hronic heart failure (CHF) is characterized by depressed left ventricular performance and changes in peripheral tissue, such as impaired peripheral blood flow, 1,2 abnormalities of mitochondrial structure and function, alterations in the oxidative metabolism of skeletal muscle and atrophy of predominantly oxidative insulinsensitive slow twitch (type I) fibers, resulting in a relatively larger proportion of glycolytic, less insulin-sensitive fast twitch (type IIb) fibers. [3][4][5][6] These peripheral changes are associated with decreased exercise tolerance 7 and are also related to the insulin resistance (IR) observed in patients with CHF. 8,9 Physical training has beneficial effects on exercise capacity and quality of life in patients with CHF. [10][11][12] Because it improve insulin sensitivity in healthy subjects and in athletes, [13][14][15] exercise is potentially an appealing method of improving IR in patients with CHF, but there have been few reports of the effect of physical training in such cases. [16][17][18] Methods PatientsThe study group comprised 20 consecutive patients with CHF who were admitted to Kurume University Medical Center. Criteria for the diagnosis of heart failure were: New York Heart Association functional class II or III, echocardiographic left ventricular diastolic diameter ≥50 mm and left ventricular ejection fraction ≤50%. Underlying heart diseases causing CHF were dilated cardiomyopathy in 7, hypertensive heart disease in 4, coronary artery disease in 4, hypertrophic cardiomyopathy in 2, valvular heart disease in 2, and chronic myocarditis in 1. Patients were excluded from the study if they had fasting blood sugar >110 mg/dl, inflammatory diseases, or any other organ failure. Informed consent was given by each patient.Of the 20 patients, 14 were eligible for physical training and the remaining 6 who were unable to perform the exercise stress test and physical training because of orthopedic or neuromuscular diseases were allocated to the control group. Left ventricular function was determined by echocardiography before and after physical training in the training group.All patients received conventional drug therapy as required throughout the study. Medications included angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (n=16), diuretics (n=12), digitalis (n=9), -adrenergic blocking agents (n=9), antiarrhythmic agents (n=7), calcium-channel antagonists (n=6), isosorbide dinitrate (n=7), nicorandil (n=3), -adrenergic blocking agents (n=1) and vesnarinone (n=1). Blood Samples and Hormone MeasurementsBlood samples were collected in the morning following an overnight fast. After supine rest for at least 20 min, a sample was taken from the antecubital vein and after immediate centrifugation, aliquots were stored at -70°C until analysis. Fasting levels of glucose and uric acid were measured by enzymatic methods and fasting levels of insulin were measured by radioimmunoassay kits (Linco Research, Inc, St Charles, MO, USA). Norepinephrine were measured with high-perf...
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