Sport Sciences for Health

, Volume 14, Issue 2, pp 217–226 | Cite as

Exercise training in heart failure patients: effects on skeletal muscle abnormalities and sympathetic nervous activity—a literature review

  • Fotios Iliopoulos
  • Nicolas Mazis


Patients suffering from heart failure exhibit fatigue resulting in reduced exercise tolerance and thus, decreased functional capacity and quality of life. Evidence supporting that cardiac function is poorly correlated with the exercise capacity, led to investigations into peripheral abnormalities, such as impaired function and oxidative capacity of the skeletal muscle, and increased activation of the sympathetic nervous system. Although in the past exercise training was discouraged, today it is recognized that has unique beneficial effects on the peripheral alterations that are seen in this clinical population, as well as, it is a safe therapeutic intervention for patients with heart failure. There is ample evidence demonstrating that improvements in muscle metabolism and sympathetic nervous activity, which are closely connected with exercise capacity, lead to lower rates of hospitalization and improvements in quality of life. Thus, in fact, exercise training is considered an integral, non-pharmacological, component in heart failure management, contributing to attenuate systemic effects and to ameliorate, or even reverse, skeletal myopathy.


Exercise training Heart failure Skeletal muscle Skeletal myopathy Exercise capacity Sympathetic nerve activity 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki an its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Zizola C, Schulze CP (2013) Metabolic and structural impairment of skeletal muscle in heart failure. Heart Fail Rev 18:623–630PubMedPubMedCentralGoogle Scholar
  2. 2.
    Bui AL, Horwich TB, Fonarow GC (2011) Epidemiology and risk profile of heart failure. Nat Rev Cardiol 8:30–41PubMedGoogle Scholar
  3. 3.
    Conraads VM, Beckers P, Bosmans J et al (2002) Combined endurance/resistance training reduces plasma TNF-α receptor levels in patients with chronic heart failure and coronary artery disease. Eur Heart J 23:1854–1860PubMedGoogle Scholar
  4. 4.
    Barretto AC, Del Carlo CH, Cardoso JN et al (2008) Hospital readmissions and death from heart failure-rates still alarming. Arq Bras Cardiol 91:335–341PubMedGoogle Scholar
  5. 5.
    Haykowsky MJ, Kouba EJ, Brubaker PH et al (2014) Skeletal muscle composition and its relation to exercise intolerance in older patients with heart failure and preserved ejection fraction. Am J Cardiol 113:1211–1216PubMedPubMedCentralGoogle Scholar
  6. 6.
    Piepoli MF (2006) Exercise training in heart failure. Curr Heart Fail Rep 3:189–196PubMedGoogle Scholar
  7. 7.
    Crisafulli A, Tocco F, Milia R et al (2013) Progressive improvement in hemodynamic response to muscle metaboreflex in heart transplant recipients. J Appl Physiol 1985 114:421–427PubMedGoogle Scholar
  8. 8.
    Maurer MS, Schulze PC (2012) Exercise intolerance in heart failure with a preserved ejection faction (HFPEF): Shifting focus from the heart to peripheral skeletal muscle. J Am Coll Cardiol 60:129–131PubMedPubMedCentralGoogle Scholar
  9. 9.
    Green DJ, Watts K, Maiorana AJ et al (2001) A comparison of ambulatory oxygen consumption during circuit training and aerobic exercise in patients with chronic heart failure. J Cardiopulm Rehabil 21:164–174Google Scholar
  10. 10.
    Van Tol BAF, Huijsmans RJ, Kroon DW et al (2006) Effects of exercise training on cardiac performance, exercise capacity and quality of life in patients with heart failure: a meta-analysis. Eur J Heart Fail 8:841–850PubMedGoogle Scholar
  11. 11.
    Laoutaris ID, Adamopoulos S, Manginas A et al (2013) Benefits of combined aerobic/resistance/inspiratory training in patients with chronic heart failure. A complete exercise model? A prospective randomised study. Int J Cardiol 167:1967–1972PubMedGoogle Scholar
  12. 12.
    Toth MJ, Shaw AO, Miller MS et al (2010) Reduced knee extensor function in heart failure is not explained by inactivity. Int J Cardiol 143:276–282PubMedGoogle Scholar
  13. 13.
    Volaklis KA, Tokmakidi SP (2005) Resistance exercise training in patients with heart failure. Sports Med 35:1085–1103PubMedGoogle Scholar
  14. 14.
