PDF herunterladen
Erfahrungsheilkunde 2017; 66(04): 228-233
DOI: 10.1055/s-0043-118168
Praxis
© Karl F. Haug Verlag in MVS Medizinverlage Stuttgart GmbH & Co. KG

Trainingstherapie bei Herzinsuffizienz – Forschungsstand 2017

Klaus Edel
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
05. September 2017 (online)

    Lizenzen und Reprints

Zusammenfassung

Körperliches Training ist in den aktuellen Leitlinien ein fester Bestandteil der Therapie bei stabiler chronischer Herzinsuffizienz (Klasse-IA-Indikation) sowohl bei reduzierter als auch bei erhaltener linksventrikulärer Pumpfunktion. Belastung, Symptomatik und Lebensqualität können durch körperliches Training signifikant verbessert werden. Epidemiologische Daten und verschiedene Studien zeigen, dass ein aktiver Lebensstil im Alter vor der Entwicklung einer Herzinsuffizienz schützt und ein regelmäßiges körperliches Training das Risiko einer Herzinsuffizienz reduziert. Die Wirksamkeit ist sowohl dosis- als auch adhärenzabhängig. Empfohlen wird ein Ausdauertraining in Form eines moderaten, aeroben Trainings („moderate continuous training", MCT), das idealerweise durch ein Krafttraining ergänzt werden sollte.

Abstract

In the current guidelines, physical training is incorporated as an integral part of the therapy of stable chronic cardiac insufficiency (class IA indication) with reduced as well as preserved left ventricular pumping function. Stress, symptoms, and quality of life can be significantly improved by physical training. Epidemiological data as well as different studies show, that in the case of older people, an active lifestyle protects from developing cardiac insufficiency and a regular physical training reduces the risk of cardiac insufficiency. The effectiveness is dose-dependent as well as adherence-dependent. An endurance training in the form of a moderate aerobic training ("moderate continuous training", MCT) is recommended, which should ideally be complemented by a strength training.

Schlüsselwörter

Herzinsuffizienz - Herzerkrankung - Körpertraining - Krafttraining - Ausdauertraining - Prävention - Therapie

Keywords

Cardiac insufficiency - cardiac disease - physical training - strength training - endurance training - prevention - therapy
 

