The influence of aetiology on the benefits of exercise training in patients with heart failure

Abstract

Background Exercise training improves neurovascular control and functional capacity in heart failure (HF) patients. However, the influence of the aetiology on these benefits is unknown. We compared the effects of exercise training on neurovascular control and functional capacity in idiopathic, ischaemic and hypertensive HF patients. Design Subjects consisted of 45 exercise-trained HF patients from our database (2000-2015), aged 40-70 years old, functional class II/III and ejection fraction ≤40%, and they were divided into three groups: idiopathic ( n = 11), ischaemic ( n = 18) and hypertensive ( n = 16). Methods Functional capacity was determined by cardiopulmonary exercise testing. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography. Forearm blood flow (FBF) was measured by venous occlusion plethysmography. Results Four months of exercise training significantly reduced MSNA and significantly increased FBF in all groups. However, the relative reduction in MSNA was greater in hypertensive patients compared with that in idiopathic patients (frequency: -34% vs . -15%, p = 0.01; incidence: -31% vs . -12%, p = 0.02). No differences were found between hypertensive patients and ischaemic patients. The relative increase in FBF was greater in hypertensive patients than in ischaemic and idiopathic patients (42% vs. 15% and 17%, respectively, p = 0.02). The relative increase in forearm vascular conductance was greater in hypertensive patients compared with those in ischaemic and idiopathic patients (57% vs . 13% and 26%, respectively, p = 0.001). Exercise training significantly and similarly increased peak oxygen consumption in all groups. Conclusion The exercise-induced improvement in neurovascular control is more pronounced in hypertensive HF patients than in idiopathic and ischaemic HF patients. The increase in functional capacity is independent of aetiology.

Effects of aerobic and inspiratory training on skeletal muscle microRNA‐1 and downstream‐associated pathways in patients with heart failure

“…Increase in functional capacity after exercise training has been reported in patients with chronic HFrEF regardless of age, gender, and aetiology . Our study is consistent with this observation.…”

“…Accumulated evidence shows that exercise training increases muscle blood flow in chronic heart failure . Our study confirms this finding.…”

“…We speculate that increase in endothelial function and reduction in sympathetic nerve activity contribute to the amelioration in LBF. Previous studies demonstrate that AET increases endothelial‐mediated blood flow and reduces muscle sympathetic nerve activity in chronic heart failure . IMT also increased LBF, but the mechanisms underlying this response are virtually unknown.…”

“…The clinical improvement in exercise‐trained patients with HFrEF has been associated with changes in neurovascular control, inflammatory response, and amelioration in skeletal myopathy . Aerobic exercise training (AET) has been shown to provoke a remarkable reduction in muscle sympathetic nerve activity and vasoconstriction . In skeletal muscle, AET reduces inflammation, oxidative stress, and energy metabolism and improves the balance between muscle protein synthesis and degradation .…”

Exercise during transition from compensated left ventricular hypertrophy to heart failure in aortic stenosis rats

“…Nonetheless, the majority of experimental studies in genetic models of systemic hypertension as well as some clinical studies point towards regular exercise having a beneficial effect on cardiac remodelling. In fact, it was recently observed that exercise‐induced improvement in functional capacity is independent of heart failure aetiology . A few studies have reported negative effects of rodents subjected to long‐term exercise .…”