Managing heart failure with exercise

heart failure

What is heart failure?

Heart failure is defined as the inability of the heart to meet the demands of the tissues in the body. This inability often manifests itself in tiredness, shortness of breath and oedema, which is fluid retention in the lungs, abdomen or ankles.

The causes of heart failure are varied and can be abrupt (e.g. heart attack or virus), gradual (e.g. high blood pressure) or hereditary (e.g. cardiomyopathy).

Chronic heart failure is unlike other cardiovascular diseases as it is associated with more concomitant deleterious effects on the peripheral system such as the lungs, muscles and organs.

How can exercise help?

Exercise is often avoided by individuals with heart failure due to breathlessness and fatigue, however, inactivity is in fact likely to worsen these symptoms through a vicious cycle of deconditioning. A structured exercise regime is vital in breaking this cycle, but crucially the emphasis should be on a very gradual increase. Exercise intensity and/or duration should only be increased if symptoms of fatigue, shortness of breath and fluid retention (shown by sudden increases in body mass) are well managed both during and in the days after activity.

Which exercise is best?

A great way to start for most people is simply to use a step counter and aim to gradually increase the number of steps you are doing each day. Ensure you take your time to warm up and cool down and that you can maintain a conversation at all times during exercise.

Due to the deconditioning that occurs in the lungs and muscles it is also now well recognised that some muscular resistance and/or inspiratory muscle training should be included. Start gently by using light weights and small amounts of muscle, before progressing to more advanced movements including those which use lots of muscles and cause sudden changes in posture (e.g. squats). Inspiratory work can begin simply by practicing deep breathing before potentially, if required, using the assistance of an inspiratory muscle training device.

NB: The severity of heart failure can vary from day-to-day and your exercise should match this. Exercise is beneficial for individuals with heart failure when performed in a safe and controlled environment.

You can read more about the subject of heart failure and exercise via these web links and articles:

+ https://www.bhf.org.uk/heart-health/conditions/heart-failure

+ Exercise training in heart failure: from theory to practice. Piepoli et al. 2011 European Journal of Heart Failure 13, 347-357. (Paper and supplementary Material)

+ Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Sagar et al. 2015. Open Heart.