Introduction. In the world practice, the selection of CHF patients physical training intensity is based on anaerobic threshold achievement during cardiorespiratory test (CPET). But the majority of patients with severe HF are not able to achieve it, that requires the use of certain indicators in the appointment of physical training. This alternative indicator can be lactate threshold, which achieved by every HF patient during the CPET.
Purpose. To evaluate aerobic physical training efficiency in CHF patients, selected on the basis of achievement the lactate threshold during CPET.
Methods. 90 patients, CHF NYHA II-III were randomized into two groups - primary (aerobic training) and control (standard treatment of CHF). Main group - 77 patients, mean age 52±12,5 years, body mass index (BMI) 25,3±5,4 kg/m2, among them 55 patients (72%) had CHF NYHA III, 22 patients (28%) – II. Control group - 13 patients, age 51±13,4 years, BMI was 25,4±5.2 kg/m2, 12 patients had CHF NYHA III, 1 patient – II. The original estimated results of physical examination, laboratory parameters, comorbidity. CPET, quality of life (QOL), exercise tolerance (ET) was assessed at baseline and after 1,3,6 months of follow-up. The CPET served on tredmile using hardware. Echocardiography (EchoCG) was performed at baseline and after 6 months. The data were statistically processed using software package "Statistika, 9.0".
Results. Main group - after 6 months of training EF increased by 8.7±0.5% and End-diastolic volume decreased by 6±2.0 ml from baseline, QOL was changed by 17.5±8 points (significant regression of symptoms), ET increased by 9.5±1 points and VO2 peak increased by 4.4 ml/min/kg. Control group - EF increased by 4±1,1%, End-diastolic volume decreased by 68±14,8 ml, QOL changed 14± 7,22 points, ET increased at 1.5 points, VO2 peak decreased by 1,7 ml/min/kg. Revealed a strong positive correlation between the initial values of VO2 peak and EF (rEF=0,4, p), and between baseline levels of sodium, hemoglobin and the of physical rehabilitation efficiency (rNa= 0,41, p,0,05; rHb = 0,45, p<0,05). There was a positive impact of the initial content of red blood cells (rEr=0,6, p=0.03), sodium (rNa=0,4, p=0.05), LV EF (r=0.5, p=0.05) and VE level at the peak of exercise load (r=0.5,p=0.01) on training efficiency. BNP level and a long history of CHF had a negative effect on the result of physical training (rBNP=-0,7, p=0.05; rCHF=-0,6, p=0.05). The most significant impact on physical training efficiency of CHF NYHA III patients had a CHF duration (rCHF =-0,4, p=0,05). Significant differences in training performance between patients CHF NYHA II and III were not received.
Conclusion. Aerobic physical exercise in CHF patients, selected on the basis of lactate threshold achievement during the CPET, is effective in improving values of CPET, EchoCG, QOL and increasing exercise tolerance.