Phone: 866-782-6258

Improving the Aerobic Capacity in Patients with CHF

Donald K. Shaw, PT, PhD, D.Min., FAACVPR

April 23, 2013



Do CHF patients improve aerobic capacity primarily through heart rate?


No they do not.  Here is the bottom line.  Because the central function, meaning the heart itself or the central mechanism. Because of rate limitations. Because of contraction limitations. The improvement in someone with CHF does not come through changes in central mechanism because we cannot count on that.  It comes through a second mechanism. Oxygen uptake is a function of stroke volume times heart rate times the AVO2 difference.  If my heart is shot, forgive me for that rather dramatic term, but if it is not going to be rehabable - it is not once the scar is formed - what mechanism homeostatically do I have to improve a patient's function?  Why not just say to them, "I am sorry, you have 3 to 5 years. You are just going to have to get your affairs in order."  How can we and why should we work with these patients?  Because it has been shown that when the central mechanism of the heart cannot function, the periphery's ability to extract oxygen picks up and helps make up for the deficit of the heart itself.  I had a physician one time say to me, "this patient is here to die.  They have an ejection fraction of 17. Just make them comfortable."  I said, "you keep them stable. I will get them stronger."  This patient was on a transplant list.  We got into a rehab program, and that patient was taken off the transplant list because we progressively exercised him.  We could not change the scarred heart.  The damage had been done, but the periphery, the muscles, improved their extraction of oxygen. That patient enjoyed an enhanced quality of life again due to the training that had improved oxygen extraction in the periphery.  That is our whole rationale for working with these patients.  That is a great question and provides the rationale for what it is that we do.  You may be backed against a wall one day being asked why are you working with that patient if their heart is bad?  Their periphery is not bad.  We can still make a difference that way.  


donald k shaw

Donald K. Shaw, PT, PhD, D.Min., FAACVPR

Donald K. Shaw is a Professor of Physical Therapy at Midwestern University. Prior to his present position, Dr. Shaw was an Associate Professor of Physical Therapy at Texas State University where he was Director of the Telehealth Program. In 1997 he joined the physical therapy faculty at East Carolina University serving as an Associate Professor in the Physical Therapy Department until 2002. He has also served as Director of Cardiac Rehabilitation at Saint Thomas Hospital in Nashville, Tennessee and as Adjunct Assistant Professor at Vanderbilt University.  Dr. Shaw is a Fellow and former national board member of the American Association of Cardiovascular and Pulmonary Rehabilitation. He has lectured and presented research in Argentina, Scotland, Ireland, Puerto Rico, the Dominican Republic, the Peoples Republic of China, and throughout the United States. His published work appears widely in medical journals including the Journal of Cardiopulmonary Rehabilitation, Respiratory Care, Medicine & Science in Sports & Exercise, Cardiopulmonary Physical Therapy Journal, Heart and Lung, Journal of Allied Health, and the American Journal of Cardiology.


Related Courses

Neuro Examination: Back to Basics
Presented by Jill Seale, PT, PhD, NCS
Recorded Webinar


Jill Seale, PT, PhD, NCS
Course: #3862Level: Introductory2 Hours
  'nice review of old info and highlights new resting options'   Read Reviews
This course will provide participants with a practical guide through the comprehensive neurological physical therapy examination. The course will progress from the neurological screen through all the specific areas of examination common in persons with neurological diagnoses. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 2 hours of Direct Access CE credit.

Initiate Management of Urinary Incontinence in Any PT Setting
Presented by Nicole Sadeghi, MPT
Recorded Webinar


Nicole Sadeghi, MPT
Course: #2866Level: Introductory2 Hours
  'Pretty good'   Read Reviews
This session will describe classifications of urinary incontinence, treatment and education to initiate in any physical therapy setting, and when to refer to a specialist. Constipation and pelvic organ prolapse will be addressed and its affects on urinary incontinence. Finally, patient care case studies will be presented that will help the learner with problem-solving how to incorporate pelvic floor interventions into their treatment plans, along with appropriate goal writing. The content of this course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Contemporary Guidelines for Exercise and Diabetes: Application to Physical Therapy Cases
Presented by Gina Pariser, PT, LDE, PhD
Recorded Webinar


Gina Pariser, PT, LDE, PhD
Course: #3387Level: Introductory2 Hours
  'This course was full of pertinent information; however, I felt it didn't focus on the learning outcomes primarily or practically'   Read Reviews
Physical activity is established as an important therapy in the prevention and management of diabetes and diabetes-related health comorbidities. This course reviews new guidelines related to physical activity for improving glucose control and cardiovascular health in people with Type 1 and Type 2 diabetes and highlights ways to apply these guidelines in different physical therapy cases. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Surgical Updates for Less Invasive Partial and Total Knee Replacement
Presented by Alexander P. Sah, MD
Recorded Webinar


Alexander P. Sah, MD
Course: #3139Level: Introductory1 Hour
  'i loved how Dr Sah explained everything and showed videos and success stories!'   Read Reviews
This course will cover surgical updates for both total knee replacement and partial knee replacement. It will include benefits of both surgeries and reasoning behind the surgical decision as well as operative technique, outcomes, and future directions. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Endurance Assessment and Intervention
Presented by Pamela Bartlo, PT, DPT, CCS
Recorded Webinar


Pamela Bartlo, PT, DPT, CCS
Course: #3404Level: Intermediate2 Hours
  'This course will help me as I work in home health'   Read Reviews
It is important to assess a patient's endurance and then provide interventions to improve it. It is not enough to just say someone has decreased endurance. We need to quantify it and progress it. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.