Análisis del ejercicio físico en la Insuficiencia Cardíaca
DOI:
https://doi.org/10.19230/jonnpr.4442Palabras clave:
Insuficiencia cardiaca; Actividad fisica; Rehabilitacion cardiacaResumen
La rehabilitación cardiaca (RC) ha demostrado ser una intervención eficaz y segura para mejorar el pronóstico de los pacientes con insuficiencia cardiaca (IC). Sin embargo, existen dudas sobre cuál es el mejor método de entrenamiento en estos pacientes. Actualmente, el más recomendado es el entrenamiento aeróbico continuo de intensidad moderada (MICT). En este trabajo se compara este tipo de entrenamiento con el entrenamiento de alta intensidad basado en intervalos (HIIT). La variable de estudio principal es la capacidad física, medida con el Vo2max. Además, también se valoran la función cardiaca y la calidad de vida relacionada con la salud. Se obtiene una ligera mejoría con HIIT, pero ambos métodos son eficaces y válidos, por lo que lo más importante será la individualización en función de las características, contexto y preferencias de cada paciente. Por otro lado, también se compara el entrenamiento basado en MICT en solitario con el entrenamiento concurrente, es decir, la combinación de MICT y entrenamiento de fuerza (EF), obteniendo conclusiones favorables para el segundo grupo. De esta manera, el EF no sustituye al entrenamiento aeróbico, pero si es fundamental para complementarlo ya que las adaptaciones son diferentes y el aumento de la fuerza y masa muscular en pacientes con IC es altamente beneficioso.
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Pullen AB, Jadapalli JK, Rhourri-Frih B, Halade GV. Re-evaluating the Causes and Consequences of Non-Resolving Inflammation in Chronic Cardiovascular Disease. Heart Fail Rev. marzo de 2020;25(2):381-91.
Danesh J, Whincup P, Walker M, Lennon L, Thomson A, Appleby P, et al. Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses. BMJ. 22 de julio de 2000;321(7255):199-204.
Estadísticas de ECV 2017 [Internet]. [citado 2 de mayo de 2021]. Disponible en: https://ehnheart.org/cvd-statistics/cvd-statistics-2017.html
Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 1 de agosto de 2016;37(29):2315-81.
Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 1 de enero de 2021;42(1):17-96.
Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. diciembre de 2015;25 Suppl 3:1-72.
European Association of Cardiovascular Prevention and Rehabilitation Committee for Science Guidelines, EACPR, Corrà U, Piepoli MF, Carré F, Heuschmann P, et al. Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur Heart J. agosto de 2010;31(16):1967-74.
Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JAM, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. J Cardiopulm Rehabil Prev. junio de 2007;27(3):121-9.
Cowie A, Buckley J, Doherty P, Furze G, Hayward J, Hinton S, et al. Standards and core components for cardiovascular disease prevention and rehabilitation. Heart. 1 de abril de 2019;105(7):510-5.
Corbin CB, Pangrazi RP, Franks BD. Definitions: Health, Fitness, and Physical Activity. President’s Council on Physical Fitness and Sports Research Digest. President’s Council on Physical Fitness and Sports, 200
Independence Avenue, S; 2000.
Fletcher GF, Balady G, Froelicher VF, Hartley LH, Haskell WL, Pollock ML. Exercise standards. A statement for healthcare professionals from the American Heart Association. Writing Group. Circulation. 15 de enero de 1995;91(2):580-615.
Ponikowski P, Anker SD, AlHabib KF, Cowie MR, Force TL, Hu S, et al. Heart failure: preventing disease and death worldwide. ESC Heart Fail. septiembre de 2014;1(1):4-25.
Piepoli MF, Davos C, Francis DP, Coats AJS, ExTraMATCH Collaborative. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ. 24 de enero de 2004;328(7433):189.
Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, Coats AJ, et al. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev. 29 de enero de 2019;1:CD003331.
Taylor RS, Walker S, Smart NA, Piepoli MF, Warren FC, Ciani O, et al. Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual patient data meta-analysis of randomised trials. Eur J Heart Fail. diciembre de 2018;20(12):1735-43.
Rees K, Taylor RS, Singh S, Coats AJS, Ebrahim S. Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev. 2004;(3):CD003331.
