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Hypothalamic dysfunction in heart failure: pathogenetic mechanisms and therapeutic implications. Heart Fail Rev 2017; 23:55-61. [DOI: 10.1007/s10741-017-9659-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Karavidas AI, Raisakis KG, Parissis JT, Tsekoura DK, Adamopoulos S, Korres DA, Farmakis D, Zacharoulis A, Fotiadis I, Matsakas E, Zacharoulis A. Functional electrical stimulation improves endothelial function and reduces peripheral immune responses in patients with chronic heart failure. ACTA ACUST UNITED AC 2016; 13:592-7. [PMID: 16874150 DOI: 10.1097/01.hjr.0000219111.02544.ff] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Previous studies have shown beneficial effects of functional electrical stimulation (FES) on muscle performance and exercise capacity of patients with chronic heart failure. This study evaluates the impact of FES on endothelial function and peripheral markers of immune activation in patients with moderate to severe heart failure. METHODS Twenty-four patients with a left ventricular ejection fraction of less than 40% and New York Heart Association class II-III symptoms, undergoing optimized drug therapy, were randomly assigned (2 : 1) to a 6-week training programme of FES (n=16) or served as controls (n=8). Endothelial function was assessed by Doppler flow-mediated dilatation (FMD) of the brachial artery before and after the training programme. Peripheral pro-inflammatory/anti-inflammatory markers such as tumour necrosis factor (TNF)-alpha, interleukin (IL)-6, soluble intercellular adhesion molecule (sICAM)-1, soluble vascular cell adhesion molecule (sVCAM)-1 and IL-10 were also measured before and after training. RESULTS A significant improvement on the 6-min walk test (7.5+/-3.3%), Minnesota Living Score (18.2+/-8.6%) and FMD (38.5+/-15.1%) was observed only in the FES-treated group. FES also causes a significant reduction of TNF-alpha (-11.5+/-8.9%), sICAM-1 (-13.1+/-9.8%), and sVCAM-1 (-10.6+/-6.6%), as well as a respective increase in the ratio IL-10/TNF-alpha (37.1+/-29.4%). In the FES group, the percentage improvement in the Minnesota Living Score was significantly correlated with respective changes in circulating TNF-alpha (r=0.624, P<0.01), sVCAM-1 (r=0.665, P<0.001) and the ratio IL-10/TNF-alpha (r=-0.641, P<0.01). CONCLUSION FES is an exercise training programme that improves endothelial function in patients with chronic heart failure, and also has anti-inflammatory effects.
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Effects of Exercise Training on Autonomic Function in Chronic Heart Failure: Systematic Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:591708. [PMID: 26543861 PMCID: PMC4620239 DOI: 10.1155/2015/591708] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/10/2015] [Accepted: 09/13/2015] [Indexed: 11/25/2022]
Abstract
Objectives. Cardiac autonomic imbalance accompanies the progression of chronic heart failure (CHF). It is unclear whether exercise training could modulate autonomic control in CHF. This study aimed to review systematically the effects of exercise training on heart rate recovery (HRR) and heart rate variability (HRV) in patients with CHF. Methods. Literatures were systematically searched in electronic databases and relevant references. Only published randomized controlled trials (RCTs) focusing on exercise training for CHF were eligible for inclusion. Outcome measurements included HRR and HRV parameters. Results. Eight RCTs were eligible for inclusion and provided data on 280 participants (186 men). The participants were 52–70 years of age with New York Heart Association functional class II-III of CHF. Each study examined either aerobic or resistance exercise. Two trials addressed outcome of HRR and six HRV among these studies. Two RCTs showed that moderate aerobic exercise could improve HRR at 2 minutes after exercise training in CHF. Five of six RCTs demonstrated positive effects of exercise training on HRV which revealed the increments in high frequency (HF) and decrements in LF (low frequency)/HF ratio after training. Conclusion. Participation in an exercise training program has positive effects on cardiac autonomic balance in patients with CHF.
