Effect of Physical Training on Insulin Resistance in Patients With Chronic Heart Failure

Nishiyama, Yasuhiro; Minohara, Motooki; Ohe, Masatugu; Hirai, Yuji; Katoh, Atsushi; Miyamoto, Tomofumi; Iwami, Gensyo; Nakata, Masao; Koga, Yoshinori

doi:10.1253/circj.70.864

Cited by 14 publications

(9 citation statements)

References 31 publications

(36 reference statements)

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“…182 In obese subjects, short-term exercise improves insulin-mediated perfusion of skeletal muscle and glucose delivery. In HF, exercise training reduces IR 183 consonant with its effect in the increase in skeletal and cardiac glucose uptake. The latter increase occurs in HF despite unchanged insulin signaling 184 ; the likely mechanism is by stimulation of the insulin insensitive GLUT-1 transporters.…”

Section: Exercise and Dietary Modificationmentioning

confidence: 88%

Metabolic Mechanisms in Heart Failure

Ashrafian

Frenneaux

Opie³

2007

Circulation

457

301

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Abstract-Although neurohumoral antagonism has successfully reduced heart failure morbidity and mortality, the residual disability and death rate remains unacceptably high. Though abnormalities of myocardial metabolism are associated with heart failure, recent data suggest that heart failure may itself promote metabolic changes such as insulin resistance, in part through neurohumoral activation. A detrimental self-perpetuating cycle (heart failure 3 altered metabolism 3 heart failure) that promotes the progression of heart failure may thus be postulated. Accordingly, we review the cellular mechanisms and pathophysiology of altered metabolism and insulin resistance in heart failure. It is hypothesized that the ensuing detrimental myocardial energetic perturbations result from neurohumoral activation, increased adverse free fatty acid metabolism, decreased protective glucose metabolism, and in some cases insulin resistance. The result is depletion of myocardial ATP, phosphocreatine, and creatine kinase with decreased efficiency of mechanical work. On the basis of the mechanisms outlined, appropriate therapies to mitigate aberrant metabolism include intense neurohumoral antagonism, limitation of diuretics, correction of hypokalemia, exercise, and diet. We also discuss more novel mechanistic-based therapies to ameliorate metabolism and insulin resistance in heart failure. For example, metabolic modulators may optimize myocardial substrate utilization to improve cardiac function and exercise performance beyond standard care. The ultimate success of metabolic-based therapy will be manifest by its capacity further to lessen the residual mortality in heart failure. Key Words: fatty acids Ⅲ glucose Ⅲ heart failure Ⅲ insulin resistance D espite significant therapeutic advances, heart failure (HF) remains a leading cause of morbidity and mortality in developed 1 and increasingly in developing countries, 2 with a 5-year mortality rate of Ϸ50%, which rivals or exceeds that of many cancers. 3 This unacceptably high residual mortality and morbidity has mandated a reevaluation of cardiac biology with the aim to identify novel therapeutic strategies for HF. Because the daily turnover of ATP (Ϸ6 to 35 kg) is very many times that of the myocardial ATP pool, and even the healthy heart only extracts Ϸ25% of energy derivable from substrates, 4 it is not surprising that even subtle variations in the efficiency of energy generation or utilization may have a profound cumulative impact on cellular energy levels. 5 Thus cardiac energetics in particular and metabolism in general represent promising targets for HF therapy. 6 Correspondingly, numerous studies have identified decreased cardiac energy levels and flux as a consistent feature of HF. 6,7 These observations have been reinforced by genomic studies 8 and have focused considerable attention on metabolic modulation as a therapy for HF. 6 Specifically, altered myocardial carbohydrate metabolism and the related state of myocardial insulin resistance (IR), in which given concentrations of...

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Section: Exercise and Dietary Modificationmentioning

confidence: 88%

Metabolic Mechanisms in Heart Failure

Ashrafian

Frenneaux

Opie³

2007

Circulation

457

301

View full text Add to dashboard Cite

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“…Though many factors could explain the benefits of exercise in these PAH patients, and many mechanisms could be invoked to explain an improved 6MWD, it is plausible that such enhancement is associated with improved insulin and lipid profiles. Interestingly, physical training has also been shown to improve hyperinsulinemia and insulin resistance in patients with CHF [41]. The mechanism of development of insulin resistance is extremely complex and may be influenced by hypoxemia and a deconditioned state.…”

