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Trainingstherapie bei Herzinsuffizienz

Exercise training in heart failure

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Zusammenfassung

Körperliches Training bei stabiler chronischer Herzinsuffizienz ist neben pharmakologischen und nichtpharmakologischen Behandlungskonzepten eine in den aktuellen Leitlinien empfohlene und besonders bei eingeschränkter linksventrikulärer (LV) Funktion [“heart failure with reduced ejection fraction“ (HFrEF)] breit akzeptierte Therapieoption. Eine Vielzahl randomisierter Studien zu körperlichem Training bei HFrEF und eine wachsende Zahl von Studien zu Herzinsuffizienz mit erhaltener LV-Funktion [“heart failure with preserved ejection fraction“ (HFpEF)] belegen, dass die Belastungstoleranz, Symptomatik und Lebensqualität signifikant verbessert werden können. Ursächlich hierfür sind durch körperliches Training induzierte Verbesserungen der zentralen Hämodynamik, der Endothelfunktion, der Inflammation, der neurohumoralen Aktivierung, aber auch der Skelettmuskulatur. HF-ACTION, die größte randomisierte, kontrollierte Studie zu körperlichem Training, zeigte für Patienten mit HFrEF in Abhängigkeit von der Compliance einen positiven Effekt auf Mortalität und Hospitalisierungen. Bei HFpEF fehlen Studien zu den prognostischen Effekten von Training bislang. Neben der Compliance beeinflussen auch die gewählte Trainingsintensität und -modalität die Wirksamkeit von körperlichem Training. So scheinen eine höhere Intensität und ein zusätzlich zum aeroben Ausdauertraining durchgeführtes Krafttraining vorteilhaft zu sein. Individualisierte Trainingskonzepte sollten zukünftig dazu beitragen, eine langfristige Motivation zum körperlichen Training bei Herzinsuffizienz aufrechtzuerhalten.

Abstract

Exercise training in patients with chronic stable heart failure (HF) is a recommended and broadly accepted treatment strategy that is an integral part of an evidence-based management involving pharmacological and non-pharmacological therapies. There is ample scientific evidence that exercise training in HF with reduced (HFrEF) and with preserved ejection fraction (HFpEF) improves exercise capacity, HF symptoms and quality of life. This is due to an improvement of central hemodynamics, endothelial function, neurohumoral activation, skeletal muscle structure and function as well as a decrease in inflammatory markers. The largest randomized, controlled HF-ACTION study (Heart Failure-A Controlled Trial Investigating Outcomes of exercise TraiNing) demonstrated that exercise training results in a modest improvement of all-cause mortality and hospitalizations in HFrEF, depending on adequate compliance. Outcome data in HFpEF are lacking. Besides compliance, efficacy of exercise training is dependent on the intensity and type of exercise. Resistance and high intensity endurance training in addition to a standard aerobic exercise seem to be superior in improving the clinical status of HF patients. In the future, individualized exercise programs will help to improve long-term adherence to exercise training.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. F. Edelmann, V. Grabs und M. Halle geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to F. Edelmann.

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F. Edelmann und V. Grabs sind als gleichberechtige Erstautoren anzusehen.

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Edelmann, F., Grabs, V. & Halle, M. Trainingstherapie bei Herzinsuffizienz. Internist 55, 669–675 (2014). https://doi.org/10.1007/s00108-013-3429-y

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