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Mammi C, la Sala A, Volterrani M, Gatta L, Antelmi A, Feraco A, Caminiti G, Marazzi G, Vitale C, Caprio M, Rosano GMC. Exercise training reduces serum capacity to induce endothelial cell death in patients with chronic heart failure. Eur J Heart Fail 2014; 13:642-50. [DOI: 10.1093/eurjhf/hfr026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Caterina Mammi
- Department of Medical Sciences, Centre of Clinical and Basic Research; IRCCS San Raffaele Pisana, Via dei Bonacolsi 81; 00163 Rome Italy
| | - Andrea la Sala
- Department of Medical Sciences, Centre of Clinical and Basic Research; IRCCS San Raffaele Pisana, Via dei Bonacolsi 81; 00163 Rome Italy
| | - Maurizio Volterrani
- Department of Medical Sciences, Centre of Clinical and Basic Research; IRCCS San Raffaele Pisana, Via dei Bonacolsi 81; 00163 Rome Italy
| | - Lucia Gatta
- Research Centre, San Raffaele; Sulmona Italy
| | - Antonella Antelmi
- Department of Medical Sciences, Centre of Clinical and Basic Research; IRCCS San Raffaele Pisana, Via dei Bonacolsi 81; 00163 Rome Italy
| | - Alessandra Feraco
- Department of Human Nutrition; University of Tor Vergata; Rome Italy
| | - Giuseppe Caminiti
- Department of Medical Sciences, Centre of Clinical and Basic Research; IRCCS San Raffaele Pisana, Via dei Bonacolsi 81; 00163 Rome Italy
| | - Giuseppe Marazzi
- Department of Medical Sciences, Centre of Clinical and Basic Research; IRCCS San Raffaele Pisana, Via dei Bonacolsi 81; 00163 Rome Italy
| | - Cristiana Vitale
- Department of Medical Sciences, Centre of Clinical and Basic Research; IRCCS San Raffaele Pisana, Via dei Bonacolsi 81; 00163 Rome Italy
| | - Massimiliano Caprio
- Department of Medical Sciences, Centre of Clinical and Basic Research; IRCCS San Raffaele Pisana, Via dei Bonacolsi 81; 00163 Rome Italy
| | - Giuseppe Massimo Claudio Rosano
- Department of Medical Sciences, Centre of Clinical and Basic Research; IRCCS San Raffaele Pisana, Via dei Bonacolsi 81; 00163 Rome Italy
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Nunan D, Sandercock GR, George RS, Jakovljevic DG, Donovan G, Bougard R, Yacoub MH, Brodie DA, Birks EJ. Cardiovascular autonomic control in patients undergoing left ventricular assist device (LVAD) support and pharmacologic therapy. Int J Cardiol 2013; 168:4145-9. [DOI: 10.1016/j.ijcard.2013.07.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 07/08/2013] [Indexed: 11/24/2022]
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Vanzelli AS, Medeiros A, Rolim N, Bartholomeu JB, Cunha TF, Bechara LG, Gomes ERM, Mattos KC, Sirvente R, Salemi V, Mady C, Negrao CE, Guatimosim S, Brum PC. Integrative effect of carvedilol and aerobic exercise training therapies on improving cardiac contractility and remodeling in heart failure mice. PLoS One 2013; 8:e62452. [PMID: 23658728 PMCID: PMC3641040 DOI: 10.1371/journal.pone.0062452] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 03/21/2013] [Indexed: 11/19/2022] Open
Abstract
The use of β-blockers is mandatory for counteracting heart failure (HF)-induced chronic sympathetic hyperactivity, cardiac dysfunction and remodeling. Importantly, aerobic exercise training, an efficient nonpharmacological therapy to HF, also counteracts sympathetic hyperactivity in HF and improves exercise tolerance and cardiac contractility; the latter associated with changes in cardiac Ca2+ handling. This study was undertaken to test whether combined β–blocker and aerobic exercise training would integrate the beneficial effects of isolated therapies on cardiac structure, contractility and cardiomyocyte Ca2+ handling in a genetic model of sympathetic hyperactivity-induced HF (α2A/α2C- adrenergic receptor knockout mice, KO). We used a cohort of 5–7 mo male wild-type (WT) and congenic mice (KO) with C57Bl6/J genetic background randomly assigned into 5 groups: control (WT), saline-treated KO (KOS), exercise trained KO (KOT), carvedilol-treated KO (KOC) and, combined carvedilol-treated and exercise-trained KO (KOCT). Isolated and combined therapies reduced mortality compared with KOS mice. Both KOT and KOCT groups had increased exercise tolerance, while groups receiving carvedilol had increased left ventricular