Author/Editor		Keber, Irena; Gužič-Salobir, Barbara
Title		Telesna vadba pri bolnikih s kroničnim srčnim popuščanjem
Translated title		Physical training in patients with chronic heart failure
Type		članek
Source		Zdrav Vars
Vol. and No.		Letnik 40, št. 3-6
Publication year		2001
Volume		str. 175-9
Language		slo
Abstract		Physical inactivity that used to be advised to patients with chronic heart failure (CHF) not so long ago, contributes to their poor exercise capacity which js characteristic of these patients. Regular physical training has proved to improve their peak oxygen cansumption and submaximal work capacity. This is achieved mainly by peripheral adaptations in skeletal muscles and peripheral blood flow distribution, while no changes in left ventricular systolic function have been observed after physical training. Only patients with stable compensated CHF could be included in training program, considering also all other established contraindications for exercise training. The intensity of physical activity and the duration of supervision should be individually prescribed. Aerobic activity is used most frequently, and 50 to 70% of peak oxygen consumption which corresponds to 60 to 80% of peak heart rate is prescribed for training intensity. There are still many unanswered questions regarding physical training of CHF patients. It is not clear which patients are benefiting the most. There is also still not enough evidence how safe training is for CHF patients due to valvular regurgitation, and whether it could lead to malignant arrhythmia or how it affects the prognosis of CHF patients. In spite of these unresolved facts, it is wise even now to advise physical training to stable patients with CHF due to ischaemic or dilative cardiomyopathy, since it can significantly improve their quality of life.
Summary		Dolgotrajna telesna neaktivnost in mirovanje, ki smo jo še nedavno svetovali bolnikom s kroničnim srčnim popuščanjem (KSP), jim še poslabšuje že tako okrnjeno telesno zmogljivost. Ob redni telesni vadbi se jim poveča maksimalna telesna zmogljivost in vzdržljivost za submaksimalne obremenitve, kar je predvsem posledica perifemih prilagoditev v skeletnih mišicah in perifernem žilju, medtem ko vadba ne vpliva pomembno na sistolično funkcijo levega prekata. Za program telesne vadbe so primerni le stabilni bolniki s kompenziranim KSP. Med zadržke za vadbo sodijo vse znane kontraindikacije za telesno obremenjevanje. Večinoma uporabljajo aerobno vadbo, uveljavlja pa se tudi vadba z izometrično aktivnostjo. Predpis je individualen tako glede začetne intenzivnosti kot nadaljnjega stopnjevanja telesne aktivnosti in trajanja monitorskega nadzora. Običajno naj bi obremenitve pri treningu dosegale 50 do 70% maksimalne porabe kisika oziroma 60 do 80% največje srčne frekvence. Ni še jasno, kateri bolniki največ pridobijo s telesno vadbo. Prav tako ni izkušenj, ali je varna za bolnike s KSP zaradi regurgitacije srčnih zaklopk in kako vpliva na nastanek malignih motenj srčnega ritma. Prav tako še ni podatkov o vplivu telesne vadbe na prognozo teh bolnikov. Kljub tem nejasnostim pa že sedaj lahko svetujemo telesno vadbo stabilnim bolnikom s KSP zaradi ishemične ali dilatativne kardiomiopatije, saj jim z njo bistveno izboljšamo kakovost življenja.
Descriptors		HEART FAILURE, CONGESTIVE EXERCISE THERAPY EXERCISE TOLERANCE