Patient Recommendations for Congestive Heart Failure

Original Editor - Beau Lawrence Top Contributors - Dinalize Purcell, Lucinda hampton, Beau Lawrence and Kim Jackson

Introduction

Congestive heart failure (CHF) is condition that arises due to decreased myocardial function and leads to a decreased in quality of life as seen in this page dedicated to CHF .

Cardiac rehabilitation is a very promising management of CHF and physiotherapists play an important role in the multidisciplinary team. One part of cardiac rehabilitation is the patient recommendations and continued care post-discharge .

Bozkurt et al they suggest that a cardiac rehabilitation addressed exercise prescription, nutritional counseling, stress management and group support. It is also important that there is collaboration between the primary care team, the family and the patient.

Exercise specific recommendations

Exercise is important because it promotes vasodilation, increases muscle strength, improves quality of life, and decreases mortality.

Exercise can include aerobic or endurance training, resistance training, high-intensity interval training, and inspiratory training. For patients that have difficulty exercising they can also do localised small muscle group training.

Structured cardiac rehabilitation can be very beneficial, and it should be encouraged, however if this is not possible the following exercise recommendations can be given to people that are not in a formal CR program

Aerobic exercise:

Example of aerobic lifestyle exercise

• Lifestyle exercise such as walking, parking further away from the store, taking the stairs, dancing, walking your dog or incorporating hobbies such as gardening can be beneficial.
• Frequency: 3-5 times per week
• Intensity: it is recommended to be at low to moderate intensity, preferably lower than 14 on the Borg scale, or at resting heart rate plus 30 beats per minute . An easy way to remember this is you can talk but not sing while exercising.
• Time: the duration should start slow and be gradually increased to 45-60 min per day, this can be for example be broken up into 3 sessions of 15 min each.
• Type: rhythmic moderate continuous exercise such as walking, swimming, or biking.

Strength exercise:

The following are merely a summary of suggestions for exercise goals. It is important to evaluate each patient and take into account any risk factors for prescribing strength training, more information is available on the cardiac rehabilitation page.

• Frequency: 2-3 days per week, resting a day in between.
• Intensity: this depends on the person and the resistance used, however the goal is to reach 8-10 different exercises, with 8-16 repetitions each, and 1-3 sets of these repetitions
• Time: this also depends on the type and intensity of the exercise, but the goal can be an hour total duration. This can be split up into various sessions.
• Type: personal preference can be taken into account, commonly used are hand weights, resistance bands or body weight exercises such as push-ups.

Example of strength training with resistance bands

Words of caution:

The following are tips suggested by the American College of Sports Medicine (ACSM) to keep in mind when exercising with CHF

• As the person improves and gets stronger the intensity, incline or resistance of the exercises can be gradually increased.
• Start exercises with a warm-up and end with a cool down.
• Do not exercise in extreme weather.
• Keep breathing normally throughout exercises, specifically during strength training. If a person holds their breath during exercises it can cause dizziness.

The recommendations above are only a short summary, please read the following page on Physical Activity and Cardiovascular Disease for a more complete overview.

General recommendations

• It is important to stress the benefits of lifestyle modification for patients with CHF.
• It is recommended that patients alter their diet in order to live a healthier lifestyle. Dietary changes would consist of decreasing sodium intake and fatty foods, while increasing whole grains, fruits, and vegetables. Other educational tools are information on weight loss and label reading.
• In addition, patients should decrease alcohol consumption and smoking.
• Patients should also be educated on signs to monitor if their CHF is under control, and when to notify emergency personnel.  An easy way to monitor fluid retention is through a daily weighing. An increase in more than 5 pounds in 3 days is a sign to give the primary care physician a call.
• It is also pertinent to bring education to those patients at risk before the disease starts. Keeping patients in the primary prevention stage of the disease is much easier to manage and with less long-term effects. Patient education and lifestyle changes can be extremely effective in the management of CHF.
• Educate patients on self-care strategies for co-morbidities
• Teach patients how to recognise psychological stress and how to seek appropriate care
• Encourage return to work and hobbies
• Encourage patients to seek support from family, friends and to join a CHF support group

Illustration of healthy food

Additional Resources

Infographic by the American College of Sports Medicine on Being Active When You Have Heart Failure.