise in patients with chronic heart
failure.
Am J Cardiol.
1999;
83
1537-1543
- 59
Karlsdottir A E, Foster C, Porcari J P, Palmer-McLean K, White-Kube R, Backes R C.
Hemodynamic responses during aerobic and resistance exercise.
J Cardiopulm Rehabil.
2002;
22
170-177
- 60
Pu C T, Johnson M T, Forman D E. et al .
Randomized trial of progressive resistance training to counteract the myopathy
of chronic heart failure.
J Appl Physiol.
2001;
90
2341-2350
- 61
Maiorana A, O'Driscoll G, Cheetham C. et al .
Combined aerobic and resistance exercise training improves functional capacity
and strength in CHF.
J Appl Physiol.
2000;
88
1565-1570
- 62
Adamopoulos S, Parissis J, Kroupis C. et al .
Physical training reduces peripheral markers of inflammation in patients with
chronic heart failure.
Eur Heart J.
2001;
22
791-797
- 63
Conraads V M, Beckers P, Bosmans J. et al .
Combined endurance/resistance training reduces plasma TNF-alpha receptor levels
in patients with chronic heart failure and coronary artery disease.
Eur Heart J.
2002;
23
1854-1860
- 64
McKoy G, Ashley W, Mander J. et al .
Expression of insulin growth factor-1 splice variants and structural genes in
rabbit skeletal muscle induced by stretch and stimulation.
Journal of Physiology.
1999;
516.2
583-592
- 65
Mancini D M, Eisen H, Kussmaul W, Mull R, Edmunds Jr L H , Wilson J R.
Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation
in ambulatory patients with heart failure.
Circulation.
1991;
83
778-786
- 66
Piepoli M F, Davos C, Francis D P, Coats A J.
Exercise training meta-analysis of trials in patients with chronic heart failure
(ExTraMATCH).
BMJ.
2004;
328
189
PD Dr. med. Stephan Gielen
Universität Leipzig - Herzzentrum
Klinik für Innere Medizin/Kardiologie
Strümpellstr. 39
04289 Leipzig
eMail: stephan.gielen@medizin.uni-leipzig.de
