Heart Health - Physical Activity and Exercise for Chronic Heart Failure

The treatment and management of chronic heart failure (CHF) has changed dramatically over the last 30 years leading to significantly improved outcomes and quality of life. A prevalent condition within the Australian community, over 110,000 people live with chronic heart failure, and exercise programs play a crucial role in their treatment, management, and quality of life.

What is Chronic Heart Failure?

Chronic heart failure (CHF), also known as congestive heart failure, is a clinical syndrome characterized by the inability of the heart to pump blood adequately to meet the body's metabolic demands. This results in symptoms such as shortness of breath (dyspnoea), fatigue, reduced exercise tolerance, and fluid retention.

Some of the signs of CHF include an enlarged heart (due to the heart trying to work harder and beat faster), persistent cough or wheeze, rapid or irregular heart rate and abnormal blood pressure, the latter contributing to other signs such as swollen ankles and pulmonary crackles on auscultation. The body tries to make other physiological adaptations too, like retaining water and salt and narrowing the blood vessels in its attempt to keep blood pressure up and circulation normal. However, these compensatory measures are not sustainable processes. Left untreated, symptoms will gradually progress with increasing risk of heart attack, stroke, and organ failure.

What causes chronic heart failure?

The causes of CHF are varied and complex. Broadly speaking, CHF results from either:

1.     Factors affecting the pumping ability of the heart (systolic function), and;

2.     Factors affecting the hearts filling ability (dystolic function)

Factors contributing to the development of CHF can be intrinsic, such as the genetics we inherit, and extrinsic,

such as lifestyle choices like diet and smoking. Other disease processes can also contribute to the development

of CHF, such as infections and diabetes.

Lifestyle factors that increase the chance of developing CHF are considered modifiable as we can generally choose how much we are exposed to them. Things like smoking, excessive alcohol consumption, poor dietary choices, and lack of physical exercise are modifiable risk factors for CHF that can contribute to the build-up of plaque on arteries and increase blood pressure.

Is exercise and physical activity safe for people with chronic heart failure?

Yes! Individuals diagnosed with CHF are routinely advised to engage in physical activity by their health care team. However, physical activity remains low in this population group. Many people with a heart condition fear that exercising may be harmful, but evidence shows that those people who are more physically active and exercise are generally healthier than those who don’t. However, it is important to get advice from a health care professional before getting into exercise to gradually improve your fitness. 

What type of physical activity should I be completing?

Physical activity for people with CHF should be tailored to the individual’s goals and objectives and should be engaging for the person. It is important to explore different exercise strategies with your physiotherapist to find a type and style that you are interested in, fits your lifestyle, and can safely enjoy. 

There is strong evidence that aerobic and resistance training, tai chi, and hydrotherapy

are suitable means of exercise for people with CHF.

These programs can be done at home, using personal equipment such as a treadmill or stationary bike and dumbbells, as part of a group such as aqua aerobics, through a local gym, or swimming at your local pool.

Personal trainers can be beneficial to keep you motivated and committed, provided you have consulted with your health team first and have had your exercise program prescribed by a physiotherapist.

Remember that exercise and physiotherapy is just one part of the management strategy for CHF. Your heart health team comprising your doctors, nurse practitioner, pharmacist, dietician, and psychologist all play an important role in your heart health. Physical activity should be prescribed, managed, and progressed by your physiotherapist as part of this multi-disciplinary team.

How much physical activity should I be completing?

The volume and intensity of physical activity that an individual with CHF will be able to undertake will be dependent on the stage of disease, physical symptoms, mental health, and age of the person. This is why consulting with a physiotherapist who is part of a multi-disciplinary team is so important. 

Baseline exercise tolerance must be assessed and determined in a controlled environment.

Monitoring heart rate and other physical symptoms while exercising on a treadmill or stationary bike, or while doing other simple functional activities, and then assessing recovery rates is a valuable way of safely setting a baseline for physical activity. Some individuals will only manage 5-10mins of light physical activity twice a day, while others will tolerate much more.

This data can then be used to tailor an exercise program to the individual and safely progressed accordingly.

The Take Home

Chronic Heart Failure is a relatively common condition that affects thousands of Australians. While outcomes and quality of life have improved dramatically over the past 30 years, the uptake of physical activity by people with CHF remains poor. Physiotherapists have an extensive knowledge of cardiac health and exercise prescription. As a valued health professional they can assist in engaging people with CHF with physical activity and have a positive impact on the health outcomes of individuals and thus the broader community.   

Got a heart complaint or want to improve your heart health? Give us a call.

At Movement for Life Physiotherapy, we understand heart health and can safely assess your tolerance to physical activity in a controlled environment.  With a clear understanding of your physical capacity and a tailored management plan, we'll help get you moving to your own beat and back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

1. Amirova, A., Fteropoulli, T., Williams, P., & Haddad, M. (2021). Efficacy of interventions to increase physical activity for people with heart failure: a meta-analysis. Open heart, 8(1), e001687. https://doi.org/10.1136/openhrt-2021-001687
2. Andersson, B., Cider, Å., Schaufelberger, M., & Sunnerhagen, K. S. (2003). Hydrotherapy—A new approach to improve function in the older patient with chronic heart failure. European Journal of Heart Failure, 5(4), 527–535. https://doi.org/10.1016/S1388-9842(03)00048-5
3. Care, A. G. D. of H. and A. (2021). Australian Government Department of Health and Aged Care; Australian Government Department of Health and Aged Care. https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-adults-18-to-64-years
4. Chun, K. H., & Kang, S. M. (2021). Cardiac rehabilitation in heart failure. International Journal of Heart Failure, 3(1), 1.
5. McDonagh, T. A., Metra, M., Adamo, et al (2022). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 24(1), 4-131.
6. Patti, A., Merlo, L., Ambrosetti, M., & Sarto, P. (2021). Exercise-based cardiac rehabilitation programs in heart failure patients. Heart Failure Clinics, 17(2), 263-271.
7. Taylor, R. S., Dalal, H. M., & McDonagh, S. T. (2022). The role of cardiac rehabilitation in improving cardiovascular outcomes. Nature Reviews Cardiology, 19(3), 180-194.