Upper-extremity exercise training in heart failure

PURPOSE: Aerobic exercise training (ExTR), predominately performed with lower extremities, has been used to reverse heart failure (HF)-related exercise intolerance. The present study determined the safety and efficacy of upper-extremity exercise in HF subjects because daily activities are performed using both upper and lower extremities and there is little cross-training effects between extremities. METHODS: Seven subjects underwent 36 sessions (40 minutes, 3 times per week for 12 weeks) of upper-extremity ExTR (ARM ExTR) using arm ergometers, the arm function of a NuStep device, and an Airdyne stationary cycle. Exercise intensity and duration during weeks 1 to 4 were gradually increased to achieve a 75% to 85% peak heart rate. Pre- and post-ExTR tests included arm ergometer cardiopulmonary testing with echocardiography and quality of life self-administered surveys. RESULTS: After ARM ExTR test duration increased by 22% (P =.008), respiratory exchange ratio increased by 10% (P =.02), whereas peak oxygen consumption was not improved. Echocardiographic parameters were not altered by ARM ExTR. The total scores of both the Minnesota Living With Heart Failure Questionnaire (P =.02) and the Medical Outcomes Study-36 questionnaire (P =.05) were improved, but the Functional Status Questionnaire scores were not improved. CONCLUSIONS: Although this study was limited in the number of subjects and lacked a control group, results indicate that ARM ExTR is safe and well-tolerated by persons diagnosed with HF, a finding that is relevant for individuals with HF who cannot exercise with lower extremities.