fractional shortening and reduced cardiac collagen volume fraction compared with KOS group. Cellular data confirmed that cardiomyocytes from KOS mice displayed abnormal Ca2+ handling. KOT group had increased intracellular peak of Ca2+ transient and reduced diastolic Ca2+ decay compared with KOS group, while KOC had increased Ca2+ decay compared with KOS group. Notably, combined therapies re-established cardiomyocyte Ca2+ transient paralleled by increased SERCA2 expression and SERCA2:PLN ratio toward WT levels. Aerobic exercise trained increased the phosphorylation of PLN at Ser16 and Thr17 residues in both KOT and KOCT groups, but carvedilol treatment reduced lipid peroxidation in KOC and KOCT groups compared with KOS group. The present findings provide evidence that the combination of carvedilol and aerobic exercise training therapies lead to a better integrative outcome than carvedilol or exercise training used in isolation.
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Affiliation(s)
- Andréa S. Vanzelli
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - Natale Rolim
- Department of Circulation and Medical Imaging and K.G. Jebsen Center of Exercise in Medicine, Trondheim, Norway
| | - Jan B. Bartholomeu
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Telma F. Cunha
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Luiz G. Bechara
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Enéas R. M. Gomes
- Physiology and Biophysics Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Katt C. Mattos
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Raquel Sirvente
- Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil
| | - Vera Salemi
- Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil
| | - Charles Mady
- Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil
| | - Carlos E. Negrao
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
- Heart Institute (InCor), University of São Paulo, Medical School, São Paulo, Brazil
| | - Silvia Guatimosim
- Physiology and Biophysics Department, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Patricia C. Brum
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
- * E-mail:
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Aufradet E, Bessaad A, Alsaid H, Schäfer F, Sigovan M, De Souza G, Chirico E, Martin C, Canet-Soulas E. In vivo cardiac anatomical and functional effects of wheel running in mice by magnetic resonance imaging. Exp Biol Med (Maywood) 2012; 237:263-70. [PMID: 22328593 DOI: 10.1258/ebm.2011.011034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Physical activity is frequently used as a strategy to decrease pathogenesis and improve outcomes in chronic pathologies such as metabolic or cardiac diseases. In mice, it has been shown that voluntary wheel running (VWR) could induce an aerobic training effect and may provide a means of exploring the relationship between physical activity and the progression of pathology, or the effect of a drug on locomotor activity. To the best of our knowledge, in vivo magnetic resonance imaging (MRI) and other non-invasive methods had not been investigated for training evaluation in mice; therefore, it was proposed to test an MRI method coupled with a cardiorespiratory gating system on C57Bl/6 mice for in vivo heart anatomical and functional characterization in both trained and untrained animals. Twenty mice were either assigned to a 12-week VWR program or to a control group (CON - no wheel in the cage). At week 12, MRI scans showed an increase in the left ventricular (LV) wall mass in the VWR group compared with the CON group. The ex vivo measurements also found an increase in the heart and LV weight, as well as an increase in oxidative enzyme activities (i.e. cytochrome c oxidase [COx] in the soleus). In addition, correlations have been observed between ex vivo LV/body weight ratio, COx activity in the soleus and in vivo MRI LV wall mass/body weight. In conclusion, mouse cardiac MRI methods coupled with a cardio-respiratory gating system are sufficiently effective and feasible for non-invasive, training-induced heart hypertrophy characterization, and may be used for longitudinal training level follow-up in mouse models of cardiovascular and metabolic diseases.