    Bacurau AVN, Jardim MA, Ferreira JCB et al (2009) Sympathetic hyperactivity differentially affects skeletal muscle mass in developing heart failure: role of exercise training. J Appl Physiol 106:1631–1640PubMedGoogle Scholar
  15. 15.
    Morley JE, Thomas DR, Wilson MM (2006) Cachexia: pathophysiology and clinical relevance. Am J Clin Nutr 83:735–743PubMedGoogle Scholar
  16. 16.
    Borlaug BA, Melenovsky V, Russell SD et al (2006) Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction. Circulation 114:2138–2147PubMedGoogle Scholar
  17. 17.
    Kishimoto S, Kajikawa M, Maruhashi T et al (2017) Endothelial dysfunction and abnormal vascular structure are simultaneously present in patients with heart failure with preserved ejection fraction. Int J Cardiol 231:181–187PubMedGoogle Scholar
  18. 18.
    Haykowsky MJ, Herrington DM, Brubaker PH et al (2013) Relationship of flow mediated arterial dilation and exercise capacity in older patients with heart failure and preserved ejection fraction. J Gerontol A Biol Sci Med Sci 68:161–167PubMedGoogle Scholar
  19. 19.
    Lee JF, Barrett-O’Keefe Z, Garten RS et al (2016) Evidence of microvascular dysfunction in heart failure with preserved ejection fraction. Heart 102:278–284PubMedGoogle Scholar
  20. 20.
    Yancy CW, Jessup M, Bozkurt B et al (2013) 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 128:1810–1852PubMedGoogle Scholar
  21. 21.
    Jonsdottir S, Andersen KK, Sigurosson AF et al (2006) The effect of physical training in chronic heart failure. Eur J Heart Fail 8:97–101PubMedGoogle Scholar
  22. 22.
    Chung CJ, Schulze PC (2011) Exercise in patients with heart failure. Phys Sportsmed 39:37–43PubMedPubMedCentralGoogle Scholar
  23. 23.
    Keteyian SJ (2011) Exercise training in congestive heart failure: risks and benefits. Prog Cardiovasc Dis 53:419–428PubMedGoogle Scholar
  24. 24.
    Basaraba JE, Barry AR (2015) Pharmacotherapy of heart failure with preserved ejection fraction. Pharmacotherapy 35:351–360PubMedGoogle Scholar
  25. 25.
    Ladage D, Schwinger RH, Brixius K (2013) Cardio-selective beta-blocker: pharmacological evidence and their influence on exercise capacity. Cardiovasc Ther 31:76–83PubMedGoogle Scholar
  26. 26.
    Dekleva M, Düngen HD, Gelbrich G et al (2012) Beta blockers therapy is associated with improved left ventricular systolic function and sustained exercise capacity in elderly patients with heart failure. CIBIS-ELD sub-study. Aging Clin Exp Res 24:675–681PubMedGoogle Scholar
  27. 27.
    Beloka S, Gujic M, Deboeck G et al (2008) Beta-adrenergic blockade and metabo-chemoreflex contributions to exercise capacity. Med Sci Sports Exerc 40:1932–1938PubMedGoogle Scholar
  28. 28.
    Conraads VM, Metra M, Kamp O et al (2012) Effects of the long-term administration of nebivolol on the clinical symptoms, exercise capacity, and left ventricular function of patients with diastolic dysfunction: results of the ELANDD study. Eur J Heart Fail 14:219–225PubMedGoogle Scholar
  29. 29.
    Houssiere A, Najem B, Ciarka A et al (2005) Chemoreflex and metaboreflex control during static hypoxic exercise. Am J Physiol Heart Circ Physiol 288:H1724–H1729PubMedGoogle Scholar
  30. 30.
    Yamamoto K (2015) β-Blocker therapy in heart failure with preserved ejection fraction: Importance of dose and duration. J Cardiol 66:189–194PubMedGoogle Scholar
  31. 31.
    Kiilavuori K, Naveri H, Salmi T et al (2000) The effect of physical training on skeletal muscle in patients with chronic heart failure. Eur J Heart Fail 2:53–63PubMedGoogle Scholar
  32. 32.
    Klocek M, Kubinyi A, Bacior B et al (2005) Effect of physical training on quality of life and oxygen consumption in patients with congestive heart failure. Int J Cardiol 103:323–329PubMedGoogle Scholar
  33. 33.
