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Exercise training in chronic heart failure: mechanisms and therapies

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Abstract

Decreased exercise capacity negatively affects the individuals’ ability to adequately perform activities required for normal daily life and, therefore, the independence and quality of life. Regular exercise training is associated with improved quality of life and survival in healthy individuals and in cardiovascular disease patients. Also in patients with stable heart failure, exercise training can relieve symptoms, improve exercise capacity and reduce disability, hospitalisation and probably mortality. Physical inactivity can thus be considered a major cardiovascular risk factor, and current treatment guidelines recommend exercise training in patients with heart failure in NYHA functional classes II and III. Exercise training is associated with numerous pulmonary, cardiovascular, and skeletal muscle metabolic adaptations that are beneficial to patients with heart failure. This review discusses current knowledge of mechanisms by which exercise training is beneficial in these patients.

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References

  1. Jeger RV, Radovanovic D, Hunziker PR, et al. Ten-year trends in the incidence and treatment of cardiogenic shock. Ann Intern Med. 2008;149:618–26.

    PubMed  Google Scholar 

  2. Remme WJ, Swedberg K. Task force for the diagnosis and treatment of chronic heart failure. European society of cardiology. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J. 2001;22:1527–60.

    Article  CAS  PubMed  Google Scholar 

  3. Correale M, Passero T, Totaro A, et al. Cardiopulmonary exercise test predicts sustained ventricular arrhythmias in chronic heart failure. Neth Heart J. 2012. doi:10.1007/s12471-012-0339-x

  4. Piña IL, Apstein CS, Balady GJ, et al. Exercise and heart failure: a statement from the American heart association committee on exercise, rehabilitation, and prevention. Circulation. 2003;107:1210–25.

    Article  PubMed  Google Scholar 

  5. Luttik ML, Brons M, Jaarsma T, et al. Design and methodology of the COACH-2 (comparative study on guideline adherence and patient compliance in heart failure patients) study: HF clinics versus primary care in stable patients on optimal therapy. Neth Heart J. 2012;20:307–12.

    Article  CAS  PubMed  Google Scholar 

  6. Meyer FJ, Borst MM, Zugck C, et al. Respiratory muscle dysfunction in congestive heart failure: clinical correlation and prognostic significance. Circulation. 2001;103:2153–8.

    Article  CAS  PubMed  Google Scholar 

  7. Thompson PD, Buchner D, Piña IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the council on clinical cardiology (subcommittee on exercise, rehabilitation, and prevention) and the council on nutrition, physical activity, and metabolism (subcommittee on physical activity). Circulation. 2003;107:3109–16.

    Article  PubMed  Google Scholar 

  8. Myers J, Prakash M, Froelicher V, et al. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346:793–801.

    Article  PubMed  Google Scholar 

  9. Brugts JJ, de Maat MP, Danser AH, et al. Individualised therapy of angiotensin converting enzyme (ACE) inhibitors in stable coronary artery disease: overview of the primary results of the PERindopril GENEtic association (PERGENE) study. Neth Heart J. 2012;20:24–32.

    Article  CAS  PubMed  Google Scholar 

  10. Piepoli MF, Davos C, Francis DP, et al. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ. 2004;328:189.

    Article  CAS  PubMed  Google Scholar 

  11. McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European society of cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33:1787–847.

    Article  PubMed  Google Scholar 

  12. van Tol BA, Huijsmans RJ, Kroon DW, et al. 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. 2006;8:841–50.

    Article  PubMed  Google Scholar 

  13. Ignarro LJ, Balestrieri ML, Napoli C. Nutrition, physical activity, and cardiovascular disease: an update. Cardiovasc Res. 2007;73:326–40.

    Article  CAS  PubMed  Google Scholar 

  14. Kortekaas KA, Lindeman JH, Versteegh MI, et al. Preexisting heart failure is an underestimated risk factor in cardiac surgery. Neth Heart J. 2012;20:202–7.

    Article  CAS  PubMed  Google Scholar 

  15. Jankowska EA, Ponikowski P, Piepoli MF, et al. Autonomic imbalance and immune activation in chronic heart failure—pathophysiological links. Cardiovasc Res. 2006;70:434–45.

    Article  CAS  PubMed  Google Scholar 

  16. Ponikowski P, Anker SD, Chua TP, et al. Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 1997;79:1645–50.

    Article  CAS  PubMed  Google Scholar 

  17. Ponikowski P, Chua TP, Piepoli M, et al. Augmented peripheral chemosensitivity as a potential input to baroreflex impairment and autonomic imbalance in chronic heart failure. Circulation. 1997;96:2586–94.

    Article  CAS  PubMed  Google Scholar 

  18. Malliani A, Montano N. Emerging excitatory role of cardiovascular sympathetic afferents in pathophysiological conditions. Hypertension. 2002;39:63–8.

    Article  CAS  PubMed  Google Scholar 

  19. Ponikowski P, Chua TP, Francis DP, et al. Muscle ergoreceptor overactivity reflects deterioration in clinical status and cardiorespiratory reflex control in chronic heart failure. Circulation. 2001;104:2324–30.

