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Assessment of the effects of physical training in patients with chronic heart failure: the utility of effort-independent exercise variables

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Abstract

Traditionally, the effects of physical training in patients with chronic heart failure (CHF) are evaluated by changes in peak oxygen uptake (peak \( \dot{V}{\text{O}}_{2} \)). The assessment of peak \( \dot{V}{\text{O}}_{2} \), however, is highly dependent on the patients’ motivation. The aim of the present study was to evaluate the clinical utility of effort-independent exercise variables for detecting training effects in CHF patients. In a prospective controlled trial, patients with stable CHF were allocated to an intervention group (N = 30), performing a 12-week combined cycle interval and muscle resistance training program, or a control group (N = 18) that was matched for age, gender, body composition and left ventricular ejection fraction. The following effort-independent exercise variables were evaluated: the ventilatory anaerobic threshold (VAT), oxygen uptake efficiency slope (OUES), the \( \dot{V}_{\text{E}} /\dot{V}{\text{CO}}_{ 2} \) slope and the time constant of \( \dot{V}{\text{O}}_{2} \) kinetics during recovery from submaximal constant-load exercise (τ-rec). In addition to post-training increases in peak \( \dot{V}{\text{O}}_{2} \) and peak \( \dot{V}_{\text{E}} , \), the intervention group showed significant within and between-group improvements in VAT, OUES and τ-rec. There were no significant differences between relative improvements of the effort-independent exercise variables in the intervention group. In contrast with VAT, which could not be determined in 9% of the patients, OUES and τ-rec were determined successfully in all patients. Therefore, we conclude that OUES and τ-rec are useful in clinical practice for the assessment of training effects in CHF patients, especially in cases of poor subject effort during symptom-limited exercise testing or when patients are unable to reach a maximal exercise level.

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Acknowledgments

This work was supported in part by research grants from foundation “Friends of the Heart”, Eindhoven, The Netherlands and the Scientific Foundation of Máxima Medical Centre, Veldhoven, The Netherlands.

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Correspondence to Hareld M. C. Kemps.

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Communicated by Susan Ward.

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Kemps, H.M.C., de Vries, W.R., Schmikli, S.L. et al. Assessment of the effects of physical training in patients with chronic heart failure: the utility of effort-independent exercise variables. Eur J Appl Physiol 108, 469–476 (2010). https://doi.org/10.1007/s00421-009-1230-3

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  • DOI: https://doi.org/10.1007/s00421-009-1230-3

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