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Affiliation(s)
- Emeline Aufradet
- Center of Research and Innovation on Sports, University of Lyon 1, University of Lyon, 69622 Villeurbanne Cedex, France
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Annegarn J, Spruit MA, Uszko-Lencer NH, Vanbelle S, Savelberg HH, Schols AM, Wouters EF, Meijer K. Objective Physical Activity Assessment in Patients With Chronic Organ Failure: A Validation Study of a New Single-Unit Activity Monitor. Arch Phys Med Rehabil 2011; 92:1852-1857.e1. [DOI: 10.1016/j.apmr.2011.06.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 05/25/2011] [Accepted: 06/09/2011] [Indexed: 10/15/2022]
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Effect of Exercise-Based Cardiac Rehabilitation Following Coronary Artery Bypass Surgery on Ventricular Repolarization Indices. J Cardiopulm Rehabil Prev 2011; 31:239-44. [DOI: 10.1097/hcr.0b013e318211e3c0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Smart NA, Larsen AI, Le Maitre JP, Ferraz AS. Effect of exercise training on interleukin-6, tumour necrosis factor alpha and functional capacity in heart failure. Cardiol Res Pract 2011; 2011:532620. [PMID: 21403878 PMCID: PMC3051173 DOI: 10.4061/2011/532620] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 01/12/2011] [Accepted: 01/14/2011] [Indexed: 11/25/2022] Open
Abstract
Background. We pooled data from four studies, to establish whether exercise training programs were able to modulate systemic cytokine levels of tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). A second aim was to establish if differences in ExT regimens are related to degree of change in cytokines and peak VO2. Methods. Data from four centres relating to training protocol, exercise capacity, and cytokine measures (TNF-alpha and IL-6) were pooled for analysis. Results. Data for 106 CHF patients were collated (98 men, age 62 ± 10 yrs, wt 79 ± 14 Kg). Patients were moderately impaired (peak VO2 16.9 ± 4.4 mls/kg/min), with moderate LV systolic dysfunction (EF 30 ± 6.9%), 78% (83) had ischaemic cardiomyopathy. After ExT, peak VO2 increased 1.4 ± 3.4 ml/kg/min (P < .001), serum TNF-alpha decreased 1.9 ± 8.6 pg/ml (P = .02) and IL-6 was not significantly changed (0.5 ± 5.4 pg/ml, P = .32) for the whole group. Baseline and post-training peak VO2 changes were not correlated with change in cytokine levels. Conclusions. Exercise training reduces levels TNF-alpha but not IL-6 in CHF. However, across a heterogenic patient group, change in peak VO2 was not correlated with alterations in cytokine levels. While greater exercise volume (hours) was superior in improving peak VO2, no particular characteristic of ExT regimes appeared superior in effecting change in serum cytokines.
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Affiliation(s)
- Neil A Smart
- Faculty of Health Science, Bond University, QLD 4229, Australia
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Tsarouhas K, Karatzaferi C, Tsitsimpikou C, Haliassos A, Kouretas D, Pavlidis P, Veskoukis A, Adamopoulos S, Kyriakides Z, Constantinou L, Koutedakis Y, Rentoukas E. Effects of walking on heart rate recovery, endothelium modulators and quality of life in patients with heart failure. ACTA ACUST UNITED AC 2011; 18:594-600. [DOI: 10.1177/1741826710397099] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Konstantinos Tsarouhas
- ‘Amalia Fleming’ General Hospital, Athens, Greece
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Christina Karatzaferi
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | - Christina Tsitsimpikou
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | | | - Demetrios Kouretas
- Department of Biochemistry and Biotechnology, University of Thessaly, Larisa, Greece
| | | | - Aristidis Veskoukis
- Department of Biochemistry and Biotechnology, University of Thessaly, Larisa, Greece
| | - Stamatis Adamopoulos
- 2nd Department of Cardiovascular Medicine, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Zenon Kyriakides
- B Cardiology Department, Red Cross General Hospital, Athens, Greece
| | | | - Yannis Koutedakis
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