Taylor RS, Walker S, Smart NA, Piepoli MF, Warren FC, Ciani O, et al. Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis. J Am Coll Cardiol. 2 de abril de 2019;73(12):1430-43.
O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 8 de abril de 2009;301(14):1439-50.
Sagar VA, Davies EJ, Briscoe S, Coats AJS, Dalal HM, Lough F, et al. Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart. 2015;2(1):e000163.
Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, et al. Guía ESC 2020 sobre cardiología del deporte y ejercicio físico en pacientes con enfermedad cardiovascular. Rev Esp Cardiol [Internet]. [citado 1 de mayo de 2021]; Disponible en: http://www.revespcardiol.org/es-guia-esc-2020-sobre-cardiologia-avance-S0300893221000750
Gielen S, Adams V, Niebauer J, Schuler G, Hambrecht R. Aging and heart failure--similar syndromes of exercise intolerance? Implications for exercise-based interventions. Heart Fail Monit. 2005;4(4):130-6.
Piepoli MF, Conraads V, Corrà U, Dickstein K, Francis DP, Jaarsma T, et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. abril de 2011;13(4):347-57.
El-Sayed MS, El-Sayed Ali Z, Ahmadizad S. Exercise and training effects on blood haemostasis in health and disease: an update. Sports Med Auckl NZ. 2004;34(3):181-200.
Milani RV, Lavie CJ, Mehra MR. Reduction in C-reactive protein through cardiac rehabilitation and exercise training. J Am Coll Cardiol. 17 de marzo de 2004;43(6):1056-61.
Malfatto G, Blengino S, Annoni L, Branzi G, Bizzi C, Facchini M. Original articles primary coronary angioplasty and subsequent cardiovascular rehabilitation are linked to a favorable sympathovagal balance after a first anterior myocardial infarction. Ital Heart J Off J Ital Fed Cardiol. enero de 2005;6(1):21-7.
Linke A, Erbs S, Hambrecht R. Effects of exercise training upon endothelial function in patients with cardiovascular disease. Front Biosci J Virtual Libr. 1 de enero de 2008;13:424-32.
Papadakis S, Oldridge NB, Coyle D, Mayhew A, Reid RD, Beaton L, et al. Economic evaluation of cardiac rehabilitation: a systematic review. Eur J Cardiovasc Prev Rehabil Off J Eur Soc Cardiol Work Groups Epidemiol Prev Card Rehabil Exerc Physiol. diciembre de 2005;12(6):513-20.
Pandey A, Parashar A, Kumbhani D, Agarwal S, Garg J, Kitzman D, et al. Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials. Circ Heart Fail. enero de 2015;8(1):33-40.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 15 de octubre de 2013;62(16):e147-239.
Bjarnason-Wehrens B, McGee H, Zwisler A-D, Piepoli MF, Benzer W, Schmid J-P, et al. Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey. Eur J Cardiovasc Prev Rehabil. 1 de agosto de 2010;17(4):410-8.
Tjønna AE, Lee SJ, Rognmo Ø, Stølen TO, Bye A, Haram PM, et al. Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation. 22 de julio de 2008;118(4):346-54.
Carbone S, Kirkman DL, Garten RS, Rodriguez-Miguelez P, Artero EG, Lee D-C, et al. Muscular Strength and Cardiovascular Disease: AN UPDATED STATE-OF-THE-ART NARRATIVE REVIEW. J Cardiopulm Rehabil Prev. septiembre de 2020;40(5):302-9.
Stamatakis E, Lee I-M, Bennie J, Freeston J, Hamer M, O’Donovan G, et al. Does Strength-Promoting Exercise Confer Unique Health Benefits? A Pooled Analysis of Data on 11 Population Cohorts With All-Cause, Cancer, and Cardiovascular Mortality Endpoints. Am J Epidemiol. 1 de mayo de 2018;187(5):1102-12.
Giuliano C, Karahalios A, Neil C, Allen J, Levinger I. The effects of resistance training on muscle strength, quality of life and aerobic capacity in patients with chronic heart failure - A meta-analysis. Int J Cardiol. 15 de enero de 2017;227:413-23.