Section: Discussionmentioning

confidence: 99%

Insulin resistance in pulmonary arterial hypertension

Zamanian¹,

Hansmann²,

Snook³

et al. 2008

European Respiratory Journal

246

267

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Although obesity, dyslipidemia and insulin resistance (IR) are well known risk factors for systemic cardiovascular disease, their impact on pulmonary arterial hypertension (PAH) is unknown. The present authors' previous studies indicate that IR may be a risk factor for PAH. The current study has investigated the prevalence of IR in PAH and explored its relationship with disease severity.Clinical data and fasting blood samples were evaluated in 81 nondiabetic PAH females. In total, 967 National Health and Nutrition Examination Surveys (NHANES) females served as controls. The fasting triglyceride to high-density lipoprotein cholesterol ratio was used as a surrogate of insulin sensitivity.While body mass index was similar in NHANES versus PAH females (28.6 versus 28.7 kg?m -2 ), PAH females were more likely to have IR (45.7 versus 21.5%) and less likely to be insulin sensitive (IS; 43.2 versus 57.8%). PAH females mostly (82.7%) had New York Heart Association (NYHA) class II and III symptoms. Aetiology, NYHA class, 6-min walk-distance and haemodynamics did not differ between IR and IS PAH groups. However, the presence of IR and a higher NYHA class was associated with poorer 6-months event-free survival (58 versus 79%).Insulin resistance appears to be more common in pulmonary arterial hypertension females than in the general population, and may be a novel risk factor or disease modifier that might impact on survival.

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“…Such modifications, combined with other possible favorable actions on plaque and metabolism, 26,27 represent a desirable outcome in those patients with decreased regular physical activity and an unfavorable prognosis. 19,28 This test in-train out model of intervention is adaptable to different settings.…”

Section: Discussionmentioning

confidence: 99%

Training Rather Than Walking The Test In - Train Out Program for Home-Based Rehabilitation in Peripheral Arteriopathy

Manfredini

Malagoni

Mascoli

et al. 2008

Circ J

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xercise training is an effective, low-cost therapy that improves the functional ability of patients with intermittent claudication. [1][2][3][4] Its diffusion could be favoured by models of intervention that would help ensure functional and cardiovascular improvements, patient compliance and lower costs for the healthcare system.In order to optimise these positive outcomes, the model of intervention and the prescribed exercise intensity are of primary importance. Unfortunately, specific recommendations regarding exercise prescription and programming are limited. 2 However, it is known that exercise is preferably carried out at moderate to near-maximal pain, and that better results are obtained at the hospital under the supervision of the rehabilitative team. These center-based programs for peripheral arterial disease (PAD) have been found to be more effective at improving walking ability in training up to 6 months compared with home-based programs, with unclear effect of supervision. 5,6 On the other hand, home-based programs, which are based on simple instructions about the exercise to be performed (eg, walk up to pain tolerance), in general, show higher long-term adherence to exercise, with lower cost to the healthcare system. 6 An alternative model without supervision, based on the assessment of functional capacity at hospital during monthly check-ups and a personalized prescription of exercise to be performed at home at maximal asymptomatic speed (MAS) has been developed recently. 7,8 This novel approach to rehabilitation for patients with PAD, the 'test in -train out' program (Ti-To), aims to combine the advantages of a traditional home-based program (eg, long-term adherence and lower cost) with those of a supervised program (especially, exercise at selected intensities).The Ti-To program makes use of the MAS; that is, the walking intensity below the individual pain threshold speed (PTS) 9 that combines pain-free training with functional, hemodynamic and cardiovascular adaptations. 7 The present study aimed to test the effectiveness of the Ti-To program on walking ability and hemodynamic parameters in a group of patients exercising at home at their MAS compared with patients following a traditional home-based free walking exercise (Tr-E) at self-selected speeds up to pain tolerance over a 6-month period. Background Exercise training reduces walking disability in peripheral arterial disease (PAD). This non-randomized study evaluates the effects on walking ability and hemodynamic parameters of a novel approach to home-based rehabilitation, the test in -train out program (Ti-To), compared with the traditional home-based free walking exercise (Tr-E). Methods and Results A total of 143 patients with claudication (117 men, average age 68±10 years), were included in a Ti-To (n=83) or Tr-E program (n=60). Evaluations, which were carried out upon entry and at 1, 2, 3, 4 and 6 months, included: self-reported claudication, walking ability (ie, absolute claudication distance, pain threshold speed), resting/exercise hea...

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Effect of Physical Training on Insulin Resistance in Patients With Chronic Heart Failure

Cited by 14 publications

References 31 publications

Metabolic Mechanisms in Heart Failure

Metabolic Mechanisms in Heart Failure

Insulin resistance in pulmonary arterial hypertension

Training Rather Than Walking The Test In - Train Out Program for Home-Based Rehabilitation in Peripheral Arteriopathy

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