Effect of Exercise Training on Autonomic Derangement and Neurohumoral Activation in Chronic Heart Failure

Gademan, Maaike G.J.; Swenne, Cees A.; Verwey, Harriette F.; van der Laarse, Arnoud; Maan, Arie C.; van de Vooren, Hedde; van Pelt, Johannes; van Exel, Henk J.; Lucas, Caroline M.H.B.; Cleuren, Ger V.J.; Somer, Soeresh; Schalij, Martin J.; van der Wall, Ernst E.

doi:10.1016/j.cardfail.2006.12.006

« Previous Next »Journal of Cardiac Failure
Volume 13, Issue 4 , Pages 294-303, May 2007

Effect of Exercise Training on Autonomic Derangement and Neurohumoral Activation in Chronic Heart Failure

Maaike G.J. Gademan, MSc
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Cees A. Swenne, PhD
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Reprint requests: Cees A. Swenne, PhD, Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
Harriette F. Verwey, MD
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Arnoud van der Laarse, PhD
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Arie C. Maan, PhD
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Hedde van de Vooren, MSc
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Johannes van Pelt, PhD
- Department of Clinical Chemistry, Leiden University Medical Center, Leiden, The Netherlands
Henk J. van Exel, MD
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Deparment of Cardiopulmonary Rehabilitation, Rijnland Rehabilitation Center, Leiden, The Netherlands
Caroline M.H.B. Lucas, MD
- Heart Failure Outpatient Clinic, Rijnland Hospital, Leiderdorp, The Netherlands
Ger V.J. Cleuren, RN
- Heart Failure Outpatient Clinic, Rijnland Hospital, Leiderdorp, The Netherlands
Soeresh Somer, MD
- Regional Heart Rehabilitation Center, Bronovo Hospital, Den Haag, The Netherlands
Martin J. Schalij, MD
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Ernst E. van der Wall, MD
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

Received 9 May 2006; received in revised form 15 December 2006; accepted 27 December 2006.

Leiden, The Netherlands; Leiderdorp, The Netherlands; Den Haag, The Netherlands

Abstract

Background

In chronic heart failure (CHF), persistent autonomic derangement and neurohumoral activation cause structural end-organ damage, decrease exercise capacity, and reduce quality of life. Beneficial effects of pharmacotherapy and of exercise training in CHF have been documented at various functional and structural levels. However, pharmacologic treatment can not yet reduce autonomic derangement and neurohumoral activation in CHF to a minimum. Various studies suggest that exercise training is effective in this respect.

Methods and Results

After reviewing the available evidence we conclude that exercise training increases baroreflex sensitivity and heart rate variability, and reduces sympathetic outflow, plasma levels of catecholamines, angiotensin II, vasopressin, and brain natriuretic peptides at rest.

Conclusions

Exercise training has direct and reflex sympathoinhibitory beneficial effects in CHF. The mechanism by which exercise training normalizes autonomic derangement and neurohumoral activation is to elucidate for further development of CHF-related training programs aimed at maximizing efficacy while minimizing workload.

Key Words: Rehabilitation, exercise training, baroreflex sensitivity, heart rate, variability, sympathetic outflow, neurohormones, RAAS, BNP