Ramires PR, Moriscot AS, Brum PC. Sympathetic hyperactivity differentially affects skeletal muscle mass in developing heart failure: role of exercise training. J Appl Physiol 106: 1631-1640, 2009. First published January 29, 2009 doi:10.1152/japplphysiol.91067.2008.-Sympathetic hyperactivity (SH) is a hallmark of heart failure (HF), and several lines of evidence suggest that SH contributes to HFinduced skeletal myopathy. However, little is known about the influence of SH on skeletal muscle morphology and metabolism in a setting of developing HF, taking into consideration muscles with different fiber compositions. The contribution of SH on exercise tolerance and skeletal muscle morphology and biochemistry was investigated in 3-and 7-mo-old mice lacking both ␣2A-and ␣2C-adrenergic receptor subtypes (␣2A/␣2CARKO mice) that present SH with evidence of HF by 7 mo. To verify whether exercise training (ET) would prevent skeletal muscle myopathy in advanced-stage HF, ␣2A/␣2CARKO mice were exercised from 5 to 7 mo of age. At 3 mo, ␣2A/␣2CARKO mice showed no signs of HF and preserved exercise tolerance and muscular norepinephrine with no changes in soleus morphology. In contrast, plantaris muscle of ␣2A/␣2CARKO mice displayed hypertrophy and fiber type shift (IIA 3 IIX) paralleled by capillary rarefaction, increased hexokinase activity, and oxidative stress. At 7 mo, ␣ 2A/␣2CARKO mice displayed exercise intolerance and increased muscular norepinephrine, muscular atrophy, capillary rarefaction, and increased oxidative stress. ET reestablished ␣2A/ ␣2CARKO mouse exercise tolerance to 7-mo-old wild-type levels and prevented muscular atrophy and capillary rarefaction associated with reduced oxidative stress. Collectively, these data provide direct evidence that SH is a major factor contributing to skeletal muscle morphological changes in a setting of developing HF. ET prevented skeletal muscle myopathy in ␣2A/␣2CARKO mice, which highlights its importance as a therapeutic tool for HF. oxidative stress; ␣2A/␣2C-adrenergic receptor knockout mice; cardiac cachexia HEART FAILURE (HF) is a clinical syndrome with poor prognosis characterized by exercise intolerance, early fatigue, and skeletal muscle myopathy associated with atrophy and shift toward fast-twitch fibers (27,28,49). The development of end-stage HF often involves a myocardial insult that reduces cardiac output, which leads to a compensatory increase in sympathetic nervous activity (4, 5). Although beneficial acutely, chronic increase of sympathetic activity leads to further pathological changes in the heart with a progressive deterioration of cardiac function (7,24,38,39), which is closely related to increased cardiac oxidative stress (52).Several lines of evidence suggest that sympathetic hyperactivity also contributes to the skeletal myopathy of HF, since it leads to chronic vasoconstriction in HF patients (22,35,44) associated with skeletal muscle oxidative stress (34,46,53) and increased concentrations of proinflammatory cytokines (12, 23). However, little is known ...