Page 132 - Petelin, Ana, Nejc Šarabon, Boštjan Žvanut, eds. 2017. Zdravje delovno aktivne populacije ▪︎ Health of the Working-Age Population. Proceedings. Koper: Založba Univerze na Primorskem/University of Primorska Press
P. 132
avje delovno aktivne populacije | health of the working-age population 130 Risk during training in cardiac diseases
In general, the occurrence of major cardiovascular events during supervised
aerobic training in cardiac rehabilitation programmes is rare: from 1 in 50 000
to 1 in 120 000 patient-hours of exercise, with fatality incidence ranging be-
tween 1 in 340 000 and 1 in 750 000 patient/hours of exercise. The same is also
true for patients with chronic heart failure and reduced left ventricular func-
tion, New York Heart Association class II–IV symptoms, and treated with op-
timal, guideline-based background heart failure therapy. More evidences are
needed therefore training supervision is now facilitated by tele monitoring.
Heart Failure
The effects of aerobic exercise training on cardiac mortality rate in patients
with chronic heart failure have been evaluated in a meta-analysis. Overall,
moderate to vigorous intensity aerobic exercise training resulted in improved
survival in patients with chronic heart failure due to left ventricular systolic
dysfunction, and time to readmission to hospital was also significantly extend-
ed. Regular physical activity not only reduces morbidity and rehospitalisation
but also mortality. Left ventricular function increases as shown by V02max
and ejection fraction. Physical capacity thus is improved and quality of life in-
creased by 27 % (Edelmann et al., 2011, Kitzmann et al., 2010).
Current multicenter study demonstrated that high intensity interval
training (HIIT) in patients with cardiac failure can be safe and effective in in-
creasing physical capacity (Class II a, Evidence B). During interval exercise,
there are short bouts with high intensity (up to 90% of maximal exercise ca-
pacity) alternating with lower recovery periods. This kind of training improves
cardiorespiratory fitness within short time (some months). HITT can also be
combined with endurance training as a kind of basis training. However, one
large, just finished multicenter study on HITT shows that there is no differ-
ence on the long time between endurance training or HIIT (Smartex-Project).
Therefore, interval training will only be partly integrated into the physical ac-
tivity program. Endurance training will be the mainstay of training in prima-
ry and secondary prevention. For competitive athletes, such a combination of
longer duration endurance training together with longer intervals is well estab-
lished since long.
General recommendations for physical activity
For long-term development and conservation of health related fitness and risk
reduction, moderate intensity recommendations are first line and most impor-
tant approach (150 min/week of moderate and 75 min/week of vigorous exer-
cise). Ratings of perceived exertion related to exercise intensity are between 11
and 13, they can easily used by healthy and ill subjects. The rate of progression
within an exercise program depends on the individual’s health and fitness sta-
tus. To get started, the advice is start low and go slow. Details and comprehen-
In general, the occurrence of major cardiovascular events during supervised
aerobic training in cardiac rehabilitation programmes is rare: from 1 in 50 000
to 1 in 120 000 patient-hours of exercise, with fatality incidence ranging be-
tween 1 in 340 000 and 1 in 750 000 patient/hours of exercise. The same is also
true for patients with chronic heart failure and reduced left ventricular func-
tion, New York Heart Association class II–IV symptoms, and treated with op-
timal, guideline-based background heart failure therapy. More evidences are
needed therefore training supervision is now facilitated by tele monitoring.
Heart Failure
The effects of aerobic exercise training on cardiac mortality rate in patients
with chronic heart failure have been evaluated in a meta-analysis. Overall,
moderate to vigorous intensity aerobic exercise training resulted in improved
survival in patients with chronic heart failure due to left ventricular systolic
dysfunction, and time to readmission to hospital was also significantly extend-
ed. Regular physical activity not only reduces morbidity and rehospitalisation
but also mortality. Left ventricular function increases as shown by V02max
and ejection fraction. Physical capacity thus is improved and quality of life in-
creased by 27 % (Edelmann et al., 2011, Kitzmann et al., 2010).
Current multicenter study demonstrated that high intensity interval
training (HIIT) in patients with cardiac failure can be safe and effective in in-
creasing physical capacity (Class II a, Evidence B). During interval exercise,
there are short bouts with high intensity (up to 90% of maximal exercise ca-
pacity) alternating with lower recovery periods. This kind of training improves
cardiorespiratory fitness within short time (some months). HITT can also be
combined with endurance training as a kind of basis training. However, one
large, just finished multicenter study on HITT shows that there is no differ-
ence on the long time between endurance training or HIIT (Smartex-Project).
Therefore, interval training will only be partly integrated into the physical ac-
tivity program. Endurance training will be the mainstay of training in prima-
ry and secondary prevention. For competitive athletes, such a combination of
longer duration endurance training together with longer intervals is well estab-
lished since long.
General recommendations for physical activity
For long-term development and conservation of health related fitness and risk
reduction, moderate intensity recommendations are first line and most impor-
tant approach (150 min/week of moderate and 75 min/week of vigorous exer-
cise). Ratings of perceived exertion related to exercise intensity are between 11
and 13, they can easily used by healthy and ill subjects. The rate of progression
within an exercise program depends on the individual’s health and fitness sta-
tus. To get started, the advice is start low and go slow. Details and comprehen-
