Individual patient meta-analysis of exercise training effects on systemic brain natriuretic peptide expression in heart failure

Smart, Neil A.; Meyer, Tim; Butterfield, John; Faddy, Steven; Passino, Claudio; Malfatto, Gabriella; Jónsdóttir, Sólrún; Sarullo, Filippo M.; Wisløff, U.; Vigorito, Carlo; Giallauria, Francesco

doi:10.1177/1741826711409171

Cited by 63 publications

(62 citation statements)

References 23 publications

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“…The low level of bias and significant improvement in both NTproBNP and the VE/VCO 2 slope associated with AEX is a relevant finding to help the management of patients with HF. One previous meta-analysis and one systematic review [28,78] found a positive effect of an exercise-based treatment on NTproBNP. Although recent studies have reported that NTproBNP is more prognostic in mild to severe HF patients [43], we evidenced this lack of information on this subgroup (mild to severe HF patients is not a subgroup-it is likely all patients with HF with mild, moderate, and severe HF-mild to severe HF encompasses all).…”

Section: Discussionmentioning

confidence: 97%

“…Evidence demonstrating that EX training attenuates pathological hypertrophy [26] and improves endothelial dysfunction has also been put forth [27] It is therefore reasonable to hypothesize that the improvement in endothelial function as a result of AEX training program will have a positive impact on BNP. There are a few systematic studies evaluating the impact of AEX on NTproBNP in HF patients, especially in those with a diagnosis of systolic heart failure [13,15,28].…”

Section: Introductionmentioning

confidence: 99%

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Aerobic exercise effect on prognostic markers for systolic heart failure patients: a systematic review and meta-analysis

Cipriano

Silva

et al. 2013

Heart Fail Rev

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From previous systematic reviews and meta-analyses, there is consensus about the positive effect of exercise training on exercise capacity for systolic heart failure (HF); however, the effect on actual prognostic markers such as NTproBNP and minute ventilation/carbon dioxide production (VE/VCO2) slope has not been evaluated. The primary aim of the proposed study is to determine the effect of aerobic exercise training (AEX) on the VE/VCO2 slope and NTproBNP. The following databases (up to February 30, 2013) were searched with no language limitations: CENTRAL (The Cochrane Library 2013, issue 2), MEDLINE (from January 1966), EMBASE (from January 1980), and Physiotherapy Evidence Database (PEDro) (from January 1929). We screened reference lists of articles and also conducted an extensive hand search of the literature. Randomized controlled trials of exercise-based interventions with 2-month follow-up or longer compared to usual medical care or placebo were included. The study population comprised adults aged between 18 and 65 years, with evidence of chronic systolic heart failure (LVEF < 45 % and baseline NTproBNP > 300 pg/ml). Two review authors independently extracted data on study design, participants, interventions, and outcomes. We assessed the risk of bias using PEDro scale. We calculated mean differences (MD) or standardized mean differences between intervention and control groups for outcomes with sufficient data; for other outcomes, we described findings from individual studies. Eight studies involving a total of 408 participants met the inclusion criteria across the NTproBNP (5 studies with 191 patients) and VE/VCO2 slope (4 studies with 217 patients). Aerobic exercise significantly improved NTproBNP by a MD of -817.75 [95 % confidence interval (CI) -929.31 to -706.19]. Mean differences across VE/VCO2 slope were -6.55 (95 % CI -7.24 to -5.87). Those patients' characteristics and exercise were similar (frequency = 3-5 times/week; duration = 20-50 min/day; intensity = 60-80 % of VO2 peak) on the included studies. Moreover, the risk of bias across all studies was homogeneous (PEDro scale = 7-8 points). However, based on the statistical analysis, the heterogeneity among the studies was still high, which is related to the variable characteristics of the studies. Aerobic exercise may be effective at improving NTproBNP and the VE/VCO2 slope in systolic HF patients, but these effects are limited to a specific HF population meeting specific inclusion criterion in a limited number of studies. Future randomized controlled studies including diastolic and HF overleap with pulmonary diseases are needed to better understand the exact influence of AEX.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Aerobic exercise effect on prognostic markers for systolic heart failure patients: a systematic review and meta-analysis