  • Literatur

  • 1 Anderson L. et al. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol 2016; 67 (01) 1-12
    PubMedGoogle Scholar
  • 2 Arbab-Zadeh A. et al. Effect of aging and physical activity on left ventricular compliance. Circulation 2004; 110 (13) 1799-805
    CrossrefPubMedGoogle Scholar
  • 3 Arena R, Myers J, Guazzi M. The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure: an evidence-based review. Heart Fail Rev 2008; 13 (02) 245-69
    CrossrefPubMedGoogle Scholar
  • 4 Baum K, Ruther T, Essfeld D. Reduction of blood pressure response during strength training through intermittent muscle relaxations. Int J Sports Med 2003; 24 (06) 441-5
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 5 Barbour KA, Miller NH. Adherence to exercise training in heart failure: a review. Heart Fail Rev 2008; 13 (01) 81-9
    CrossrefPubMedGoogle Scholar
  • 6 Beckers PJ. et al. Maintaining physical fitness of patients with chronic heart failure: a randomized controlled trial. Eur J Cardiovasc Prev Rehabil 2010; 17 (06) 660-7
    CrossrefPubMedGoogle Scholar
  • 7 Belardinelli R. et al. 10-year exercise training in chronic heart failure: a randomized controlled trial. J Am Coll Cardiol 2012; 60 (16) 1521-8
    CrossrefPubMedGoogle Scholar
  • 8 Brinker SK. et al. Association of cardiorespiratory fitness with left ventricular remodeling and diastolic function: the Cooper Center Longitudinal Study. JACC Heart Fail 2014; 2 (03) 238-46
    CrossrefPubMedGoogle Scholar
  • 9 Destatis-Statistisches Bundesamt. Todesursachen in Deutschland. Fachserie 12, Reihe 4. Wiesbaden: 2013 Im Internet: www.destatis.de/DE/.../Todesursachen/Todesursachen2120400127004 Stand 20.08.2017
    PubMedGoogle Scholar
  • 10 Chen YM, Li Y. Safety and efficacy of exercise training in elderly heart failure patients: a systematic review and meta-analysis. Int J Clin Pract 2013; 67 (11) 1192-8
    CrossrefPubMedGoogle Scholar
  • 11 Conraads VM, Beckers PJ. Exercise training in heart failure: practical guidance. Heart 2010; 96 (24) p. 2025-31
    CrossrefPubMedGoogle Scholar
  • 12 Conraads VM. et al. Adherence of heart failure patients to exercise: barriers and possible solutions: a position statement of the Study Group on Exercise Training in Heart Failure of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2012; 14 (05) 451-8
    CrossrefPubMedGoogle Scholar
  • 13 Dorr M, Halle M. [Exercise training as a key component of heart failure therapy]. Herz 2015; 40 (02) 206-14
    CrossrefPubMedGoogle Scholar
  • 14 Downing J, Balady GJ. The role of exercise training in heart failure. J Am Coll Cardiol 2011; 58 (06) 561-9
    CrossrefPubMedGoogle Scholar
  • 15 Edelmann F. et al. Contribution of comorbidities to functional impairment is higher in heart failure with preserved than with reduced ejection fraction. Clin Res Cardiol 2011; 100 (09) 755-64
    CrossrefPubMedGoogle Scholar
  • 16 Edelmann F. et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol 2011; 58 (17) 1780-91
    CrossrefPubMedGoogle Scholar
  • 17 Edelmann F, Grabs V, Halle M. [Exercise training in heart failure]. Internist (Berl) 2014; 55 (06) 669-75
    CrossrefPubMedGoogle Scholar
  • 18 Ellingsen ØH, Conraads M, Støylen VM. et al. High Intensity Interval Training in Heart Failure Patients with Reduced Ejection Fraction. Circulation. 2017 (published online January 12, 2017)
    PubMedGoogle Scholar
  • 19 Haykowsky MJ. et al. Meta-analysis of aerobic interval training on exercise capacity and systolic function in patients with heart failure and reduced ejection fractions. Am J Cardiol 2013; 111 (10) 1466-9
    CrossrefPubMedGoogle Scholar
  • 20 Deutsche Herzstiftung. Zahlen und Fakten zur Herzinsuffizienz 2004. Im Internet: http://web1718.joomla13.konto.name/files/hw_fact_sheet_daten_und_fakten_bildmaterial_herzschwaeche_2013-10-18_neu....pdf
    PubMedGoogle Scholar
  • 21 Hobbs FD. et al. Prognosis of all-cause heart failure and borderline left ventricular systolic dysfunction: 5 year mortality follow-up of the Echocardiographic Heart of England Screening Study (ECHOES). Eur Heart J 2007; 28 (09) 1128-34
    CrossrefPubMedGoogle Scholar
  • 22 Isaksen K. et al. Exercise training and cardiac rehabilitation in patients with implantable cardioverter defibrillators: a review of current literature focusing on safety, effects of exercise training, and the psychological impact of programme participation. Eur J Prev Cardiol 2012; 19 (04) 804-12
    CrossrefPubMedGoogle Scholar
  • 23 Isaksen K. et al. Aerobic interval training in patients with heart failure and an implantable cardioverter defibrillator: a controlled study evaluating feasibility and effect. Eur J Prev Cardiol 2015; 22 (03) 296-303
    CrossrefPubMedGoogle Scholar
  • 24 Ismail H. et al. Clinical outcomes and cardiovascular responses to different exercise training intensities in patients with heart failure: a systematic review and meta-analysis. JACC Heart Fail 2013; 1 (06) 514-22
    CrossrefPubMedGoogle Scholar
  • 25 Ismail H. et al. Exercise training program characteristics and magnitude of change in functional capacity of heart failure patients. Int J Cardiol 2014; 171 (01) 62-5
    CrossrefPubMedGoogle Scholar
  • 26 Keteyian SJ. et al. Relation between volume of exercise and clinical outcomes in patients with heart failure. J Am Coll Cardiol 2012; 60 (19) 1899-905
    CrossrefPubMedGoogle Scholar
  • 27 Kitzman DW. et al. Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure. JAMA 2002; 288 (17) 2144-50
    CrossrefPubMedGoogle Scholar
  • 28 Kraigher-Krainer E. et al. Association of physical activity and heart failure with preserved vs. reduced ejection fraction in the elderly: the Framingham Heart Study. Eur J Heart Fail 2013; 15 (07) 742-6
    CrossrefPubMedGoogle Scholar
  • 29 McMurray JJ. et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012
    PubMedGoogle Scholar
  • 30 Neumann T. et al. Heart failure: the commonest reason for hospital admission in Germany: medical and economic perspectives. Dtsch Arztebl Int 2009; 106 (16) 269-75
    CrossrefPubMedGoogle Scholar
  • 31 O’Connor CM. et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 2009; 301 (14) 1439-50
    CrossrefPubMedGoogle Scholar
  • 32 Pandey A. et al. Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials. Circ Heart Fail 2015; 8 (01) 33-40
    CrossrefPubMedGoogle Scholar
  • 33 Piepoli MF. et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail 2011; 13 (04) 347-57
    CrossrefPubMedGoogle Scholar
  • 34 Pina IL. et al. Effects of exercise training on outcomes in women with heart failure: analysis of HF-ACTION (Heart Failure-A Controlled Trial Investigating Outcomes of Exercise TraiNing) by sex. JACC Heart Fail 2014; 2 (02) 180-6
    CrossrefPubMedGoogle Scholar
  • 35 Ponikowski P. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J; 2016
    PubMedGoogle Scholar
  • 36 Rognmo O. et al. Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation 2012; 126 (12) 1436-40
    CrossrefPubMedGoogle Scholar
  • 37 Schwarz S, Halle M. [Exercise training in heart failure patients]. Dtsch Med Wochenschr 2014; 139 (16) 845-50
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 38 Smart NA, Dieberg G, Giallauria F. Intermittent versus continuous exercise training in chronic heart failure: a meta-analysis. Int J Cardiol 2013; 166 (02) 352-8
    CrossrefPubMedGoogle Scholar
  • 39 Stoylen A. et al. Controlled study of myocardial recovery after interval training in heart failure: SMARTEX-HF-rationale and design. Eur J Prev Cardiol 2012; 19 (04) 813-21
    CrossrefPubMedGoogle Scholar
  • 40 Vanhees L. et al. Effect of exercise training in patients with an implantable cardioverter defibrillator. Eur Heart J 2004; 25 (13) 1120
    CrossrefPubMedGoogle Scholar
  • 41 Wisloff U. et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation 2007; 115 (24) 3086-94
    CrossrefPubMedGoogle Scholar