Arm Exercise Training in the Rehabilitation of Patients with Impaired Ventricular Function and Heart Failure

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Abstract
Although exercise training is an accepted part of comprehensive coronary care programs in patients with coronary artery disease, it still remains to be demonstrated whether or not exercise training should also be applied to patients with impaired ventricular function. Circumstantial evidence exists that patients with impaired ventricular function may eventually benefit from an individually adapted exercise training program provided that contraindications for acceptance of cardiac patients to such a program are well observed. Our study is based on 22 patients with impaired ventricular function, of which 18 were at least 6 months after a Q-wave myocardial infarction and the remaining 4 after coronary artery bypass grafting. Eleven patients with impaired left ventricular function performing upper extremity (arm) ergometry were followed up for 36 months. These patients were trained twice weekly with exercise periods of 30 min duration. The reason for choosing arm ergometry training was that the peak heart rate obtained in arm ergometry is higher when compared to leg ergometry. Rate-pressure product and heart rate were higher for given submaximal work tasks in arm ergometry, while maximal work aerobic capacity was found to be lower in comparison to leg work. The assessment of our patients was based on cardiopulmonary testing, continuous electrocardiographic monitoring (48 h), two-dimensional echocardiography and equilibrium multigated radionuclide ventriculography (99mTc). Group 1, consisting of 11 patients with left ventricular ejection fraction (LVEF) 30.1 ± 9.5%, were trained by arm exercise for 3 years with a significant increase in work capacity and LVEF. Group 2 consisted of 11 patients with LVEF 25.5 ± 6.8% who underwent a 12 months’ calisthenic program. Peak work capacity and LVEF remained unchanged. No patient developed heart failure during follow-up. We conclude that our results may indicate that a supervised arm training program in coronary patients with significant impairment of ventricular function may prove justified, provided that necessary percautions are observed.