1
|
Dubé BP, Laveneziana P. Effects of aging and comorbidities on nutritional status and muscle dysfunction in patients with COPD. J Thorac Dis 2018; 10:S1355-S1366. [PMID: 29928518 DOI: 10.21037/jtd.2018.02.20] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a prevalent, complex and debilitating disease which imposes a formidable burden on patients and the healthcare system. The recognition that COPD is a multifaceted disease is not new, and increasing evidence have outlined the importance of its extra-pulmonary manifestations and its relation to other comorbid conditions in the clinical course of the disease and its societal cost. The relationship between aging, COPD and its comorbidities on skeletal muscle function and nutritional status is complex, multidirectional and incompletely understood. Despite this, the current body of knowledge allows the identification of various, seemingly partially independent factors related both to the normal aging process and to the independent deleterious effects of chronic diseases on muscle function and body composition. There is a dire need of studies evaluating the relative contribution of each of these factors, and their potential synergistic effects in patients with COPD and advanced age/comorbid conditions, in order to delineate the best course of therapeutic action in this increasingly prevalent population.
Collapse
Affiliation(s)
- Bruno-Pierre Dubé
- Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM) Montréal, Québec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) - Carrefour de l'Innovation et de l'Évaluation en Santé, Montréal, Québec, Canada
| | - Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée du Département R3S, Paris, France
| |
Collapse
|
2
|
Hemati F, Rahmani A, Asadollahi K, Soleimannejad K, Khalighi Z. Effects of Complementary Creatine Monohydrate and Physical Training on Inflammatory and Endothelial Dysfunction Markers Among Heart Failure Patients. Asian J Sports Med 2016; 7:e28578. [PMID: 27217930 PMCID: PMC4870830 DOI: 10.5812/asjsm.28578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/21/2015] [Accepted: 05/19/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Previous studies have reported endothelial dysfunction and inflammatory cytokine in heart failure patients (HF). OBJECTIVES The purpose of this study was to determine the effects of creatine monohydrate and exercise on inflammatory and endothelial dysfunction markers among HF patients. PATIENTS AND METHODS One hundred patients were prospectively randomized into two groups: Intervention group which received 5 grams/day creatine monohydrate and exercised for 8 weeks; and control group which did not receive any interventions. Interleukine-6 (IL-6), high sensitivity C reactive protein (hs-CRP), P-selectin, intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule 1 (VCAM-1) were measured at the start and end of the study for both groups. RESULTS In total, 100 patients including 50 controls and 50 intervention group (54% male, mean EF of 34.2 ± 10.5% and 52% male, mean EF of 35.6 ± 12.7%, respectively) were analyzed. The serum levels of hs-CRP and IL-6 increased at the end of the study in the control group compared to the baseline, (7.5 ± 1.5 mg/L vs. 6.9 ± 1.3 mg/L, P < 0.05 and 3.0 ± 0.75 ng/L vs. 2.55 ± 0.9 ng/L, P < 0.05, respectively). However, compared to the baseline, the level of both markers decreased at the end of the study in the intervention group (6.3 ± 1.6 mg/L vs.7.5 ± 1.5 mg/L, P < 0.05 and 2.1 ± 0.8 ng/L vs.2.5 ± 0.5 ng/L, P < 0.05). Also, P-selectin and ICAM-1 levels increased at the end of study (56.9 ± 1.8 ng/L vs. 51.9 ± 1.5 ng/L, P < 0.05 and 368.1 ± 25.4 µg/L vs. 353.1 ± 10.4 µg/L, P < 0.05 respectively). Inversely, the levels of these markers decreased in the intervention group, at the end of study (49.7 ± 1.9 ng/l vs. 51.4 ± 2.1 ng/l, P < 0.05 and 342.7 ± 16.5 µg/l vs. 350.4 ± 14.7 µg/l, P < 0.05, respectively). VCAM-1 level was not decreased significantly at the end of the study in the intervention group (570.5 ± 78.4 µg/L vs. 575.3 ± 86.5 µg/L, P > 0.05). CONCLUSIONS Combination of creatine monohydrate and exercise attenuated inflammation and endothelial dysfunction markers among heart failure patients.
