Exercise in patients with chronic heart failure. With emphasis on peripheral muscle training, hydrotherapy and type 2 diabetes mellitus

Chronic heart failure (CHF) is not uncommon in developed countries with a growing ageing population. CHF is a chronic syndrome, which markedly impact negatively on the patient s life situation. Considerable impaired physical function and reduced health related quality of life is often present. Type 2 diabetes mellitus is a frequent comorbidity in patients with CHF and results in an even greater impairment of physical function. Exercise is physiologically beneficial for patients with these conditions, however little is known about the effect of peripheral muscle training, and hydrotherapy has never earlier been studied in these patients. The aim of this thesis was to evaluate: 1). the chronic effect of peripheral muscle training in patients with CHF, 2). the chronic effect of hydrotherapy in patients with CHF withor without type 2 diabetes mellitus, 3). the acute cardiorespiratory reaction during warm water immersion in patients with CHF and in healthy subjects. Peripheral muscle training during five months was evaluated using ergospirometry, clinical and isokinetic muscle function tests and health related quality of life questionnaires. Twenty-four patients were randomised to either peripheral muscle training or control group. Peripheral muscle training resulted in a significantly improved anaerobic threshold and muscle endurance. The effect of eight weeks hydrotherapy (combined peripheral muscle training and aerobic exercise in warm water) was assessed in two studies, one where 25 randomised older patients with CHF and in another study where 20 patients with the combination of CHF and type 2 diabetes mellitus were evaluated. Exercise capacity, muscle function and health related quality of life was assessed. A test for metabolic function was added in patients with type 2 diabetes mellitus. Hydrotherapy resulted, in both studies, in a significant improved exercise capacity, walking distance and muscle function as well as a decreased HbA1c in type 2 diabetes mellitus. In some items, health related quality of life improved within the training group, both in patients with and without type 2 diabetes mellitus. The cardiorespiratory reaction during warm water immersion was studied in 12 patients with CHF and in 12 healthy subjects using gas analysis and with echocardiography in 13 patients with CHF and 13 healthy subjects. Patients with CHF had a lower oxygen uptake in warm water, at rest compared to healthy subjects. Hemodynamics increased during warm water immersion i.e. ejection fraction increased significantly in patients with CHF and stroke volume and cardiac output increased significantly in healthy subjects. Conclusion: Peripheral muscle training improves muscle function in patients with CHF and hydrotherapy improves exercise capacity and muscle function in patients with CHF, with or without type 2 diabetes mellitus. Moreover, immersion in warm water and hydrotherapy result immediately in an improved heamodynamic function in patients with CHF. These training regimens can therefore be included in the rehabilitation programme for patients with CHF, with or without type 2 diabetes mellitus. A smorgasbord with different exercise regimens might increase the possibility for patients with pronounced disability to remain physically active