Κωνσταντίνος Δάβος, Ερευνητής Β΄, ΙΙΒΕΑΑ
Νικόλαος Κουλούρης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Σπυρίδων Ζακυνθινός, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Chronic heart failure (CHF) is a complex clinical syndrome which leads to a significant morbidity, institutionalisation and mortality, as well as to an enormous socio‐economic burden. The causes of CHF vary, but the consequences seem to be detrimental for the patient’s health, physical ability and quality of life (QoL). Reduced peripheral blood flow, increased oxidative stress and inflammatory factors, skeletal muscle atrophy and endothelial dysfunction are some of the pathophysiologic mechanisms leading to poor prognosis. CHF prevalence increases strongly with age as it mainly affects the elderly population with numbers reaching approximately 2% of the population. The numbers of affected people are expected to rise with the increased overall life expectancy. It is therefore expected that many of the CHF patients may be frail at the onset of the disease or become frail during its course. Frailty is a geriatric syndrome characterised by a vulnerability status associated with declining function of multiple physiological systems and loss of physiological reserves. Moreover, alterations to the body composition (i.e. skeletal muscle, fat and bone density), are frequent in CHF. Cachexia is recognized as a complex multi-factorial syndrome in chronic diseases that leads to weight loss and is a common consequence of CHF. Cachexia is defined as a non-edematous weight loss of more than 7,5% within over 6 months. Sarcopenia is also present in these patients and it means loss of muscle mass without necessarily weight loss because the functional muscle can be replaced by adipocytes. Different measuring instruments are used to define and assess sarcopenia, frailty and cardiac cachexia; nevertheless, there is no specific officially agreed method to detect them. The way to treat sarcopenia and cardiac cachexia and improve frailty status in patients with CHF is still a great challenge. Apart from drug therapy and nutritional supplementation, exercise-based cardiac rehabilitation (CR) could have been a way to improve aspects related to patient’s subjective and objective parameters of health and life quality such as physical ability, capillary density, vascular function, self-efficacy, fatigue, and stress. The purpose of this review was to investigate the role of exercise-based CR in CHF patients, along with frailty, cachexia or sarcopenia, based on the related bibliography. It was hypothesised that, even if CR, and more specifically exercise training, does not reverse the process of cachexia, frailty, sarcopenia and CHF; it could at least constitute a drastic change in patient’s lives. Relevant data and information, from approximately 90 published papers, were extracted and used as reference. Various types of exercise-based CR were studied as regards their effect on CHF patients such as: aerobics exercise, calisthenics, strength training, respiratory muscles training, neuromusclular stimulation (NMES), yoga, hydrotherapy, tai chi. These different exercise protocols offer a plethora of benefits and are shown to increase QoL. There is no clear answer regarding morbidity and mortality even if the results seem optimistic. Exercise-based CR when methodically applied may be a powerful way to drastically and optimistically change people’s lives. However, CR programs for CHF patients so far are not orientated in sarcopenia, cardiac cachexia and frailty. More answers are needed regarding the type of exercise, the methods, and other parameters of exercise which play a leading role in the result exercise-based CR may have.
Heart failure, Frailty, Cachexia, Sarcopenia, Cardiac rehabilitation, Exercise training