Rehabilitation program for heart failure (guidelines and practical modalities)
Dr Bertrand LEDERMANNa, Dr Monique LOSCOSa, Dr Christelle ROBERTa, Prof Guillaume CAYLAa
a CHU Carémeau
Chronic Heart failure (CHF), a highly prevalent condition, is a major cause of morbidity and mortality, and generates significant costs. CHF causes a reduction in physical capacity of patients with low exercise tolerance and a significant decrease in quality of life.
International recommendations include a diet adaptation, regular exercises and therapeutic education : Cardiac Rehabilitation (CR) for CHF in specialized cardiovascular centers allows the comprehensive care with Class I level recommendation in patients with systolic CHF in NYHA class II or III.
In France, twenty sessions are usually supported by the French health system and the program runs with three sessions per week. The reference exercise testing should be performed with simultaneous measurement of peak oxygen uptake as well as a six-minute walk test.
Exercise prescription consists in a moderate intensity continuous training or more recently in a high interval training guided by the measurement of expired gases.
Resistance training must be associated with gymnastics sessions, respiratory training and possible electromyostimulation for the most severe disease (class IIIb).
Therapeutic education, structured and provided by a multidisciplinary team, is crucial and should include education about CHF and warning signs, about adherence to medications, dietary sodium restriction and excessive fluid intake.
CR in CHF is associated with a improvement of sympathetic activity, peripheral resistance and endothelial function, as well as a decrease of circulating neurohormones. These improvements confer significant clinical benefits with a net decrease in hospital readmissions and significant better quality of life.
Pavy et al. French Society of Cardiology guidelines for cardiac rehabilitation in adults. Arch Cardiovasc Dis. 2012;105:309-28.
ESC Guidelines for the diagnosis and treatment of acute and chronique heart failure 2012, European Journal of heart failure 2012;14:803-69.
Douard H. Réadaptation de l’insuffisance cardiaque. EMC, 2010 Elsevier Masson SAS.
Keywords : chronic heart failure, cardiac rehabilitation, therapeutic education