[Cardiac rehabilitation in patients with heart failure--is there a treatment beyond pharmacotherapy, surgery and device implantation?].

The reduced exercise capacity of patients with chronic heart failure cannot be explained solely on the basis of cardiac dysfunction. It seems to be the case that within the frame of the disease progression the importance of peripheral factors steadily increases. Chronic diminished perfusion of skeletal muscles, inactivity as well as harmful neuro-humoral activation leads to myopathy with loss of mitochondria and capillaries and to increased fibrosis. A systematic, controlled and properly dosed training improves in heart failure patients their cardiac symptoms like dyspnoe and exercise capacity. In addition an improved quality of life, augmented ejection fraction, diminished enddiastolic dimensions, improved respiratory efficiency will be achieved and the incidence of rehospitalization decreased. In the European guidelines there is a "class I recommendation" that is of the same class as the recommendation for a pharmacological standard therapy. The exact mechanism of the training of patients with heart failure is not known. In patients with ischemic heart failure training improves the myocardial perfusion due to a reduction of the endothelial dysfunction, and furthermore the training promotes collateralisation due to intermittend ischemic stimuli. The training is counteracting peripheral myopathy and it diminishes or even reverses the development of cardiac cachexia. In comparison of the prevalence of heart failure as well as the importance of training the referral pattern of some 500 patients per year encompasing all Swiss rehabilitation centers is considerably less than one would wish for. Heart failure exercise training should be started in a properly equipped center and evidenced with the advantage that it could be continued at home as a life long procedure.