From the Guidelines
For patients with dilated cardiomyopathy, the recommended initial workout should be low-intensity, supervised exercise starting with short durations and gradually increasing in intensity and duration, as supported by the 2013 ACCF/AHA guideline for the management of heart failure 1.
Key Considerations
- The initial stage of exercise training should have a low intensity, with a goal of achieving an exercise duration of 10–15 min before increasing intensity or duration, as recommended by the European Heart Journal in 2001 1.
- Exercise should be initiated only after medical stabilization and ideally under cardiac rehabilitation supervision initially.
- The American College of Cardiology Foundation/American Heart Association task force on practice guidelines recommends exercise training as a Class I recommendation for patients with heart failure who are able to participate to improve functional status 1.
Exercise Details
- Low-intensity aerobic exercise, such as walking on level ground or using a stationary bike at low resistance, is ideal to begin with.
- Heart rate should generally be kept below 120 beats per minute or at 50-70% of maximum heart rate.
- Patients should maintain the ability to comfortably hold a conversation during exercise (the "talk test").
- Patients should be instructed to stop exercising immediately if they experience chest pain, excessive shortness of breath, dizziness, or unusual fatigue.
Benefits of Exercise
- Exercise has been shown to improve endothelial function, reduce inflammation, and enhance cardiac remodeling in dilated cardiomyopathy patients when properly prescribed and monitored.
- Regular physical activity can improve functional status and quality of life in patients with heart failure, as supported by the 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults 1.
From the Research
Initial Workout for Dilated Cardiomyopathy
The recommended initial workout for a patient with dilated cardiomyopathy is a topic of interest, and several studies have investigated the effects of exercise on patients with this condition.
- The optimal exercise prescription for patients with dilated cardiomyopathy is not well established, but a systematic review 2 suggests that exercise frequency should range from 3 to 5 times per week, with an intensity of 50% to 80% of oxygen uptake reserve.
- Exercise time can be as high as 45 minutes by the final month of the exercise prescription, and the type of exercise should mainly be aerobic exercise and resistance training.
- Another study 3 found that exercise training improves left ventricular diastolic filling in patients with dilated cardiomyopathy, which can account for an increase in exercise capacity.
- The improvement in peak VO2 is significantly correlated with an increase in peak early filling rate and peak filling rate, as well as a decrease in atrial filling rate.
Key Considerations
When designing an initial workout for a patient with dilated cardiomyopathy, several key considerations should be taken into account:
- The patient's individual exercise capacity and medical history should be assessed to determine the appropriate intensity and frequency of exercise.
- The exercise program should be tailored to the patient's specific needs and goals, and should include a combination of aerobic and resistance training exercises.
- Regular monitoring and evaluation of the patient's progress and response to exercise is crucial to ensure safety and efficacy.
Additional Factors
Other factors that may influence the initial workout for a patient with dilated cardiomyopathy include:
- The use of beta-blockers, which has been shown to prevent deterioration of left ventricular systolic function in patients with recovered dilated cardiomyopathy 4.
- The patient's overall health and medical status, including the presence of any comorbidities or underlying conditions that may affect their ability to exercise safely.