Körperliches Training bei Herzinsuffizienz

Zusammenfassung

Zu den leitlinienempfohlenen Behandlungsmaßnahmen einer chronisch-stabilen Herzinsuffizienz gehört heutzutage unbedingt ein strukturiertes und regelmäßiges körperliches Training. Dieses steigert in erster Linie Belastbarkeit und Lebensqualität; Daten zur Verbesserung der Ventrikelfunktion, Senkung der Hospitalisierung oder Letalität werden divergent bewertet. Sowohl für Herzinsuffizienz mit reduzierter wie erhaltener Ejektionsfraktion gilt moderates Ausdauertraining weiterhin als Standardform. Trainiert wird i. d. R. auf Ergometern oder vergleichbaren Geräten zwischen 50 – 80% eines zur Trainingssteuerung gewählten Maximalparameters (z. B. Sauerstoffaufnahme, Herzfrequenz). Moderates Krafttraining stärkt bei den häufig muskulär dekonditionierten Patienten die Muskelkraft und ist additiv zu sehen. Hoch-intensives Intervalltraining hat sich zumindest für Patienten mit reduzierter Pumpfunktion nicht als vorteilhafter erwiesen und sollte daher aktuell zurückhaltend bewertet werden.

Abstract

Regular physical exercise has been implemented into current guidelines as a class IA recommendation for all patients with clinically stable heart failure. Exercise significantly increases exercise capacity and health-related quality of life, whereas improvements in ventricular function as well as reductions of hospitalization rates and mortality have not clearly been shown. For both heart failure with reduced and preserved ejection fraction, moderate continuous endurance training still represents the gold standard. This is usually performed on ergometers or similar devices at 50 – 80% of a maximal parameter chosen for prescription (e.g. peak oxygen uptake, maximal heart rate). Moderate resistance exercise improves muscular strength and is recommended as an adjunct. In contrast, high-intensity interval training has not been shown to be more effective at least in heart failure patients with reduced ejection fraction and is thus currently not recommended as a primary strategy.

Was ist wichtig?

• Körperliches Training sollte gemäß Leitlinien allen Patienten mit chronisch-stabiler Herzinsuffizienz zur Steigerung von Belastbarkeit und Lebensqualität angeboten werden.

• Moderates Ausdauertraining hat nach wie vor den höchsten Stellenwert, Krafttraining ist additiv zu sehen, hoch-intensives Intervalltraining ist gemäß aktueller Datenlage dagegen zurückhaltend zu bewerten.

Schlüsselwörter

Herzinsuffizienz - körperliches Training - Belastbarkeit - Lebensqualität

Key words

physical exercise - exercise capacity - quality of life - heart failure

• Literatur

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