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Chan C, Tang D, Jones A. Clinical outcomes of a cardiac rehabilitation and maintenance program for Chinese patients with congestive heart failure. Disabil Rehabil 2009; 30:1245-53. [DOI: 10.1080/09638280701580226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pozehl B, Duncan K, Hertzog M. The effects of exercise training on fatigue and dyspnea in heart failure. Eur J Cardiovasc Nurs 2007; 7:127-32. [PMID: 17900989 DOI: 10.1016/j.ejcnurse.2007.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 08/14/2007] [Accepted: 08/16/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Physiological benefits of exercise training for heart failure (HF) patients have been demonstrated, however little is known about the effects of training on the symptoms of fatigue and dyspnea. AIM The purpose of this study was to examine HF symptoms of fatigue and dyspnea in response to a 24-week exercise training intervention. METHODS This pilot study was a randomized, two-group repeated measures design. Fifteen subjects in the intervention group completed a combination of aerobic and resistance training three times per week in a standard cardiac rehabilitation setting. The control group consisted of 6 subjects who were instructed not to begin any formal exercise program during the 24-week intervention. RESULTS Subjects (19 males and 2 females) had a mean age of 66.2+/-10.2 years and mean ejection fraction (EF) of 28.4+/-7.4%. Non-parametric Friedman Analysis of Variance by Ranks showed the exercise group significantly decreased sensory fatigue (Piper Fatigue Scale) over time (chi(2)=6.49, p=.04) while the control group did not change (chi(2)=0.93, p=.63). Dyspnea showed a non-significant decrease over time for the exercise group (chi(2)=4.16, p=.13) while the control group showed a decrease from baseline to 12 weeks but an increase to above baseline values by week 24 (chi(2)=0.18, p=.91). CONCLUSION These results provide support for the beneficial effects of exercise training on symptoms of fatigue and dyspnea in HF patients. Larger studies to evaluate symptom response to exercise are needed.
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Affiliation(s)
- Bunny Pozehl
- Lincoln Division, University of Nebraska Medical Center College of Nursing, Lincoln, Nebraska, United States.
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Nyquist-Battie C, Fletcher GF, Fletcher B, Carlson JM, Castello R, Oken K. Upper-Extremity Exercise Training in Heart Failure. J Cardiopulm Rehabil Prev 2007; 27:42-5. [PMID: 17474643 DOI: 10.1097/01.hcr.0000265019.18661.82] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Aerobic exercise training (ExTR), predominantly performed with lower extremities, has been used to reverse heart failure (HF)-related exercise intolerance. The present study determined the safety and efficacy of upper-extremity exercise in HF subjects because daily activities are performed using both upper and lower extremities and there is little cross-training effects between extremities. METHODS Seven subjects underwent 36 sessions (40 minutes, 3 times per week for 12 weeks) of upper-extremity ExTR (ARM ExTR) using arm ergometers, the arm function of a NuStep device, and an Airdyne stationary cycle. Exercise intensity and duration during weeks 1 to 4 were gradually increased to achieve a 75% to 85% peak heart rate. Pre- and post-ExTR tests included arm ergometer cardiopulmonary testing with echocardiography and quality of life self-administered surveys. RESULTS After ARM ExTR test duration increased by 22% (P = .008), respiratory exchange ratio increased by 10% (P = .02), whereas peak oxygen consumption was not improved. Echocardiographic parameters were not altered by ARM ExTR. The total scores of both the Minnesota Living With Heart Failure Questionnaire (P = .02) and the Medical Outcomes Study-36 questionnaire (P = .05) were improved, but the Functional Status Questionnaire scores were not improved. CONCLUSIONS Although this study was limited in the number of subjects and lacked a control group, results indicate that ARM ExTR is safe and well-tolerated by persons diagnosed with HF, a finding that is relevant for individuals with HF who cannot exercise with lower extremities.
