EXERCISE AND DIET IN CONGESTIVE HEART FAILURE

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Due to the high prevalence of coronary artery disease and hypertension the incidence of congestive heart failure increases 50 fold between the ages of 40 to 60 years and is currently a frequent and primary diagnosis in elderly Americans. Symptomatic reductions in left ventricular function result in marked declines in exercise capacity and functional independence. The peripheral maladaptation associated with heart failure result in detrimental changes in skeletal muscle, limb blood flow and arterial compliance. Recent small trials have shown that regular aerobic exercise training can improve the exercise tolerance of younger heart failure patients by peripheral adaptations. Unfortunately, these studies have not specifically addressed the feasibility and safety of aerobic exercise training in elderly heart failure patients. We propose that a regular exercise rehabilitation program will be a safe and effective clinical strategy to improve the functional limitations associated with heart failure in older populations. This study will enroll heart failure patients over the age of 60 years with NYHA class II and III congestive failure. Sixty heart failure patients will be randomized to an exercise intervention group and to "usual care." It is anticipated that exercise will result in a 15% increase in peak oxygen consumption and improved exercise capacity and increased functional independence. Maximal and submaximal exercise duration, peak oxygen consumption, muscle structure and function, limb blood flow neurohormonal activation and body composition will be assessed before and after training. This clinical trial will demonstrate that older heart failure patients can safely exercise with substantial improvement in the indices of functional independence.