Exercise physiology and changes in the periphery

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Abstract
Dyspnea, fatigue, and reduced exercise capacity are cardinal features of patients with chronic heart failure. The mechanisms of limitation of exercise capacity are not known. Over the last 10 years there has been increasing use of cardiopulmonary exercise testing to study the pathophysiology of heart failure. Exercise testing in patients with heart failure has revealed little or no correlation between central hemodynamic measurements at rest or during exercise and either exercise capacity or symptoms. Interest has therefore been directed toward changes in the peripheral circulation and in the function of exercising skeletal muscle. Reduced vasodilatory capacity, altered muscle fiber types, and altered muscle biochemistry (studied from muscle biopsies or by 31P-NMR spectroscopy) have all been described.

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