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Tenenbaum A, Freimark D, Ahron E, Koren-Morag N, Schwamenthal E, Fisman EZ, Shechter M, Tanne D, Kachlon D, Motro M, Adler Y. Long-term versus intermediate-term supervised exercise training in advanced heart failure: Effects on exercise tolerance and mortality. Int J Cardiol 2006; 113:364-70. [PMID: 16707174 DOI: 10.1016/j.ijcard.2005.11.098] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Revised: 10/10/2005] [Accepted: 11/17/2005] [Indexed: 11/23/2022]
Abstract
AIM To date there have been no studies exploring the effects of long-term versus intermediate-term and short-term supervised exercise training program in patients with severe chronic heart failure (CHF) on optimal medical therapy. We assessed exercise tolerance and mortality in CHF patients undergoing long- versus intermediate-term exercise training (ET). METHODS Forty-two consecutive severe CHF patients (New York Heart Association functional class III) were referred for a supervised exercise and cardiac rehabilitation program and were followed-up for 3 years: 20/42 (48%) patients discontinued ET after intermediate-term period of 1.6+/-0.8 years (Group A, intermediate-term ET), and 22/42 (52%) remained on the ET program for 3.0+/-0.3 years (Group B, long-term ET). Exercise duration, 6-min walked distance and metabolic equivalents (METs) assessed by modified Bruce protocol were recorded before, 4.5 months after, and 3 years after initiation of ET. RESULTS Both groups were comparable regarding age, gender, prevalence of ischemic etiology, mean ejection fraction and medications. Risk factors for ischemic heart disease were similar, except for the prevalence of diabetes, which was higher in Group A compared to Group B (11/20 versus 5/22, p=0.03). Significantly more Group A patients died after ET discontinuation (4/20 versus 0/22, p=0.01). At the end of follow-up a significant improvement could be seen in Group B patients compared to A in exercise duration, 6-min walked distance and metabolic equivalents (p<0.01 for all). CONCLUSIONS Higher survival rate was observed in severe CHF patients undergoing long-term versus intermediate-term exercise training. Long-term supervised exercise training is safe and improves exercise tolerance in these patients.
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Affiliation(s)
- Alexander Tenenbaum
- Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Brassard P, Bédard E, Jobin J, Rodés-Cabau J, Poirier P. Exercise capacity and impact of exercise training in patients after a Fontan procedure: a review. Can J Cardiol 2006; 22:489-95. [PMID: 16685313 PMCID: PMC2560550 DOI: 10.1016/s0828-282x(06)70266-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
After a successful Fontan procedure, children and adolescents should improve their exercise capacity. However, several studies have shown that these children have a reduced maximal oxygen consumption compared with healthy children. The lower exercise performance in these patients was mainly explained by a reduced cardiorespiratory functional capacity. However, it has recently been reported that the lower exercise performance may also be related to altered skeletal muscle function. Moreover, exercise training had a beneficial impact on several parameters related to exercise tolerance in these patients. The main studies supporting these observations are reviewed, with a focus on the physiological adaptation and limitation of the exercise performance as well as the benefits of exercise training in patients after a Fontan procedure.
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Affiliation(s)
- Patrice Brassard
- Institut Universitaire de Cardiologie et de Pneumologie, Hôpital Laval, Université Laval, Sainte-Foy, Québec
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Coats AJS. Advances in the non-drug, non-surgical, non-device management of chronic heart failure. Int J Cardiol 2005; 100:1-4. [PMID: 15820278 DOI: 10.1016/j.ijcard.2005.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 01/19/2005] [Indexed: 12/13/2022]
Abstract
There have been many articles, reviews and editorials about the recent advances in pharmaceutical and device management of chronic heart failure in this and other journals over the last few years. What has been less praised are the significant advances we have made in understanding the best management of heart failure using other non-drug, non-surgical, non-device approaches. Approaches as diverse as nutrition, education, exercise, physiotherapy, psychotherapy and therapies for sleep-disordered breathing have shown considerable promise in improving the lot of our chronic heart failure (CHF) patients. Chronic heart failure is a common condition with a poor prognosis. It generates many debilitating symptoms for the sufferer. Non-pharmacologic treatment modalities play an important role alongside effective modern pharmaceutical, surgical and device therapies in relieving symptoms and improving prognosis. These treatments include those lifestyle measures that reduce the risk of underlying diseases such as coronary artery disease, diabetes, and hypertension lifestyle interventions of benefit in established CHF. Recent advances are reviewed including specialist nursing care, multi-disciplinary heart failure clinics, exercise rehabilitation, the treatment of sleep-disordered breathing, depression, obesity and cachexia. The day of the multi-disciplinary patient-centred CHF clinic has arrived and all sufferers deserve experienced management using all these approaches.
