Recovery of cardiac autonomic responsiveness with low-intensity physical training in patients with chronic heart failure

Eur J Heart Fail. 2002 Mar;4(2):159-66. doi: 10.1016/s1388-9842(01)00221-5.


Background: A gradual worsening of autonomic control of cardiovascular function accompanies the progression of heart failure. Exercise training modulates autonomic balance, and may affect the prognosis of the disease.

Aims: The sympathovagal balance was studied after 3 months of low-intensity rehabilitation compared with conventional therapy in 45 patients with heart failure (52% ischemic, 48% idiopathic), of whom 30 underwent rehabilitation and 15 did not. In 11 rehabilitated patients we also studied the effects on autonomic profile of 6 additional months of home-based training. Rehabilitated and non-rehabilitated patients had similar NYHA class, ejection fraction, exercise pVO2; 50% assumed carvedilol (39+/-5 mg/day).

Methods and results: Autoregressive power spectral density of RR intervals variability were assessed during 10 min of: (1) supine rest and free breathing; (2) supine rest and breathing at 20 acts/min (=vagal stimulus); (3) standing (=sympathetic stimulus). During each period, the ratio LF/HF of the individual autospectrum indicated the sympathovagal balance. After 3 months of rehabilitation, pVO2 increased (20%); LF/HF at rest was unchanged (8.7+/-1.2 vs. 9.2+/-1.2); it decreased with controlled breathing (-18%) and increased during standing (+79%) (P<0.05). These changes were more evident after 6 months of home-based training, when pVO2 was still high: LF/HF at rest was reduced (5.4+/-0.9 vs. 8.5+/-2.1), decreased during controlled breathing (-17%) and increased during standing (87%) (P<0.05). No changes in any variable were seen in non-rehabilitated patients.

Conclusions: A low intensity rehabilitation program restores autonomic tone and reactivity to vagal and sympathetic stimuli. Some of these effects are already evident after the initial hospital-based phase.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Aged
  • Anaerobic Threshold / physiology
  • Autonomic Nervous System / physiology*
  • Chronic Disease
  • Exercise Therapy*
  • Exercise Tolerance / physiology
  • Female
  • Heart / innervation*
  • Heart / physiopathology
  • Heart Failure / physiopathology*
  • Heart Failure / therapy*
  • Heart Rate / physiology
  • Humans
  • Male
  • Middle Aged
  • Recovery of Function / physiology*
  • Stroke Volume / physiology
  • Time
  • Treatment Outcome