Effect of High Intensity Exercise on Peak Oxygen Uptake and Endothelial Function in Long-Term Heart Transplant Recipients

Abstract

Coronary allograft vasculopathy is a well-known longterm complication after cardiac transplantation. Endothelial dysfunction is involved and may be prevented by aerobic exercise. The purpose of this study was to examine whether high intensity aerobic exercise improves peak oxygen uptake (VO 2 peak ) and endothelial function in heart transplant (HT) recipients. Twentyseven long-term HT recipients were randomized to either 8-weeks high intensity aerobic exercise or no training. Flow mediated dilation of the brachial artery (FMD) was measured by ultrasound and VO 2 peak by the analysis of expired air. Blood pressure and biomarkers were measured before and after 8 weeks. VO 2 peak increased significantly in the exercise group (VO 2 peak 23.9 ± 1.79 to 28.3 ± 1.63 mL/kg/min compared to controls (VO 2 peak 24.6 ± 1.38 to 23.4 ± 1.58, p < 0.001 exercise vs. control).FMD increased in the exercise group compared to controls (8.3 ± 1.1% to 11.4 ± 1.2% vs. 5.6 ± 1.0% to 5.3 ± 1.7%, p = 0.024). No increase in nitroglycerin-induced vasodilation was observed. Systolic blood pressure fell in the exercise group (142 ± 4.2 mmHg to127 ± 3.4 mmHg, p = 0.01) and was unchanged in controls (141 ± 4.2 mmHg to 142 ± 6.4 mmHg, NS). High intensity aerobic exercise reduces systolic blood pressure and improves endothelial function in HT recipients.Key words: Blood pressure, endothelial dysfunction, exercise, exercise testing, heart transplantation Abbreviations: ANP, atrial natriuretic peptide; BNP, brain natriuretic peptide; CRP, C-reactive protein; FMD, flow mediated vasodilation; HT, heart transplant; IHD, ischemic heart disease; DCM, dilated cardiomyopathy; NTG, nitroglycerin; TNF-alfa, tumor necrosis factor-alfa; VO 2peak , peak oxygen uptake.

Peak oxygen uptake and self‐reported physical health are strong predictors of long‐term survival after heart transplantation

“…The chronotropic incompetence is most prominent the first months after HTx and tends to be largely normalized in the majority of patients after 12 months (44) as illustrated in figure 4 (unpublished data). Recent randomized controlled trials (RCT), have investigated the effect of HIT in the maintenance HTx recipients and have to a large extend overruled the traditional approach with MICT (18,24,30). These studies showed that HIT increased VO2peak significantly compared to the control groups, and that a HIT intervention was safe and well tolerated.…”

“…peripheral factors as the main mechanisms; by improvement in skeletal muscle exercise capacity (30), endothelial function and vasodilatation (24), rather than an increased CO (51).…”

Trening etter hjertetransplantasjon – gamle prinsipper for fall

“…Siden 2009 er det publisert tre studier av høyin-tensiv intervalltrening hos hjertetransplanterte, der alle viste overlegne resultater sammenliknet med kontrollgrupper og hva som tidligere er vist ved annen type trening (10)(11)(12). Ingen av studiene har rapportert om uønskede hendelser i forbindelse med den intensive treningen.…”

Effect of High-Intensity Exercise on Endothelial Function in Patients With T2dm

“…Exercise can be used as a non-pharmacological instrument to promote central (cardiovascular) and peripheral (skeletal muscle) adaptations that are linked to improved health outcomes 8,9 . Several studies have shown that high intensity training improves endothelial function due a vasorelaxation mediated an increased e-NO and IGF-1 receptor expression, including in patients with type 2 diabetes and transplanted hearts 10,8,11 , suggesting an anti-atherosclerotic effect of exercise.…”

“…Several studies have shown that high intensity training improves endothelial function due a vasorelaxation mediated an increased e-NO and IGF-1 receptor expression, including in patients with type 2 diabetes and transplanted hearts 10,8,11 , suggesting an anti-atherosclerotic effect of exercise.…”