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Nusair S, Eid A, Bardach E, Berkman N. Resolving impaired response to exercise in hepatopulmonary syndrome after liver transplantation. Int J Cardiol 2005; 102:533-5. [PMID: 16004905 DOI: 10.1016/j.ijcard.2004.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2004] [Revised: 05/21/2004] [Accepted: 06/22/2004] [Indexed: 10/25/2022]
Abstract
A series of graded cardiopulmonary exercise tests (CPET) in a patient with hepatopulmonary syndrome (HPS) who was evaluated before and after liver transplantation are described. HPS associated with marked dyspnea, results from abnormal intrapulmonary vascular dilatation with rapid transit of the blood in the pulmonary vascular bed, creating right-to-left shunt and hypoxemia. Decreased peak oxygen uptake, wasted ventilation and hypoxemia were corrected within 8 months after the transplant, thus making CPET a very useful tool for investigating and following these patients before and after transplant.
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Hagerman I, Tyni-Lenné R, Gordon A. Outcome of exercise training on the long-term burden of hospitalisation in patients with chronic heart failure. A retrospective study. Int J Cardiol 2005; 98:487-91. [PMID: 15708184 DOI: 10.1016/j.ijcard.2003.10.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2003] [Accepted: 10/12/2003] [Indexed: 11/29/2022]
Abstract
AIMS Heart failure is a major cause of hospitalisation, particularly in patients more than 65 years of age in the western world. A common endpoint in studies designed to evaluate treatment effects in heart failure is mortality and morbidity, often reported as an event of hospitalisation. It has recently been reported that this endpoint is misleading with respect to the burden of the disease with regard to the patient, the health service and costs. Furthermore, it can be hypothesized that different treatment effects are better evaluated using more sensitive parameters than those traditionally used in clinical studies. Short-term beneficial effects of exercise training in heart failure patients have previously been showed. Therefore, the aim of this study was to evaluate the long-term effects of exercise training in heart failure patients with regard to different outcome parameters. METHOD AND STUDY GROUP: Patients with chronic heart failure, stabilised on pharmacological treatment, who had participated in a physical training program for 8 weeks, were analysed retrospectively after 5 years. The study group was compared to a matched control group which received conventional treatment and was diagnosed during the same period but not participating in a training program. RESULTS Exercise training in heart failure patients resulted in significantly less hospitalisation events (2+/-3 vs. 3+/-3, p<0.05) and hospitalisation days (10+/-17 vs. 20+/-27, p<0.05) due to cardiac problems at 5 years after follow-up. Exercise training did not effect mortality. CONCLUSION Long-term effects of exercise training on burden of disease in chronic heart failure patients is associated with significantly less events and days of hospitalisation due to worsening of cardiac disease.
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Affiliation(s)
- I Hagerman
- Department of Cardiology, Karolinska Institute, Huddinge University Hospital, M52, SE-141 86 Stockholm, Sweden.
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Opocher F, Varnier M, Sanders SP, Tosoni A, Zaccaria M, Stellin G, Milanesi O. Effects of aerobic exercise training in children after the Fontan operation. Am J Cardiol 2005; 95:150-2. [PMID: 15619417 DOI: 10.1016/j.amjcard.2004.08.085] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Revised: 08/17/2004] [Accepted: 08/16/2004] [Indexed: 11/21/2022]
Abstract
It was demonstrated that patients who have undergone the Fontan operation can safely undertake exercise training and that this results in an improvement in aerobic capacity. These findings suggest that aerobic training could be useful in the long-term management of these patients to optimize their cardiovascular fitness for more active lives.
