Eccentric Cycling: A Promising Modality for Patients with Chronic Heart Failure

Abstract

Purpose: Chronic heart failure (CHF) is characterized by dyspnea and poor exercise tolerance, which decreases aerobic capacity (V˙O2peak), a measure strongly correlated with quality of life and mortality. In healthy populations, eccentric (ECC) cycling can be performed at a lower oxygen demand for matched workload, compared with concentric (CON) cycling, but few studies have previously investigated ECC cycling in CHF. We hypothesized that, when matched for external workload (W), an ECC cycling bout would be performed at a lower cardiorespiratory load (V˙O2) than CON in patients with CHF.

Methods: Eleven CHF patients (10 males) with impaired left ventricular systolic function (ejection fraction 31% ± 12%) completed a CON V˙O2peak test, with the subsequent ECC and CON protocols set at 70% of individual maximal CON power (W). Oxygen consumption (V˙O2), RER, minute ventilation (V˙E), HR, and rate pressure product were compared between conditions.

Results: ECC was performed at a lower V˙O2 (12.3 ± 1.3 vs 14.1 ± 0.8 mL·kg·min, P = 0.01), RER (0.92 ± 0.02 vs 0.96 ± 0.01, P = 0.01), and V˙E (36.5 ± 4.4 vs 40.2 ± 2.0 L·min, P = 0.04) in comparison with CON, despite both conditions being performed at matched workloads. HR (101 ± 5 vs 96 ± 1 bpm, P = 0.06) and rate pressure product (13,539 ± 788 vs 11,911 ± 227 bpm·mm Hg, P = 0.15) were not significantly different between conditions.

Conclusion: When matched for external workload, ECC cycling can be performed with a lower oxygen demand than CON in patients with CHF. Eccentric cycling is a promising modality for cardiac rehabilitation in severely deconditioned patients with CHF.