Hwang C-L, Chien C-L, Wu Y-T. Resistance training increases 6-minute walk distance in people with chronic heart failure: a systematic review. J Physiother. 1 de enero de 2010;56(2):87-96.
Corrà U, Agostoni PG, Anker SD, Coats AJS, Crespo Leiro MG, de Boer RA, et al. Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. enero de 2018;20(1):3-15.
Scherr J, Wolfarth B, Christle JW, Pressler A, Wagenpfeil S, Halle M. Associations between Borg’s rating of perceived exertion and physiological measures of exercise intensity. Eur J Appl Physiol. enero de 2013;113(1):147-55.
Wisløff U, Støylen A, Loennechen JP, Bruvold M, Rognmo Ø, Haram PM, et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation. 19 de junio de 2007;115(24):3086-94.
Ellingsen Ø, Halle M, Conraads V, Støylen A, Dalen H, Delagardelle C, et al. High-Intensity Interval Training in Patients With Heart Failure With Reduced Ejection Fraction. Circulation. 28 de febrero de 2017;135(9):839-49.
Benda NMM, Seeger JPH, Stevens GGCF, Hijmans-Kersten BTP, van Dijk APJ, Bellersen L, et al. Effects of High-Intensity Interval Training versus Continuous Training on Physical Fitness, Cardiovascular Function and Quality of Life in Heart Failure Patients. PloS One. 2015;10(10):e0141256.
Dimopoulos S, Anastasiou-Nana M, Sakellariou D, Drakos S, Kapsimalakou S, Maroulidis G, et al. Effects of exercise rehabilitation program on heart rate recovery in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil Off J Eur Soc Cardiol Work Groups Epidemiol Prev Card Rehabil Exerc Physiol. febrero de 2006;13(1):67-73.
Freyssin C, Verkindt C, Prieur F, Benaich P, Maunier S, Blanc P. Cardiac rehabilitation in chronic heart failure: effect of an 8-week, high-intensity interval training versus continuous training. Arch Phys Med Rehabil. agosto de 2012;93(8):1359-64.
Fu T-C, Wang C-H, Lin P-S, Hsu C-C, Cherng W-J, Huang S-C, et al. Aerobic interval training improves oxygen uptake efficiency by enhancing cerebral and muscular hemodynamics in patients with heart failure. Int J Cardiol. 15 de julio de 2013;167(1):41-50.
Koufaki P, Mercer TH, George KP, Nolan J. Low-volume high-intensity interval training vs continuous aerobic cycling in patients with chronic heart failure: a pragmatic randomised clinical trial of feasibility and effectiveness. J Rehabil Med. abril de 2014;46(4):348-56.
Roditis P, Dimopoulos S, Sakellariou D, Sarafoglou S, Kaldara E, Venetsanakos J, et al. The effects of exercise training on the kinetics of oxygen uptake in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil Off J Eur Soc Cardiol Work Groups Epidemiol Prev Card Rehabil Exerc Physiol. abril de 2007;14(2):304-11.
Smart NA, Steele M. A comparison of 16 weeks of continuous vs intermittent exercise training in chronic heart failure patients. Congest Heart Fail Greenwich Conn. agosto de 2012;18(4):205-11.
Ulbrich AZ, Angarten VG, Schmitt Netto A, Sties SW, Bündchen DC, Mara LS de, et al. Comparative effects of high intensity interval training versus moderate intensity continuous training on quality of life in patients with heart failure: Study protocol for a randomized controlled trial. Clin Trials Regul Sci Cardiol. 1 de enero de 2016;13:21-8.
Nechwatal RM, Duck C, Gruber G. Körperliches Training als Intervall- oder kontinuierliches Training bei chronischer Herzinsuffizienz zur Verbesserung der funktionellen Leistungskapazität, Hämodynamik und Lebensqualität – eine kontrollierte Studie. Z Für Kardiologie. 1 de abril de 2002;91(4):328-37.
Iellamo F, Manzi V, Caminiti G, Vitale C, Castagna C, Massaro M, et al. Matched dose interval and continuous exercise training induce similar cardiorespiratory and metabolic adaptations in patients with heart failure. Int J Cardiol. 10 de septiembre de 2013;167(6):2561-5.
