Chronic L-Arginine Supplementation Enhances Endurance Exercise Tolerance in Heart Failure Patients

Abstract

The purpose of the study was to determine the potential beneficial effect of six weeks oral L-arginine supplementation (LAS) on endurance exercise, an important determinant of daily-life activity in patients with chronic stable heart failure (CHF). After an initial incremental maximal exercise test, CHF patients performed an identical thirty-minute interval endurance exercise test before and after six weeks with (L-arginine group; ARG) or without LAS (control group; CTL). Hemodynamic, respiratory, and metabolic parameters were determined at rest, during exercise, and during recovery. Mean heart rate decreased throughout exercise and recovery after LAS (- 8.2 +/- 1.4 b x min(-1); p = 0.003 and - 6.7 +/- 1.6 b x min(-1); p < 0.001, respectively), systemic blood pressure and respiratory parameters remaining unchanged. Resting L-argininaemia increased from 102 +/- 11 to 181 +/- 37 micromol x l(-1) (p < 0.004) and exercise-induced peak increase in plasma lactate was blunted after LAS (4.13 +/- 0.75 vs. 3.13 +/- 0.39 mmol x l(-1); p = 0.02). No significant change was observed in the control group. In heart failure patients, six weeks oral LAS enhances endurance exercise tolerance, reducing both heart rate and circulating lactates. This suggests that chronic LAS might be useful as a therapeutic adjuvant in order to improve the patient's physical fitness.

l-Arginine supplementation improves exercise capacity after a heart transplant

“…An L-arginine-related HR decrease was described in healthy and in heart-failure patients (42). The mechanisms involved remain unclear, but a direct or indirect increase in parasympathetic activity might play a key role (42,43). Such a hypothesis might well apply in cardiac-denervated HTx patients because the cardiac hormone atrial natriuretic peptide may have a cardiac-sympathoinhibitory effect in patients after an HTx (44).…”

“…LAS significantly decreased the resting HRs of our patients, and this may theoretically improve their exercise capacity by reversing the chronotropic insufficiency of an HTx. An L-arginine-related HR decrease was described in healthy and in heart-failure patients (42). The mechanisms involved remain unclear, but a direct or indirect increase in parasympathetic activity might play a key role (42,43).…”

No effect of short-term arginine supplementation on nitric oxide production, metabolism and performance in intermittent exercise in athletes

“…The impairment of NO production and the resulting endothelial dysfunction are the major factors that limit exercise capacity in patients with various cardiopulmonary conditions. As the result, arginine supplementation has been shown to improve exercise capacity in patients with hypercholesterolemia [9], chronic heart failure [10][11][12], pulmonary hypertension [13] and stable angina pectoris [14][15][16].…”

The Role of Amino Acids in the Modulation of Cardiac Metabolism During Ischemia and Heart Failure

“…A randomized, double-blind trial found six weeks of arginine supplementation (5.6-12.6 g per day) significantly improved blood flow, arterial compliance, and functional status of HF patients compared to placebo [123]. In the study of Doureleau et al, HF subjects obtained significant improvement of the performance at exercise test after supplementation with arginine: mean heart rate decreased throughout exercise and recovery while systemic blood pressure and respiratory parameters remained unchanged [124]. Moreover, exercise-induced peak increase in plasma lactate, also was blunted in subjects taking arginine.…”