Mechanisms of the Improvement in Peak VO2 With Exercise Training in Heart Failure With Reduced or Preserved Ejection Fraction

Tucker, Wesley J.; Lijauco, Cecilia C.; Hearon, Christopher M.; Angadi, Siddhartha S.; Nelson, Michael D.; Sarma, Satyam; Nanayakkara, Shane; Gerche, André La; Haykowsky, Mark J.

doi:10.1016/j.hlc.2017.07.002

Cited by 50 publications

(42 citation statements)

References 73 publications

(138 reference statements)

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“…Recently, Billebeau et al found that of all the biomarkers they tested, for predicting change in exercise capacity, MR-proADM best correlated with VO 2peak 22. Given that adrenomedullin originates not only from the heart but also from multiple organs, tissues and blood vessels78 and that the mechanisms associated with improved exercise capacity in HF involve cardiac, vascular and skeletal muscle adaptations,79 a relationship between MR-proADM and improved exercise capacity makes sense.…”

Section: Discussionmentioning

confidence: 99%

Effect of exercise therapy on established and emerging circulating biomarkers in patients with heart failure: a systematic review and meta-analysis

2018

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BackgroundBiomarkers are important in the diagnosis, risk stratification and management of patients with heart failure (HF). The established biomarkers of myocardial stretch, brain natriuretic peptide (BNP) and amino (N) portion of BNP (NT-proBNP) have been extensively studied, and early analyses have demonstrated response to exercise training. Several other biomarkers have been identified over the last decade and may provide valuable and complementary information which may guide treatment strategies, including exercise therapy.MethodsA systematic search of PubMed, EMBASE and Cochrane Trials Register to 31 October 2017 was conducted for exercise-based rehabilitation trials in HF. Randomised and controlled trials that reported biomarkers, BNP, NT-proBNP, soluble ST2, galectin-3, mid-regional atrial natriuretic peptide, mid-regional adrenomedullin and copeptin, were included.ResultsForty-three studies were included in the systematic review, with 27 studies suitable for meta-analyses. Data pooling was only possible for NT-proBNP and BNP. Meta-analyses of conventional training studies demonstrated a statistically significant improvement in NT-proBNP (pmol/L); mean difference (MD) −32.80 (95% CI −56.19 to −9.42), p=0.006 and in BNP (pmol/L); MD −17.17 (95% CI −29.56 to −4.78), p=0.007. Pooled data of non-conventional training failed to demonstrate any statistically significant improvements.ConclusionPooled data indicated a favourable effect of conventional exercise therapy on the established biomarkers, NT-proBNP and BNP; however, this was in contrast to a number of studies that could not be pooled. Limited evidence exists as to the effect of exercise training on emerging biomarkers.

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Section: Discussionmentioning

confidence: 99%

Effect of exercise therapy on established and emerging circulating biomarkers in patients with heart failure: a systematic review and meta-analysis

2018

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“…Following the Fick principle, i.e., VO 2 = cardiac output × arteriovenous O 2 difference, improvement in peak VO 2 is caused by a cardiac factor (cardiac output), a noncardiac factor (peripheral O 2 extraction), or both. In HFrEF patients, both cardiac and noncardiac factors are improved by exercise (Tucker et al., 2018). In HFpEF, several mechanisms have been proposed, investigated, and then refuted.…”

Section: Effects Of Exercise Training In Heart Failure With Preservedmentioning

confidence: 99%

Heart Failure With Preserved Ejection Fraction: A Review of Cardiac and Noncardiac Pathophysiology

et al. 2019

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Heart failure with preserved ejection fraction (HFpEF) is one of the largest unmet clinical needs in 21st-century cardiology. It is a complex disorder resulting from the influence of several comorbidities on the endothelium. A derangement in nitric oxide bioavailability leads to an intricate web of physiological abnormalities in the heart, blood vessels, and other organs. In this review, we examine the contribution of cardiac and noncardiac factors to the development of HFpEF. We zoom in on recent insights on the role of comorbidities and microRNAs in HFpEF. Finally, we address the potential of exercise training, which is currently the only available therapy to improve aerobic capacity and quality of life in HFpEF patients. Unraveling the underlying mechanisms responsible for this improvement could lead to new biomarkers and therapeutic targets for HFpEF.

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“…Lewinter et al (5) confirmed these previous results, demonstrating significant improvements in exercise capacity and hospitalizations but not in mortality. Moreover, the results of studies examining improvements in peak VO 2 after an exercise training program vary widely (6,7).…”

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Influence of Baseline Physical Activity Level on Exercise Training Response and Clinical Outcomes in Heart Failure

Mediano

Leifer

Cooper

et al. 2018

JACC: Heart Failure

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OBJECTIVES This study sought to evaluate the influence of baseline physical activity (PA) on responses to aerobic exercise training and clinical events in outpatients with chronic systolic heart failure (HF) from the multicenter HF-ACTION (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure) trial. BACKGROUND The influence of baseline PA on exercise capacity, responses to exercise training and clinical outcomes in patients with chronic HF is unclear. METHODS Of 2,130 participants who provided consent for this analysis, 1,494 patients (64%) had complete baseline PA data, using a modified version of the International Physical Activity Questionnaire-Short Form questionnaire and were included in the analysis; 742 received usual care and 752 were allocated to the exercise training group. Changes in exercise capacity, all-cause mortality and hospitalization, cardiovascular (CV) mortality and hospitalization, and CV mortality and HF hospitalization were evaluated as a function of baseline PA tertile. RESULTS At baseline, the highest PA tertile showed greater peak oxygen uptake, cardiopulmonary exercise test duration, and 6-min walk test distance than the other 2 PA tertiles, as well as lower New York Heart Association functional class, lower Beck depression score, and lower atrial fibrillation prevalence than the lowest PA tertile. Compared to the lowest PA tertile, the middle tertile had 18% lower risk of CV death/CV hospitalizations, and the upper tertile showed 23% lower risk of CV death/HF hospitalizations. Exercise capacity and clinical outcome responses to training were similar and largely nonsignificant across baseline PA tertiles with significant benefit of training on exercise test duration for all tertiles. CONCLUSIONS In patients with chronic systolic HF, aerobic exercise training significantly improves exercise test duration to a similar extent across baseline PA tertiles. Although higher baseline PA was associated with lower risk of clinical events, no significant differences in event rates within each PA tertile were seen between subgroups randomized to exercise training versus usual care. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure [HF-ACTION]; NCT00047437) (J Am Coll Cardiol HF 2018;6:1011–9)

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Mechanisms of the Improvement in Peak VO2 With Exercise Training in Heart Failure With Reduced or Preserved Ejection Fraction

Cited by 50 publications

References 73 publications

Effect of exercise therapy on established and emerging circulating biomarkers in patients with heart failure: a systematic review and meta-analysis

Effect of exercise therapy on established and emerging circulating biomarkers in patients with heart failure: a systematic review and meta-analysis

Heart Failure With Preserved Ejection Fraction: A Review of Cardiac and Noncardiac Pathophysiology

Influence of Baseline Physical Activity Level on Exercise Training Response and Clinical Outcomes in Heart Failure

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