Left ventricular dysfunction, exercise capacity and activity recommendations

There is lack of consistent correlation between left ventricular function at rest, haemodynamic measurements at rest, symptomatic status and exercise tolerance. Haemodynamic data appear comparable in patients whose exercise tolerance is limited clinically by fatigue and by breathlessness. Selected patients with left ventricular dysfunction and compensated congestive heart failure can safely undergo both exercise testing and training, and an improvement in functional status can be anticipated to result from exercise training. Our current knowledge base for recommendations about exercise training and guidelines as to activities appropriate for patients with ventricular dysfunction is comparable to that for patients following uncom-plicated myocardial infarction two decades ago. In the early years of exercise rehabilitation, patients with depressed left ventricular function and particularly those with cardiac enlargement were arbitrarily excluded from participation because of concerns about further damage to the myocardium and the excessive risk of exercise-related cardiovascular complications, including arrhythmia-related death. Thus, the subse-quent initial attempts at exercise training of these patients weTe cautious, with pre-eminent concerns for patient safety and preservation of residual ventricular function. To date, exercise training of patients with left ventricular dysfunction and heart failure has involved carefully selected small subgroups of these individuals, studied in experienced laboratories, predominantly in a research setting, and typically involving intensive ECG and other monitoring and surveillance1'•11