    Article  CAS  PubMed  Google Scholar 

  20. Gao L, Wang W, Li YL, et al. Superoxide mediates sympathoexcitation in heart failure: roles of angiotensin II and NAD(P)H oxidase. Circ Res. 2004;95:937–44.

    Article  CAS  PubMed  Google Scholar 

  21. Liu D, Gao L, Roy SK, et al. Role of oxidant stress on AT1 receptor expression in neurons of rabbits with heart failure and in cultured neurons. Circ Res. 2008;103:186–93.

    Article  CAS  PubMed  Google Scholar 

  22. Zhang K, Li YF, Patel KP. Blunted nitric oxide-mediated inhibition of renal nerve discharge within PVN of rats with heart failure. Am J Physiol Heart Circ Physiol. 2001;281:H995–1004.

    CAS  PubMed  Google Scholar 

  23. Mousa TM, Liu D, Cornish KG, et al. Exercise training enhances baroreflex sensitivity by an angiotensin II-dependent mechanism in chronic heart failure. J Appl Physiol. 2008;104:616–24.

    Article  CAS  PubMed  Google Scholar 

  24. Zheng H, Li YF, Cornish KG, et al. Exercise training improves endogenous nitric oxide mechanisms within the paraventricular nucleus in rats with heart failure. Am J Physiol Heart Circ Physiol. 2005;288:H2332–41.

    Article  CAS  PubMed  Google Scholar 

  25. Gademan MG, Swenne CA, Verwey HF, et al. Effect of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure. J Card Fail. 2007;13:294–303.

    Article  PubMed  Google Scholar 

  26. Coats AJ, Adamopoulos S, Radaelli A, et al. Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function. Circulation. 1992;85:2119–31.

    Article  CAS  PubMed  Google Scholar 

  27. Braith RW, Welsch MA, Feigenbaum MS, et al. Neuroendocrine activation in heart failure is modified by endurance exercise training. J Am Coll Cardiol. 1999;34:1170–5.

    Article  CAS  PubMed  Google Scholar 

  28. Liu JL, Kulakofsky J, Zucker IH. Exercise training enhances baroreflex control of heart rate by a vagal mechanism in rabbits with heart failure. J Appl Physiol. 2002;92:2403–8.

    PubMed  Google Scholar 

  29. Woodman CR, Muller JM, Laughlin MH, et al. Induction of nitric oxide synthase mRNA in coronary resistance arteries isolated from exercise-trained pigs. Am J Physiol. 1997;273:H2575–9.

    CAS  PubMed  Google Scholar 

  30. Adams V, Linke A, Kränkel N, et al. Impact of regular physical activity on the NAD(P)H oxidase and angiotensin receptor system in patients with coronary artery disease. Circulation. 2005;111:555–62.

    Article  CAS  PubMed  Google Scholar 

  31. Bozkurt B, Kribbs SB, Clubb Jr FJ, et al. Pathophysiologically relevant concentrations of tumor necrosis factor-alpha promote progressive left ventricular dysfunction and remodeling in rats. Circulation. 1998;97:1382–91.

    Article  CAS  PubMed  Google Scholar 

  32. LeMaitre JP, Harris S, Fox KA, et al. Change in circulating cytokines after 2 forms of exercise training in chronic stable heart failure. Am Heart J. 2004;147:100–5.

    Article  CAS  PubMed  Google Scholar 

  33. Kokkinos PF, Choucair W, Graves P, et al. Chronic heart failure and exercise. Am Heart J. 2000;140:21–8.

    Article  CAS  PubMed  Google Scholar 

  34. Hambrecht R, Niebauer J, Fiehn E, et al. Physical training in patients with stable chronic heart failure: effects on cardiorespiratory fitness and ultrastructural abnormalities of leg muscles. J Am Coll Cardiol. 1995;25:1239–49.

    Article  CAS  PubMed  Google Scholar 

  35. Lu L, Mei DF, Gu AG, et al. Exercise training normalizes altered calcium-handling proteins during development of heart failure. J Appl Physiol. 2002;92:1524–30.

    CAS  PubMed  Google Scholar 

  36. Polcaro P, Lova RM, Guarducci, et al. Left-ventricular function and physical performance on the 6-min walk test in older patients after inpatient cardiac rehabilitation. Am J Phys Med Rehabil. 2008;87:46–52.

    Article  PubMed  Google Scholar 

  37. Piepoli MF, Conraads V, Corrà U, et al. Exercise training in heart failure: from theory to practice. A consensus document of the heart failure association and the European association for cardiovascular prevention and rehabilitation. Eur J Heart Fail. 2011;13:347–57.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy

    M. F. Piepoli

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  1. M. F. Piepoli
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Correspondence to M. F. Piepoli.

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Piepoli, M.F. Exercise training in chronic heart failure: mechanisms and therapies. Neth Heart J 21, 85–90 (2013). https://doi.org/10.1007/s12471-012-0367-6

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