Page 54 - Today's Dietitian (February 2020)

Focus on Fitness By Jennifer Van Pelt, MA

• NYHA IV: Severe limitations—unable
to perform any physical activity with-
out discomfort, and symptoms of
heart failure even at rest.

Patients generally are evaluated with
a six-minute walking test and other
clinical tests to determine NYHA status,
which will determine how they’re man-
aged. Despite several medications and
device-based treatments for heart fail-
ure, between 50% and 75% of those with
heart failure will die within five years
after diagnosis. 2
Exercise is used not only to assess
heart failure symptoms but also as a
therapeutic intervention. A large body
of high-quality published evidence sup-
ports the benefits of regular exercise for
heart failure patients who are able to
Exercising With Heart Failure perform physical activity. Systematic
reviews and meta-analyses have shown
that exercise reduces risk of hospitaliza-
F ebruary is American Heart is a progressive condition, and the heart ity of life and functioning for patients
tions and mortality and improves qual-
Month. Efforts to increase
gets weaker over time. Some causes
with heart failure.
3,4
awareness and prevention have
Cardiac rehabilitation—medically
of heart failure include CAD, previous
resulted in declining mortality
scribed after a heart attack—is recom-
rates for coronary artery disease heart attack, heart valve or muscle dis- supervised exercise commonly pre-
ease, certain lung conditions, and sub-
(CAD), the most common type of heart stance abuse. Symptoms of heart failure mended for patients with heart failure.
disease. However, while mortality rates include the following: Cardiac rehabilitation for a prescribed
associated with heart attacks from CAD number of sessions helps patients learn
have decreased, mortality and preva- • increased shortness of breath/ how to exercise appropriately to manage
lence of heart failure are increasing. labored breathing (dyspnea) on exer- their heart failure. Current guidelines
Much of this increase is related to the tion or lying down; from the AHA, American College of
overall aging of the US population, but • fatigue and weakness; Cardiology, Heart Failure Association,
heart failure also is increasing among • persistent coughing or wheezing; Canadian Cardiovascular Society, and
younger adults due to higher rates of • fluid retention leading to swelling in European Society of Cardiology recom-
obesity and CVD in this age group. the lower extremities and/or weight mend regular exercise for patients with
According to the American Heart gain; and stable chronic heart failure who are able
Association (AHA), the most current • reduced tolerance of exercise. to exercise to improve functional status,
data, from 2016, indicate that approx- symptoms, and quality of life, as well as
imately 6.2 million Americans over Patients with heart failure are staged reduce hospitalization and mortality. 3,5
20 years of age have heart failure—an based on the severity of their symptoms Guidelines emphasize aerobic endur-
increase from the 5.7 million estimated and degree of exercise limitations using ance exercise performed at moderate
in 2012. In 2017, there were 960,000 new the New York Heart Association (NYHA) to vigorous intensity for up to 30 min-
cases of heart failure diagnosed in the Functional Classification, grouped as utes at least five days a week. Resistance
United States. follows: training on two to three days a week
The AHA projects that the prevalence is recommended as a complement to
of heart failure will increase by almost • NYHA I: No symptoms or limitations aerobic exercise. Note that this inten-
50% by 2030, with more than 8 million during normal physical activity; sity, duration, and frequency of exercise
Americans aged 18 or older developing • NYHA II: Mild symptoms and some mirrors AHA recommendations for all
the disease. Medical costs of heart failure limitations (eg, fatigue, dyspnea) American adults. Exercise guidelines for
will increase by more than 127% by 2030. 1 during normal physical activity; heart failure do emphasize that exercise
In heart failure, the heart’s perfor- • NYHA III: Marked limitations during must be individualized for each patient
mance is impaired—it doesn’t fill prop- normal or lighter-than-normal physi- depending on their functional status,
erly with blood and/or is unable to cal activity due to fatigue and dys- age, comorbidities, and preferences. 5
pump enough blood. Therefore, the body pnea, but patient is comfortable at Research published since these
doesn’t get enough oxygen. Heart failure rest; and guidelines were established suggests

54 TODAY’S DIETITIAN • FEBRUARY 2020