Features March 2012 Issue

Leg Fatigue Treatment Vital for Heart Failure Patients

Physicians shouldn’t just treat the heart muscle in heart failure (HF) patients. A recent study in the Oct. 31, 2011 issue of the Journal of Applied Psychology found that leg muscle dysfunction, and in particular leg fatigue, is related to the severity of HF symptoms. That means that HF patients may face more obstacles than just a weaker heart in trying to get their daily exercise.

Slow walking, with a proper warm-up to avoid leg fatigue and discomfort, can be an appropriate exercise for patients with heart failure.

But researchers also found that in HF patients, aside from those with the most severe symptoms, proper warm-up and leg exercises can raise the energy level and performance of their leg muscles.

Mike Crawford, MS, program manager of Cleveland Clinic’s cardiac rehabilitation program, says the systemic effects of HF are complex. Leg fatigue, for example, may be partly due to a reduction in the flow of oxygenated blood to the leg muscles, as well as vasoconstriction and skeletal muscle cell injury.

“Ultimately the cascade of events lead to skeletal muscle weakening and inefficiency, resulting in symptoms of fatigue, as well as shortness of breath,” Crawford explains.

Other common HF symptoms, such as shortness of breath, palpitations and lightheadedness, can also make exercise more uncomfortable, he adds.

“Most HF patients are treated with medications, and some are treated with devices such as pacemakers or defibrillators,” Crawford says. “All of these factors may impact exercise performance.”

Improving Exercise
Whether or not you have HF, warming up before exercise is important to allow your body to prepare for physical activity. HF patients shouldn’t feel they need to do anything too ambitious to gain some benefit from exercise, Crawford says.

Daily exercise has multiple benefits, ranging from strengthening the heart muscles and lung capacity to boosting your energy level and improving your quality of sleep at night.

Slow walking, cycling or marching in place are all good examples. However, if you have HF or any heart condition, talk with your doctor first about any new exercise program and about any problems you may be experiencing, such as leg fatigue or soreness. Pay attention to the signals your body is sending you, and be willing to do simple exercises.

The key isn’t necessarily how strenuous they are, but that they are done every day, or at least most days of the week.

“Basically, anything that uses the large muscle groups in a repetitive motion is adequate,” Crawford says. “The key is to ensure the difficulty of the activity is somewhere between your resting state and what you want to do for the conditioning phase of your exercise session.”

For example, if you normally walk at 2.5 mph, start out walking at 1.5 mph and increase by 0.2 mph every minute until you achieve your exercise pace, Crawford recommends.

“A good warm-up should last three to five minutes to get all the body’s systems up and running as efficiently as possible,” he says.

If you have been diagnosed with HF, but have not participated in a cardiac rehab program, ask your doctor about referring you to such a program. A standard 12-week cardiac rehab is usually covered by most insurers and Medicare, and it provides patients with important exercise advice, diet tips and other information all in a supervised setting to help you get used to your life as a heart patient.