Reduced aerobic capacity, best quantified by maximal oxygen consumption (VO2), is a feature of both aging and chronic heart failure. There are many studies that have documented decreases in VO2 max of nearly 50% throughout adulthood in apparently healthy populations.
In men, VO2 max decreases from about 45 mL/kg/min in a healthy 25-year-old to 25 mL/kg/min in a 75-year-old. That is, it decreases by almost half. On the other hand, a healthy 80-year-old woman typically has a VO2 max of 15 to 20 mL/kg/mina range characteristic of mild heart failure.
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What is heart failure
Heart failure, like aging, is characterized by a significant reduction in VO2 max, which provides information on powerful prognosis on the risk of hospitalization, mortality and need for ventricular assist devices or heart transplantation.
In patients with systolic heart failure, maximum heart rate and stroke volume are reduced by approximately 20% to 45%, respectively, compared to healthy people. Peripheral factors that contribute to reduced VO2 max include reduced muscle mass, decreased muscle mitochondrial density, and vasoconstriction.
Benefits of physical exercise in people with heart failure
Multiple studies have shown that aerobic physical activity is effective and safe in patients with heart failure. Among these patients, who also usually receive drugs such as diuretics, inhibitors of the converting enzyme and cardiac glycosidesrandomized trials showed increases in VO2 max from 12% to 33%. On the other hand, patients taking beta-blockers appear to obtain similar training-induced improvements in aerobic capacity.
There is usually a lot of fear that these types of people do aerobic exercise due to the “possible exacerbation of complications”, but what has been seen is that there are no deleterious effects on ventricular structure or resting function after training.
Increased peripheral blood flow and improved skeletal muscle morphology and function mediate much of the benefit. aerobic exercise in patients with heart failure. Increases in leg peak blood flow and oxygen delivery and a reduction in leg vascular resistance have been observed.
Other studies observed reduced rates of hospital admissions and cardiac mortality in patients randomized to 14 months of supervised aerobic training compared to controls.
How should people with heart failure train?
The vast majority of studies that have been conducted on people with heart failure have been with aerobic physical activity, so there is a lot more data to discuss exactly how these people should train.
In studies, there are many variations of the percentage of VO2max at which they trained since they were totally individualized by the professionals who conducted the study. Even so, the studies were carried out around the 40-60%, some studies reaching 70%.
As discussed above, although most exercise training trials in heart failure patients have focused on aerobic exercise to improve reduced aerobic capacity, Another prominent feature of heart failure syndrome is skeletal muscle atrophy.
Muscle atrophy is more pronounced in highly oxidative and fatigue-resistant type I fibers. which causes a shift towards type II glycolytic fibers and more prone to fatigue.
There have been studies that have seen that working at a 30-60% of RM in people with heart failure results in an increase in VO2 max. skeletal muscle strengthblood flow and heart rate.
Therefore, if you have heart failure, the first thing to do is to hire an exercise professional to help and advise you. We recommend not doing physical exercise if you have heart failure without professional supervision In order to avoid serious side effects that, could end in hospitalization.
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