The clinical importance of cardiopulmonary exercise testing and aerobic training in patients with heart failure

Introduction: The appropriate physiological response to an acute bout of progressive aerobic exercise requires proper functioning of the pulmonary, cardiovascular and skeletal muscle systems. Unfortunately, these systems are all negatively impacted in patients with heart failure (HF), resulting in signifi cantly diminished aerobic capacity compared with apparently healthy individuals. Cardiopulmonary exercise testing (CPX) is a noninvasive assessment technique that provides valuable insight into the health and functioning of the physiological systems that dictate an individual’s aerobic capacity. The values of several key variables obtained from CPX, such as peak oxygen consumption and ventilatory effi ciency, are often found to be abnormal in patients with HF. In addition to the ability of CPX variables to acutely refl ect varying degrees of pathophysiology, they also possess strong prognostic signifi cance, further bolstering their clinical value. Once thought to be contraindicated in patients with HF, participation in a chronic aerobic exercise program is now an accepted lifestyle intervention. Following several weeks/months of aerobic exercise training, an abundance of evidence now demonstrates an improvement in several pathophysiological phenomena contributing to the abnormalities frequently observed during CPX in the HF population. These exercise-induced adaptations to physiological function result in a signifi cant improvement in aerobic capacity and quality of life. Conclusions: Furthermore, there is initial evidence to suggest that aerobic exercise training improves morbidity and mortality in patients with HF. This paper provides a review of the literature highlighting the clinical signifi cance of aerobic exercise testing and training in this unique cardiac population.