EFFECT OF EXERCISE TRAINING ON DIASTOLIC FUNCTION

老年人的充血性心力衰竭(CHF)是一个主要的卫生保健问题。它影响着300多万美国人，每年有40多万新病例和80万人住院。虽然其他疾病正在下降，但CHF是唯一正在增加的主要心血管疾病。因此，CHF被称为90年代的心血管流行病，并被指定为国家研究重点。虽然CHF的增加是多因素的，但CHF的增加很大程度上与美国人口老龄化有关。在美国老年人中，心力衰竭是最常见的出院诊断，是致病和致死事件的主要原因，每年消耗约100亿美元的医疗保健费用。大多数老年CHF患者患有舒张性心力衰竭，这是一种相对较新的认识，但最近的研究表明，老年患者CHF的50%以上是由舒张性心力衰竭引起的。尽管舒张性心力衰竭的发病率很高，并且对公众健康有很大的影响，尤其是对老年人，但关于舒张性心力衰竭的病理生理、诊断、预后和治疗方面的数据很少。这一实体可能代表了以前没有进行过系统调查的最大的心血管患者队列。舒张性心力衰竭患者有运动不耐受：疲劳和劳累时呼吸困难的症状。我们的研究重点是确定这一人群运动不耐受的原因，因为这是舒张性心力衰竭的主要慢性症状，可能导致残疾和生活质量下降。为了指导治疗干预，有必要对这一关键方面的病理生理学有一个清楚的了解。因此，本研究旨在测试运动训练对老年充血性心力衰竭的益处。运动训练是一种逐渐增加伸展运动、步行运动和静止自行车运动的计划，已被证明显著改善了中青年CHF患者的整体心血管功能。这项研究的目的是确定老年充血性心力衰竭患者是否也能同样受益。

Congestive heart failure (CHF) in the elderly is a major health care problem. It afflicts over 3 million Americans, with over 400,000 new cases and 800,000 hospitalizations annually. While others are declining, CHF is the only major cardiovascular disorder that is increasing. As a result, CHF has been termed the cardiovascular epidemic of the nineties and has been designated a national research priority. Although multifactorial, the increase in CHF is largely related to the aging of the U.S. population. Among older Americans, heart failure is the most frequent hospital discharge diagnosis, is a major cause of morbid and mortal events, and consumes approximately 10 billion health care dollars per year. Most older CHF patients have diastolic heart failure, an entity that was relatively recently recognized, but that recent research suggests accounts for more than 50% of CHF in older patients. Despite the high prevalence and the substantial public health implications particularly for the elderly, few data available regarding the pathophysiology, diagnosis, prognosis, and therapy of diastolic heart failure. This entity may represent the largest cohort of cardiovascular patients that has not previously been systematically investigated. Patients with diastolic heart failure have exercise intolerance: symptoms of fatigue and dyspnea with exertion. Our research has focused on determining the causes of exercise intolerance in this population, since this is the primary chronic symptom of diastolic heart failure and can results in disability and poor quality of life. A clear understanding of the pathophysiology of this pivotal aspect is necessary in order to guide therapeutic interventions. This research study is therefore to test the benefit of exercise training in elderly with congestive heart failure. Exercise training is a program of gradually increasing stretching, walking, and stationary bicycle exercises that has been shown to significantly improve overall cardiovascular function in young and middle-aged patient with CHF. The purpose of this study is to determine whether older patients with CHF can benefit similarly.