Cipriano

Silva

et al. 2013

Heart Fail Rev

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“…76 Another mechanism of regulating sympathetic tone is through the actions of plasma adrenomodullin and atrio/brain-natriuretic-peptides which are tied closely to aerobic consumption. 80 These molecules attenuate BP by suppressing noradrenaline and endothelin-1, and improving endothelial responsiveness and function. 81,82 ET also protects against oxidative stress, leading to lower nitric oxide scavenging by oxidation and higher nitric oxide bioavailability which have anti-hypertensive effects.…”

Section: Effects Of Et On CV Physiologymentioning

confidence: 99%

Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

Kachur

Chongthammakun

Lavie

et al. 2017

Progress in Cardiovascular Diseases

128

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“…A 2011 review by Smart [5] estimated the hospital-based exercise therapy treatment costs to prevent mortality in one systolic heart failure patient to be approximately US$60K per annum. A range of benefits are likely in patients with systolic heart failure undertaking exercise training [6][7][8][9][10][11][12][13][14]. Meta-analyses have shown exercise training to be beneficial in HFpEF patients in terms of improved cardio-respiratory fitness [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis

Chan¹,

Giallauria

Vigorito

et al. 2016

Monaldi Arch Chest Dis

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Exercise training induces physical adaptations for heart failure patients with systolic dysfunction but less is known about those patients with preserved ejection fraction. This study's aims were to establish if exercise training produces changes in peak VO 2 and related measures, quality of life, general health and diastolic function in heart failure patients with preserved ejection fraction (HFpEF).We conducted a MEDLINE search (1985( to September 1, 2015, for exercise based rehabilitation trials in heart failure, using search terms 'exercise training, heart failure with preserved ejection fraction, heart failure with normal ejection fraction, peak VO 2 and diastolic heart dysfunction'. Eight intervention studies were included providing a total of 174 exercising subjects and 143 control subjects, a total of 317 participants.Peak VO 2 increased by a mean difference (MD) 2.08 mL kg -1 min -1 (95% C.I. 1.51 to 2.65, p<0.00001) in exercise training versus sedentary control, equating to a 17% improvement from baseline. V E /VCO 2 slope was not different between groups, MD -3.10 mL kg -1 min -1 (95% C.I. -7.47 to 1.27, p=0.16); maximum heart rate was significantly increased in exercise groups, MD 3.46 bpm (95% C.I. 2.41 to 4.51, p<0.00001); 6 Minute Walk Distance (6MWT) MD 32.1m (95% C.I. 17.2 to 47.1, p<0.0001); diastolic function; the ratio of early to late filling (E/A ratio) was improved after exercise training MD 0.07 (95% C.I. 0.02 to 0.12, p=0.006); as was filling pressure E/E' ratio MD -2.38 (95% C.I. -3.47 to -1.28, p<0.0001); Deceleration time (D T ) MD -13.2 msec (95% C.I. -19.8 to -6.5, p=0.0001); Minnesota Living with Heart Failure Questionnaire (MLHFQ) MD -6.77 (95% C.I. -9.70 to -3.84, p<0.00001); Short Form-36 Health Survey MD 11.38 (95% C.I. 5.28 to 17.48, p=0.0003). In 3222 patient-hours of training, not a single death was directly attributable to exercise.Exercise training appears to effect several health-related improvements in people with heart failure and preserved ejection fraction.

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Individual patient meta-analysis of exercise training effects on systemic brain natriuretic peptide expression in heart failure

Abstract: Exercise training has favourable effects on BNP, NT-pro-BNP, and peak VO(2) in heart failure patients and BNP/NT-pro-BNP changes were correlated with peak VO(2) changes.

Cited by 63 publications

References 23 publications

Aerobic exercise effect on prognostic markers for systolic heart failure patients: a systematic review and meta-analysis

Aerobic exercise effect on prognostic markers for systolic heart failure patients: a systematic review and meta-analysis

Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

Exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis

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