    Negrao CE, Middlekauff HR, Gomes-Santos IL et al (2005) Effects of exercise training on neurovascular control and skeletal myopathy in systolic heart failure. Am J Physiol Heart Circ Physiol 308:792–802Google Scholar
  34. 34.
    Negrao CE, Middlekauff HR (2008) Adaptation in autonomic function during exercise training in heart failure. Heart Fail Rev 13:51–60PubMedGoogle Scholar
  35. 35.
    Niebauer J, Clark A, Webb-Peploe K et al (2005) Exercise training in chronic heart failure: effects on proinflammatory markers. Eur J Heart Fail 7:189–193PubMedGoogle Scholar
  36. 36.
    Hopkinson NS, Dayer MJ, Antoine-Jonville S et al (2013) Central and peripheral quadriceps fatigue in congestive heart failure. Int J Cardiol 167:2594–2599PubMedPubMedCentralGoogle Scholar
  37. 37.
    Spruit MA, Eterman R-MA, Hellwig V et al (2009) Effects of moderate-to-high intensity resistance training in patients with chronic heart failure. Heart 95:1399–1408PubMedGoogle Scholar
  38. 38.
    Piepoli MF, Crisafulli A (2014) Pathophysiology of human heart failure: importance of skeletal muscle myopathy and reflexes. Exp Physiol 99:609–615PubMedGoogle Scholar
  39. 39.
    Floras JS, Ponikowski P (2015) The sympathetic/parasympathetic imbalance in heart failure with reduced ejection fraction. Eur Heart J 36:1974–1982PubMedPubMedCentralGoogle Scholar
  40. 40.
    Richardson TE, Kindig CA, Musch TI et al (2013) Effects of chronic heart failure on skeletal muscle capillary hemodynamics at rest and during contractions. J Appl Physiol 95:1055–1062Google Scholar
  41. 41.
    Linke A, Adams V, Schulze PC et al (2005) Antioxidative effects of exercise training in patients with chronic heart failure: increase in radical scavenger enzyme activity in skeletal muscle. Circulation 111:1763–1770PubMedGoogle Scholar
  42. 42.
    Khan MH, Sinoway LI (2000) Muscle reflex control of sympathetic nerve activity in hear failure: the role of exercise conditioning. Heart Fail Rev 5:87–100PubMedGoogle Scholar
  43. 43.
    Kaur J, Senador D, Krishnan AC et al (2018) Muscle metaboreflex-induced vasoconstriction in the ischemic active muscle is exaggerated in heart failure. Am J Physiol Heart Circ Physiol 314:H11–H18PubMedGoogle Scholar
  44. 44.
    Tzanis G, Dimopoulos S, Agapitou V et al (2014) Exercise intolerance in chronic heart failure: the role of cortisol and the catabolic state. Curr Heart Fail Rep 11:70–79PubMedGoogle Scholar
  45. 45.
    Triposkiadis F, Karayannis G, Giamouzis G et al (2009) The sympathetic nervous system in heart failure physiology, pathophysiology, and clinical implications. J Am Coll Cardiol 54:1747–1762PubMedGoogle Scholar
  46. 46.
    Negrão CE, Rondon MU, Tinucci T et al (2001) Abnormal neurovascular control during exercise is linked to heart failure severity. Am J Physiol Heart Circ Physiol 280:1286–1292Google Scholar
  47. 47.
    Barretto ACP, Santos AC, Munhoz R et al (2009) Increased muscle sympathetic nerve activity predicts mortality in heart failure patients. Int J Cardiol 135:302–307PubMedGoogle Scholar
  48. 48.
    Michelini LC, Stern JE (2009) Exercise-induced neuronal plasticity in central autonomic networks: role in cardiovascular control. Exp Physiol 94:947–960PubMedPubMedCentralGoogle Scholar
  49. 49.
    Antunes-Correa LM, Melo RC, Nobre TS et al (2010) Impact of gender on benefits of exercise training on sympathetic nerve activity and muscle blood flow in heart failure. Eur J Heart Fail 12:58–65PubMedPubMedCentralGoogle Scholar
  50. 50.
    Antunes-Correa LM, Kanamura BY, Melo RC et al (2012) Exercise training improves neurovascular control and functional capacity in heart failure patients regardless of age. Eur J Prev Cardiol 19:822–829PubMedGoogle Scholar
  51. 51.
