Effects of home‐based exercise training on neurovascular control in patients with heart failure

Abstract

Background: The effect of home-based exercise training on neurovascular control in heart failure patients is unknown. Aims: To test the hypothesis that home-based training would maintain the reduction in muscle sympathetic nerve activity (MSNA) and forearm vascular resistance (FVR) acquired after supervised training. Methods and results: Twenty-nine patients (54 T 1.9 years, EF < 40%) were randomised into two groups: untrained control (n = 12) and exercise trained (n = 17). Both groups underwent assessment of Quality of Life (QoL), MSNA, and forearm blood flow. The exercise group underwent a 4-month supervised training program followed by 4 months of home-based training. After the initial 4 months of training, patients in the exercise group showed a significant increase in peak VO 2 and reduction in MSNA, compared to the untrained group, but this was not maintained during 4 months of home-based training. In contrast, the decrease in FVR (56 T 3 vs. 46 T 4 vs. 40 T 2 U, p = 0.008) and the improvement in QOL that were achieved during supervised training were maintained during home-based training. Conclusions: Home-based training following supervised training is a safe strategy to maintain improvements in QoL and reduction in FVR in chronic heart failure patients, but is an inadequate strategy to maintain fitness as estimated by peak VO 2 or reduction in neurohumoral activation.

Effects of aerobic exercise training on sympathetic and renal responses to mental stress in humans

“…Aerobic exercise training has been reported to decrease resting MSNA in patients with heart failure (6,10,25), hypertension (16), and acute myocardial infarction (22). In contrast, most (11,24,29,32), but not all (12), studies performed in subjects without cardiovascular disease report that aerobic exercise training does not alter resting MSNA.…”

“…In contrast, most (11,24,29,32), but not all (12), studies performed in subjects without cardiovascular disease report that aerobic exercise training does not alter resting MSNA. Patients with cardiovascular disease (6,10,16,22,25) have much higher levels of resting MSNA compared with subjects without cardiovascular disease (11,12,24,29,32), suggesting that reductions of MSNA with aerobic exercise training may be partly dependent on the initial levels of MSNA at rest. Our data support this concept as our young, healthy subjects (with the low levels of MSNA at rest) demonstrated that aerobic exercise training did not alter resting MSNA.…”

“…Future studies should examine neural and renal responses to stress and exercise in individuals with cardiovascular complications. Based on the ability of aerobic exercise training to reduce resting MSNA in patients with cardiovascular disease (6,10,16,22,25) and obesity (34), it is possible that aerobic training would reduce sympathoexcitation and renal vasoconstriction during mental stress in patients with cardiovascular diseases.…”

Effects of Long-Term Exercise Training on Autonomic Control in Myocardial Infarction Patients

“…In fact, in previous studies from our laboratory in patients under ␤-blocker therapy drugs, we found no changes in resting heart rate after exercise training. 31,32 In the present study, all of the patients (except 1) started ␤-blocker therapy immediately after MI, during the hospitalization phase, and the use of ␤-blockers was maintained throughout the experimental protocol.…”

Efeito do treinamento físico no controle mecanorreflexo e metaborreflexo da atividade nervosa simpática muscular em pacientes com insuficiência cardíaca

“…Outro ponto importante para ressaltar em nosso estudo é a melhora da resistência vascular periférica e da capacidade funcional em pacientes com insuficiência cardíaca após o treinamento físico. Estes resultados confirmam achados anteriores do nosso grupo 12,[57][58][59][60][61] . Uma maior perfusão no músculo esquelético aumenta a oferta de nutrientes, reduz os níveis de espécies reativas de oxigênio e citocinas inflamatórias e, em consequência, melhora as alterações metabólicas e estruturais nas fibras musculares na insuficiência cardíaca 15 .…”