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Affiliation(s)
- Francesca Opocher
- Department of Pediatrics, Medical and Surgical Sciences, University of Padova, School of Medicine, Padova, Italy
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Medeiros A, Oliveira EM, Gianolla R, Casarini DE, Negrão CE, Brum PC. Swimming training increases cardiac vagal activity and induces cardiac hypertrophy in rats. Braz J Med Biol Res 2004; 37:1909-17. [PMID: 15558199 DOI: 10.1590/s0100-879x2004001200018] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The effect of swimming training (ST) on vagal and sympathetic cardiac effects was investigated in sedentary (S, N = 12) and trained (T, N = 12) male Wistar rats (200-220 g). ST consisted of 60-min swimming sessions 5 days/week for 8 weeks, with a 5% body weight load attached to the tail. The effect of the autonomic nervous system in generating training-induced resting bradycardia (RB) was examined indirectly after cardiac muscarinic and adrenergic receptor blockade. Cardiac hypertrophy was evaluated by cardiac weight and myocyte morphometry. Plasma catecholamine concentrations and citrate synthase activity in soleus muscle were also determined in both groups. Resting heart rate was significantly reduced in T rats (355 +/- 16 vs 330 +/- 20 bpm). RB was associated with a significantly increased cardiac vagal effect in T rats (103 +/- 25 vs 158 +/- 40 bpm), since the sympathetic cardiac effect and intrinsic heart rate were similar for the two groups. Likewise, no significant difference was observed for plasma catecholamine concentrations between S and T rats. In T rats, left ventricle weight (13%) and myocyte dimension (21%) were significantly increased, suggesting cardiac hypertrophy. Skeletal muscle citrate synthase activity was significantly increased by 52% in T rats, indicating endurance conditioning. These data suggest that RB induced by ST is mainly mediated parasympathetically and differs from other training modes, like running, that seems to mainly decrease intrinsic heart rate in rats. The increased cardiac vagal activity associated with ST is of clinical relevance, since both are related to increased life expectancy and prevention of cardiac events.
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Affiliation(s)
- A Medeiros
- Departamento de Biodinâmica do Movimento do Corpo Humano, Escola de Educação Física e Esporte, Universidade de São Paulo, São Paulo, SP, Brazil
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Abstract
OBJECTIVE The purpose of this study was to gain insight from the patient's perspective into how it is to live with moderate chronic heart failure (HF). METHODS Twenty men with moderate chronic HF in New York Heart Association classes II to III, aged 43 to 73 years, were interviewed with open-ended questions. The interviews were analyzed using qualitative inductive content analysis as a method. RESULTS Both the consequences of the illness and how the patients adjusted to them were described in the narratives. The consequences were physical, emotional, cognitive, social, and vocational and included thoughts about death. Adjusting to the illness involved changing one's lifestyle, being aware of one's physical ability and disability, developing psychologic strategies, and adjusting to medication. CONCLUSIONS The findings of this study demonstrate a wider range of disabilities as a consequence of moderate chronic HF and show several more ways of adjusting to the illness than previously reported in men.
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Affiliation(s)
- Eeva Europe
- Department of Physical Therapy, Karolinska University Hospital Huddinge, Stoockholm, Sweden
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Troosters T, Gosselink R, Decramer M. Chronic Obstructive Pulmonary Disease and Chronic Heart Failure. ACTA ACUST UNITED AC 2004; 24:137-45. [PMID: 15235292 DOI: 10.1097/00008483-200405000-00001] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Chronic obstructive pulmonary disease and congestive heart failure are two increasingly prevalent chronic diseases. Although care for these patients often is provided by different clinical teams, both disease conditions have much in common. In recent decades, more knowledge about the systemic impact of both diseases has become available, highlighting remarkable similarities in terms of prognostic factors and disease management. Rehabilitation programs deal with the systemic consequences of both diseases. Although clinical research also is conducted by various researchers investigating chronic obstructive pulmonary disease and chronic heart failure, it is worthwhile to compare the progress in relation to these two diseases over recent decades. Such comparison, the purpose of the current review, may help clinicians and scientists to learn about progress made in different, yet related, fields. The current review focuses on the similarities observed in the clinical impact of muscle weakness, the mechanisms of muscle dysfunction, the strategies to improve muscle function, and the effects of exercise training on chronic obstructive pulmonary disease and chronic heart failure.
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Affiliation(s)
- Thierry Troosters
- Respiratory Division and Respiratory Rehabilitation, Respiratory Muscle Research Unit, Katholieke Universiteit Leuven, Herestraat 49, B3000 Leuven, Belgium.
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