    Antunes-Correa LM, Nobre TS, Groehs RV et al (2014) Molecular basis for the improvement in muscle metaboreflex and mechanoreflex control in exercise-trained humans with chronic heart failure. Am J Physiol Heart Circ Physiol 307:1655–1666Google Scholar
  52. 52.
    De Mello Franco FG, Santos AC, Rondon MU et al (2006) Effects of home-based exercise training on neurovascular control in patients with heart failure. Eur J Heart Fail 8:851–855PubMedGoogle Scholar
  53. 53.
    Fraga R, Franco FG, Roveda F et al (2007) Exercise training reduced sympathetic nerve activity in heart failure patients treated with carvedilol. Eur J Heart Fail 9:630–636PubMedGoogle Scholar
  54. 54.
    Roveda F, Middlekauff HR, Rondon MU et al (2003) The effects of exercise training on sympathetic neural activation in advanced heart failure: a randomized controlled trial. J Am Coll Cardiol 42:854–860PubMedGoogle Scholar
  55. 55.
    Wang H, Zucker IH, Wang W (2012) Muscle reflex in heart failure: the role of exercise training. Front Physiol 3:1–16Google Scholar
  56. 56.
    Okita K, Kinugawa S, Tsutsui H (2013) Exercise intolerance in chronic heart failure–skeletal muscle dysfunction and potential therapies. Circ J 77:293–300PubMedGoogle Scholar
  57. 57.
    Middlekauff HR, Vigna C, Verity MA et al (2012) Abnormalities of calcium handling proteins in skeletal muscle mirror those of the heart in humans with heart failure: a shared mechanism? J Card Fail 18:724–733PubMedPubMedCentralGoogle Scholar
  58. 58.
    Szentesi P, Bekedam MA, Van Beek-Harmsen BJ et al (2005) Depression of force production and ATPase activity in different types of human skeletal muscle fibers from patients with chronic heart failure. J Appl Physiol 99:2189–2195PubMedGoogle Scholar
  59. 59.
    Lunde PK, Sjaastad I, Schiotz Thorud HM et al (2001) Skeletal muscle disorders in heart failure. Acta Physiol Scand 171:277–294PubMedGoogle Scholar
  60. 60.
    Vescovo G, Volterrani M, Zennaro R et al (2000) Apoptosis in the skeletal muscle of patients with heart failure: investigation of clinical and biochemical changes. Heart 84:431–437PubMedPubMedCentralGoogle Scholar
  61. 61.
    Middlekauff HR (2010) Making the case for skeletal myopathy as the major limitation of exercise capacity in heart failure. Circ Heart Fail 3:537–546PubMedPubMedCentralGoogle Scholar
  62. 62.
    Nicoletti I, Cicoira M, Zanolla L et al (2003) Skeletal muscle abnormalities in chronic heart failure patients: relation to exercise capacity and therapeutic implications. Congest Heart Fail 9:148–154PubMedGoogle Scholar
  63. 63.
    Duscha BD, Schhulze PC, Robbins JL et al (2008) Implications of chronic heart failure on peripheral vasculature and skeletal muscle before and after exercise training. Heart Fail Rev 13:21–37PubMedGoogle Scholar
  64. 64.
    Ventura-Clapier R, De Sousa E, Veksler V (2002) Metabolic myopathy in heart failure. News Physiol Sci 17:191–196PubMedGoogle Scholar
  65. 65.
    Esposito F, Mathieu-Costello O, Shabetai R et al (2010) Limited maximal exercise capacity in patients with chronic heart failure. J Am Coll Cardiol 55:1945–1954PubMedPubMedCentralGoogle Scholar
  66. 66.
    Koelling TM, Joseph S, Aaronson KD (2004) Heart failure survival score continues to predict clinical outcomes in patients with heart failure receiving beta-blockers. J Heart Lung Transplant 23:1414–1422PubMedGoogle Scholar
  67. 67.
    Ades PA, Keteyian SJ, Balady GJ et al (2013) Cardiac rehabilitation exercise and self-care for chronic heart failure. JACC Heart Fail 1:540–547PubMedPubMedCentralGoogle Scholar
  68. 68.
    Larsen AI, Lindal S, Aukrust P et al (2002) Effect of exercise training on skeletal muscle fiber characteristics in men with chronic heart failure. Correlation between skeletal muscle alterations, cytokines and exercise capacity. Int J Cardiol 83:25–32PubMedGoogle Scholar
  69. 69.
