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Erschienen in: Herz 6/2013

01.09.2013 | Schwerpunkt

Körperliches Training bei Herzinsuffizienz

verfasst von: PD Dr. F. Edelmann, B. Pieske

Erschienen in: Herz | Ausgabe 6/2013

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Zusammenfassung

Zusätzlich zu verschiedenen pharmakologischen und nichtpharmakologischen Behandlungskonzepten ist körperliches Training bei stabiler chronischer Herzinsuffizienz eine in den aktuellen Leitlinien empfohlene und besonders bei eingeschränkter LV-Funktion (HFrEF) breit akzeptierte Therapieoption. Die pathophysiologischen Ursachen, die für die Belastungsintoleranz bei Herzinsuffizienzpatienten verantwortlich sind, sind vielfältig. Neben zentral hämodynamischen und vaskulären Komponenten sind auch ventilatorische, peripher muskuläre sowie neurohumorale und inflammatorische Ursachen zu finden. Eine Vielzahl von randomisierten Studien zu körperlichem Training bei HFrEF und eine wachsende Zahl von Studien zu Herzinsuffizienz mit erhaltener LV-Funktion (HFpEF) belegen, dass Belastungstoleranz, Symptomatik und Lebensqualität signifikant verbessert werden können. Gründe hierfür sind durch körperliches Training induzierte Verbesserungen der zentralen Hämodynamik, der Endothelfunktion, der Inflammation, der neurohumoralen Aktivierung, aber auch des Skelettmuskelmetabolismus und der peripher muskulären Struktur. Im Gegensatz zu einer wegweisenden Metaanalyse zeigte die randomisierte HF-ACTION-Studie für Patienten mit HFrEF lediglich einen gering positiven Effekt auf Mortalität und Hospitalisierungen jeglicher Ursache. Prognostische Untersuchungen fehlen bislang für HFpEF. Unabhängig davon ist die Wirksamkeit von körperlichem Training auch durch die gewählte Trainingsintensität und -modalität beeinflusst. So scheinen eine höhere Intensität und ein zusätzlich zum aeroben Ausdauertraining durchgeführtes Krafttraining vorteilhaft zu sein. Trotz der zunehmenden Evidenz zur Durchführung von körperlichem Training bei Herzinsuffizienz bleiben relevante Herausforderungen bei dessen täglicher therapeutischer Umsetzung bestehen. Das interaktive Management der Patienten ist aufwändig und die Finanzierung der Programme ungenügend. Außerdem fehlen individualisierte Konzepte zur Aufrechterhaltung der Compliance.
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Metadaten
Titel
Körperliches Training bei Herzinsuffizienz
verfasst von
PD Dr. F. Edelmann
B. Pieske
Publikationsdatum
01.09.2013
Verlag
Urban & Vogel
Erschienen in
Herz / Ausgabe 6/2013
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI
https://doi.org/10.1007/s00059-013-3918-8

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