Recovery of cardiac autonomic responsiveness with low-intensity physical training in patients with chronic heart failure

Gabriella Malfatto, Giovanna Branzi, Beatrice Riva, Luca Sala, Gastone Leonetti, Mario Facchini

Research output: Contribution to journalArticle

Abstract

Background: A gradual worsening of autonomic control of cardiovascular function accompanies the progression of heart failure. Exercise training modulates autonomic balance, and may affect the prognosis of the disease. Aims: The sympathovagal balance was studied after 3 months of low-intensity rehabilitation compared with conventional therapy in 45 patients with heart failure (52% ischemic, 48% idiopathic), of whom 30 underwent rehabilitation and 15 did not. In 11 rehabilitated patients we also studied the effects on autonomic profile of 6 additional months of home-based training. Rehabilitated and non-rehabilitated patients had similar NYHA class, ejection fraction, exercise pVO2; 50% assumed carvedilol (39 ± 5 mg/day). Methods and results: Autoregressive power spectral density of RR intervals variability were assessed during 10 min of: (1) supine rest and free breathing; (2) supine rest and breathing at 20 acts/min (= vagal stimulus); (3) standing (= sympathetic stimulus). During each period, the ratio LF/HF of the individual autospectrum indicated the sympathovagal balance. After 3 months of rehabilitation, pVO2 increased (20%); LF/HF at rest was unchanged (8.7 ± 1.2 vs. 9.2 ± 1.2); it decreased with controlled breathing (-18%) and increased during standing (+79%) (P <0.05). These changes were more evident after 6 months of home-based training, when pVO2 was still high: LF/HF at rest was reduced (5.4 ± 0.9 vs. 8.5 ± 2.1), decreased during controlled breathing (-17%) and increased during standing (87%) (P <0.05). No changes in any variable were seen in non-rehabilitated patients. Conclusions: A low intensity rehabilitation program restores autonomic tone and reactivity to vagal and sympathetic stimuli. Some of these effects are already evident after the initial hospital-based phase.

Original languageEnglish
Pages (from-to)159-166
Number of pages8
JournalEuropean Journal of Heart Failure
Volume4
Issue number2
DOIs
Publication statusPublished - 2002

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Respiration
Rehabilitation
Heart Failure
Exercise
Therapeutics

Keywords

  • Autonomic nervous system
  • Cardiac rehabilitation
  • Heart failure
  • Power spectrum

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Recovery of cardiac autonomic responsiveness with low-intensity physical training in patients with chronic heart failure. / Malfatto, Gabriella; Branzi, Giovanna; Riva, Beatrice; Sala, Luca; Leonetti, Gastone; Facchini, Mario.

In: European Journal of Heart Failure, Vol. 4, No. 2, 2002, p. 159-166.

Research output: Contribution to journalArticle

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abstract = "Background: A gradual worsening of autonomic control of cardiovascular function accompanies the progression of heart failure. Exercise training modulates autonomic balance, and may affect the prognosis of the disease. Aims: The sympathovagal balance was studied after 3 months of low-intensity rehabilitation compared with conventional therapy in 45 patients with heart failure (52{\%} ischemic, 48{\%} idiopathic), of whom 30 underwent rehabilitation and 15 did not. In 11 rehabilitated patients we also studied the effects on autonomic profile of 6 additional months of home-based training. Rehabilitated and non-rehabilitated patients had similar NYHA class, ejection fraction, exercise pVO2; 50{\%} assumed carvedilol (39 ± 5 mg/day). Methods and results: Autoregressive power spectral density of RR intervals variability were assessed during 10 min of: (1) supine rest and free breathing; (2) supine rest and breathing at 20 acts/min (= vagal stimulus); (3) standing (= sympathetic stimulus). During each period, the ratio LF/HF of the individual autospectrum indicated the sympathovagal balance. After 3 months of rehabilitation, pVO2 increased (20{\%}); LF/HF at rest was unchanged (8.7 ± 1.2 vs. 9.2 ± 1.2); it decreased with controlled breathing (-18{\%}) and increased during standing (+79{\%}) (P <0.05). These changes were more evident after 6 months of home-based training, when pVO2 was still high: LF/HF at rest was reduced (5.4 ± 0.9 vs. 8.5 ± 2.1), decreased during controlled breathing (-17{\%}) and increased during standing (87{\%}) (P <0.05). No changes in any variable were seen in non-rehabilitated patients. Conclusions: A low intensity rehabilitation program restores autonomic tone and reactivity to vagal and sympathetic stimuli. Some of these effects are already evident after the initial hospital-based phase.",
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