    Gustafsson T, Bodin K, Sylven C et al (2001) Increased expression of VEGF following exercise training in patients with heart failure. Eur J Clin Invest 31:362–366PubMedGoogle Scholar
  70. 70.
    Williams AD, Carey MF, Selig S et al (2007) Circuit resistance training in chronic heart failure improves skeletal muscle mitochondrial ATP production rate—a randomized controlled trial. J Card Fail 13:79–85PubMedGoogle Scholar
  71. 71.
    Tzanis G, Philippou A, Karatzanos E et al (2017) Effects of high-intensity interval exercise training on skeletal myopathy of chronic heart failure. J Card Fail 23:36–46PubMedGoogle Scholar
  72. 72.
    Libera LD, Vescovo G (2004) Muscle wastage in chronic heart failure, between apoptosis, catabolism and altered anabolism: a chimaeric view of information? Curr Opin Clin Nutr Metab Care 7:435–441PubMedGoogle Scholar
  73. 73.
    Adamopoulos S, Parissis J, Kremastinos D (2004) Proinflammatory cytokines and peripheral myopathy in patients with chronic heart failure: the beneficial effect of physical exercise. Hell J Cardiol 45:218–221Google Scholar
  74. 74.
    Gielen S, Adams V, Mobius-Winkler S et al (2003) Anti-inflammatory effects of exercise training in the skeletal muscle of patients with chronic HF. J Am Coll Cardiol 42:861–868PubMedGoogle Scholar
  75. 75.
    Kato A (2013) Muscle wasting is associated with reduced exercise capacity and advanced disease in patients with chronic heart failure. Future Cardiol 9:767–770PubMedGoogle Scholar
  76. 76.
    Anker SD, Volterrani M, Pflaum CD et al (2001) Acquired growth hormone resistance in patients with chronic heart failure: implications for therapy with growth hormone. J Am Coll Cardiol 38:443–452PubMedGoogle Scholar
  77. 77.
    Schulze PC, Gielen S, Adams V et al (2003) Muscular levels of proinflammatory cytokines correlate with a reduced expression of insulin-like growth factor-1 in chronic heart failure. Basic Res Cardiol 98:267–274PubMedGoogle Scholar
  78. 78.
    Schulze PC, Linke A, Schoene N et al (2004) Functional and morphological skeletal muscle abnormalities correlate with reduced electromyographic activity in chronic heart failure. Eur J Cardiovasc Prev Rehabil 11:155–161PubMedGoogle Scholar
  79. 79.
    Josiak K, Jankowska EA, Piepoli AF et al (2014) Skeletal myopathy in patients with chronic heart failure: significance of anabolic-androgenic hormones. J Cachexia Sarcopenia Muscle 5:287–296PubMedPubMedCentralGoogle Scholar
  80. 80.
    Fulster S, Tacke M, Sandek A et al (2013) Muscle wasting in patients with chronic heart failure: results from the studies investigating comorbidities aggravating heart failure (SICA-HF). Eur Heart J 34:512–519PubMedGoogle Scholar
  81. 81.
    Nilsson KR, Duscha BD, Hranitzky PM et al (2008) Chronic heart failure and exercise intolerance: the hemodynamic paradox. Curr Cardiol Rev 4:92–100PubMedPubMedCentralGoogle Scholar
  82. 82.
    Georgiadou P, Adamopoulos S (2012) Skeletal muscle abnormalities in chronic heart failure. Curr Heart Fail Rep 9:128–132PubMedGoogle Scholar
  83. 83.
    Hulsmann M, Quittan M, Berger R et al (2004) Muscle strength as a predictor of long-term survival in severe congestive heart failure. Eur J Heart Fail 6:101–107PubMedGoogle Scholar
  84. 84.
    Werber-Zion G, Goldhammer E, Shaar A et al (2004) Left ventricular function during strength testing and resistance exercise in patients with left ventricular dysfunction. J Cardiopulm Rehabil 24:100–109PubMedGoogle Scholar
  85. 85.
    Braith RW, Stewart KJ (2006) Resistance exercise training: its role in the prevention of cardiovascular disease. Circulation 113:2642–2650PubMedGoogle Scholar
  86. 86.
    Levinger I, Bronks R, Cody DV et al (2005) Resistance training for chronic heart failure patients on beta blocker medications. Int J Cardiol 102:493–499PubMedGoogle Scholar
  87. 87.