Iellamo F, Caminiti G, Sposato B, Vitale C, Massaro M, Rosano G, et al. Effect of High-Intensity interval training versus moderate continuous training on 24-h blood pressure profile and insulin resistance in patients with chronic heart failure. Intern Emerg Med. agosto de 2014;9(5):547-52.
Ismail H, McFarlane JR, Nojoumian AH, Dieberg G, Smart NA. Clinical outcomes and cardiovascular responses to different exercise training intensities in patients with heart failure: a systematic review and meta-analysis. JACC Heart Fail. diciembre de 2013;1(6):514-22.
Haykowsky MJ, Timmons MP, Kruger C, McNeely M, Taylor DA, Clark AM. Meta-analysis of aerobic interval training on exercise capacity and systolic function in patients with heart failure and reduced ejection fractions. Am J Cardiol. 15 de mayo de 2013;111(10):1466-9.
Gomes Neto M, Durães AR, Conceição LSR, Saquetto MB, Ellingsen Ø, Carvalho VO. High intensity interval training versus moderate intensity continuous training on exercise capacity and quality of life in patients with heart failure with reduced ejection fraction: A systematic review and meta-analysis. Int J Cardiol. 15 de junio de 2018;261:134-41.
Mandic S, Tymchak W, Kim D, Daub B, Quinney HA, Taylor D, et al. Effects of aerobic or aerobic and resistance training on cardiorespiratory and skeletal muscle function in heart failure: a randomized controlled pilot trial. Clin Rehabil. marzo de 2009;23(3):207-16.
Degache F, Garet M, Calmels P, Costes F, Bathélémy J-C, Roche F. Enhancement of isokinetic muscle strength with a combined training programme in chronic heart failure. Clin Physiol Funct Imaging. 2007;27(4):225-30.
Beckers PJ, Denollet J, Possemiers NM, Wuyts FL, Vrints CJ, Conraads VM. Combined endurance-resistance training vs. endurance training in patients with chronic heart failure: a prospective randomized study. Eur Heart J. agosto de 2008;29(15):1858-66.
Vromen T, Kraal JJ, Kuiper J, Spee RF, Peek N, Kemps HM. The influence of training characteristics on the effect of aerobic exercise training in patients with chronic heart failure: A meta-regression analysis. Int J Cardiol. 1 de abril de 2016;208:120-7.
Groennebaek T, Vissing K. Impact of Resistance Training on Skeletal Muscle Mitochondrial Biogenesis, Content, and Function. Front Physiol. 2017;8:713.
Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 31 de julio de 2007;116(5):572-84.
Severinsen MCK, Pedersen BK. Muscle-Organ Crosstalk: The Emerging Roles of Myokines. Endocr Rev. 1 de agosto de 2020;41(4).
Ihalainen JK, Ahtiainen JP, Walker S, Paulsen G, Selänne H, Hämäläinen M, et al. Resistance training status modifies inflammatory response to explosive and hypertrophic resistance exercise bouts. J Physiol Biochem. noviembre de 2017;73(4):595-604.
Ribeiro AS, Deminice R, Schoenfeld BJ, Tomeleri CM, Padilha CS, Venturini D, et al. Effect of Resistance Training Systems on Oxidative Stress in Older Women. Int J Sport Nutr Exerc Metab. octubre de 2017;27(5):439-47.
Piccirillo R. Exercise-Induced Myokines With Therapeutic Potential for Muscle Wasting. Front Physiol. 2019;10:287.
Srikanthan P, Horwich TB, Tseng CH. Relation of Muscle Mass and Fat Mass to Cardiovascular Disease Mortality. Am J Cardiol. 15 de abril de 2016;117(8):1355-60.
Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. junio de 2013;14(6):392-7.
Hunter GR, McCarthy JP, Bamman MM. Effects of resistance training on older adults. Sports Med Auckl NZ. 2004;34(5):329-48.
Conraads VM, Beckers PJ. Exercise training in heart failure: practical guidance. Heart Br Card Soc. diciembre de 2010;96(24):2025-31.
Eaton SB, Eaton SB. Physical Inactivity, Obesity, and Type 2 Diabetes: An Evolutionary Perspective. Res Q Exerc Sport. marzo de 2017;88(1):1-8
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In Memoriam Jesús Manuel Culebras Fernández 
