Lack of Benefits of Endurance Training in Patients with Chronic Heart Failure: Role of Asymptomatic Peripheral Artery Disease
Giuseppe Caminiti*, Maurizio Volterrani, Anna Cerrito, Barbara Sposato and Giuseppe Rosano
Centre for Clinical and Basic Research, Cardiovascular Research Unit, Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy
- *Corresponding Author:
- Giuseppe Caminiti
Centre for Clinical and Basic Research
Cardiovascular Research Unit
Department of Medical Sciences
IRCCS San Raffaele-Roma
via della Pisana 235, 00163 Roma, Italy
E-mail: [email protected]
Received Date: July 22, 2013; Accepted Date: September 05, 2013; Published Date: September 10, 2013
Citation: Caminiti G, Volterrani M, Cerrito A, Sposato B, Rosano G (2013) Lack of Benefits of Endurance Training in Patients with Chronic Heart Failure: Role of Asymptomatic Peripheral Artery Disease. Int J Phys Med Rehabil 1:156. doi: 10.4172/2329-9096.1000156
Copyright: © 2013 Caminiti G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Purpose: To evaluate the impact of asymptomatic peripheral artery disease (PAD) on exercise recovery in patients with heart failure (HF).
Methods: The study enrolled 204 HF patients in stable conditions, mean age 72 ± 12 years, M/F 138/66, consecutively admitted to our cardiac rehabilitation unit. Asymptomatic PAD was assessed by ankle/brachial index (ABI). Subjects with history of symptomatic PAD were excluded from the study. Exercise tolerance was evaluated by six minute walking test (6mwt). At admission patients were divided into three group according to their ABI index (ABI >0.9; ABI 0.6-0.9; ABI <0.6). All patients underwent an 8-weeks program of aerobic exercise training at 60-70% of heart rate reserve.
Results: Overall 52% of patients had ABI<0.9. At baseline patients with ABI <0.6 were older, had a higher rate of hypertension, diabetes, atrial fibrillation and a lower ejection fraction (EF) the other two groups. ABI resulted significantly related to EF, and it was inversely related to creatinine levels. After exercise training patients with ABI <0.6 and ABI 0.6-0.9 had a significantly lower recovery of exercise capacity (25.7% and 31.6% respectively) than patients with ABI >0.9 (41.9%). In a multivariate logistic regression model, including several covariates, asymptomatic PAD predicted a reduced performance at 6MWT in the overall population (adjusted OR 1.82; 95% CI 1.66-2.11; p=0.03).
Conclusions: Asymptomatic PAD is a marker of advanced HF and reduced physical performance. HF patients with asymptomatic PAD have lower functional recovery than subjects without asymptomatic PAD after exercise training. Asymptomatic PAD seems to be related to lack of benefit of exercise training in HF patients and a marker of frailty of these patients.