    Toth MJ, Miller MS, Vanburen P et al (2012) Resistance training alters skeletal muscle structure and function in human heart failure: effects at the tissue, cellular and molecular levels. J Physiol 590:1243–1259PubMedGoogle Scholar
  88. 88.
    Jankowska EA, Wegrzynowska K, Superlak M et al (2008) The 12-week progressive quadriceps resistance training improves muscle strength, exercise capacity and quality of life in patients with stable chronic heart failure. Int J Cardiol 130:36–43PubMedGoogle Scholar
  89. 89.
    Selig SE, Carey MF, Menzies DG et al (2004) Moderate-Intensity resistance exercise training in patients with chronic heart failure improves strength, endurance, heart rate variability and forearm blood flow. J Card Fail 10:21–30PubMedGoogle Scholar
  90. 90.
    Pu CT, Johnson MT, Forman DE et al (2001) Randomized trial of progressive resistance training to counteract the myopathy of chronic heart failure. J Appl Physiol 1985 90:2341–2350PubMedGoogle Scholar
  91. 91.
    Santoro C, Cosmas A, Forman D et al (2002) Exercise training alters mitochondrial morphometry in heart failure patients. J Cardiovasc Risk 9:377–381PubMedGoogle Scholar
  92. 92.
    Senden PJ, Sabelis LW, Zonderland ML et al (2005) The effect of physical training on workload, upper leg muscle function and muscle areas in patients with chronic heart failure. Int J Cardiol 100:293–300PubMedGoogle Scholar
  93. 93.
    Bouchla A, Karatzanos E, Dimopoulos S et al (2013) The addition of strength training to aerobic interval training. Effects on muscle strength and body composition in CHF patients. J Cardiopulm Rehabil Prev 31:47–51Google Scholar
  94. 94.
    Mckelvie RS, Teo KK, Roberts R et al (2002) Effects of exercise training in patients with heart failure: the Exercise Rehabilitation Trial (EXERT). Am Heart J 144:23–30PubMedGoogle Scholar
  95. 95.
    Maiorana A, O’Driscoll G, Cheetham C et al (2002) Combined aerobic and resistance exercise training improves functional capacity and strength in CHF. J Appl Physiol 1985 88:1565–1570Google Scholar
  96. 96.
    Mandic S, Tymchak W, Kim D et al (2009) Effects of aerobic or aerobic and resistance training on cardiorespiratory and skeletal muscle function in heart failure: a randomized controlled pilot trial. Clin Rehab 23:207–216Google Scholar
  97. 97.
    Von Haehling S, Genth-Zotz S, Anker SD et al (2002) Cachexia: a therapeutic approach beyond cytokine antagonism. Int J Cardiol 85:173–183Google Scholar
  98. 98.
    Hambrecht R, Schulze PC, Gielen S et al (2005) Effects of exercise training on insulin-like growth factor-I expression in the skeletal muscle of non-cachectic patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 12:401–406PubMedGoogle Scholar
  99. 99.
    Larsen AI, Aukrust P, Aarsland T et al (2001) Effect of aerobic exercise training on plasma levels of tumor necrosis factor alpha in patients with heart failure. Am J Cardiol 88:805–808PubMedGoogle Scholar
  100. 100.
    Gielen S, Adams V, Linke A et al (2005) Exercise training in chronic heart failure: correlation between reduced local inflammation and improved oxidative capacity in the skeletal muscle. Eur J Cardiovasc Prev 12:393–400Google Scholar
  101. 101.
    Adamopoulos S, Parissis J, Kroupis C et al (2001) Physical training reduces peripheral markers of inflammation in patients with chronic heart failure. Eur Heart J 22:791–797PubMedGoogle Scholar
  102. 102.
    Ribeiro-Samora GA, Rabelo LA, Ferreira ACC et al (2017) Inflammation and oxidative stress in heart failure: effects of exercise intensity and duration. Braz J Med Biol Res 50:e6393PubMedPubMedCentralGoogle Scholar
  103. 103.
    Lenk K, Erbs S, Hollriegel R et al (2011) Exercise training leads to a reduction of elevated myostatin levels in patients with chronic heart failure. Eur J Prev Cardiol 19:404–411PubMedGoogle Scholar
  104. 104.
    Von Haehling S, Steinbeck L, Doehner W et al (2013) Muscle wasting in heart failure: an overview. Int J Biochem Cell Biol 45:2257–2265Google Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PhysiotherapyAKMI Metropolitan CollegeMarousi, AthensGreece

Personalised recommendations