Collapse
Affiliation(s)
- Farajollah Hemati
- Department of Sports Medicine, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Asghar Rahmani
- Student Research Committee, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Khairollah Asadollahi
- Department of Epidemiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Koroush Soleimannejad
- Department of Cardiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Zahra Khalighi
- Department of Internal Medicine, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, IR Iran
| |
Collapse
|
3
|
Negrao CE, Middlekauff HR, Gomes-Santos IL, Antunes-Correa LM. Effects of exercise training on neurovascular control and skeletal myopathy in systolic heart failure. Am J Physiol Heart Circ Physiol 2015; 308:H792-802. [PMID: 25681428 DOI: 10.1152/ajpheart.00830.2014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/09/2015] [Indexed: 12/14/2022]
Abstract
Neurohormonal excitation and dyspnea are the hallmarks of heart failure (HF) and have long been associated with poor prognosis in HF patients. Sympathetic nerve activity (SNA) and ventilatory equivalent of carbon dioxide (VE/VO2) are elevated in moderate HF patients and increased even further in severe HF patients. The increase in SNA in HF patients is present regardless of age, sex, and etiology of systolic dysfunction. Neurohormonal activation is the major mediator of the peripheral vasoconstriction characteristic of HF patients. In addition, reduction in peripheral blood flow increases muscle inflammation, oxidative stress, and protein degradation, which is the essence of the skeletal myopathy and exercise intolerance in HF. Here we discuss the beneficial effects of exercise training on resting SNA in patients with systolic HF and its central and peripheral mechanisms of control. Furthermore, we discuss the exercise-mediated improvement in peripheral vasoconstriction in patients with HF. We will also focus on the effects of exercise training on ventilatory responses. Finally, we review the effects of exercise training on features of the skeletal myopathy in HF. In summary, exercise training plays an important role in HF, working synergistically with pharmacological therapies to ameliorate these abnormalities in clinical practice.
Collapse
Affiliation(s)
- Carlos E Negrao
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil; School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil; and
| | - Holly R Middlekauff
- Departament of Medicine (Cardiology) and Physiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California
| | - Igor L Gomes-Santos
- Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | |
Collapse
|
4
|
Munkvik M, Lunde PK, Aronsen JM, Birkeland JAK, Sjaastad I, Sejersted OM. Attenuated fatigue in slow twitch skeletal muscle during isotonic exercise in rats with chronic heart failure. PLoS One 2011; 6:e22695. [PMID: 21799933 PMCID: PMC3143175 DOI: 10.1371/journal.pone.0022695] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 07/04/2011] [Indexed: 01/08/2023] Open
Abstract
During isometric contractions, slow twitch soleus muscles (SOL) from rats with chronic heart failure (chf) are more fatigable than those of sham animals. However, a muscle normally shortens during activity and fatigue development is highly task dependent. Therefore, we examined the development of skeletal muscle fatigue during shortening (isotonic) contractions in chf and sham-operated rats. Six weeks following coronary artery ligation, infarcted animals were classified as failing (chf) if left ventricle end diastolic pressure was >15 mmHg. During isoflurane anaesthesia, SOL with intact blood supply was stimulated (1s on 1s off) at 30 Hz for 15 min and allowed to shorten isotonically against a constant afterload. Muscle temperature was maintained at 37°C. In resting muscle, maximum isometric force (F(max)) and the concentrations of ATP and CrP were not different in the two groups. During stimulation, F(max) and the concentrations declined in parallel sham and chf. Fatigue, which was evident as reduced shortening during stimulation, was also not different in the two groups. The isometric force decline was fitted to a bi-exponential decay equation. Both time constants increased transiently and returned to initial values after approximately 200 s of the fatigue protocol. This resulted in a transient rise in baseline tension between stimulations, although this effect which was less prominent in chf than sham. Myosin light chain 2s phosphorylation declined in both groups after 100 s of isotonic contractions, and remained at this level throughout 15 min of stimulation. In spite of higher energy demand during isotonic than isometric contractions, both shortening capacity and rate of isometric force decline were as well or better preserved in fatigued SOL from chf rats than in sham. This observation is in striking contrast to previous reports which have employed isometric contractions to induce fatigue.
Collapse
Affiliation(s)
- Morten Munkvik
- Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Per Kristian Lunde
- Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Jan Magnus Aronsen
- Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Jon Arne Kro Birkeland
- Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Ole M. Sejersted
- Institute for Experimental Medical Research, Oslo University Hospital, Ullevål, Oslo, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| |
Collapse
|
5
|
Boxer RS, Dauser DA, Walsh SJ, Hager WD, Kenny AM. The association between vitamin D and inflammation with the 6-minute walk and frailty in patients with heart failure. J Am Geriatr Soc 2008; 56:454-61. [PMID: 18194227 DOI: 10.1111/j.1532-5415.2007.01601.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To identify relationships between anabolic hormones, inflammatory markers, and physical function. DESIGN Cross-sectional. SETTING Outpatient university heart failure program in Connecticut. PARTICIPANTS Sixty patients with an ejection fraction of 40% or less. MEASUREMENTS The 6-minute walk distance and frailty phenotype were measured. The relationship between physical measures of hormones and inflammatory mediators were examined. Linear and ordinal logistic regression analyses were performed for the physical measures. RESULTS Forty-three men (mean age 77 +/- 9) and 17 women (mean age 78 +/- 12) participated. Longer 6-minute walk distance was correlated with higher 25-hydroxyvitamin D (25OHD) level, and a shorter walk was correlated with higher cortisol: dehydroepiandrosterone sulphate (DHEAS) ratio, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL6), and intact parathyroid hormone (PTH) (all P<.05). Percentage of free testosterone, DHEAS alone, and N-terminal pro-brain natriuretic peptide (NTpro-BNP) did not correlate with 6-minute walk distance. Higher frailty phenotype score (more frail) was correlated with higher high-sensitivity CRP, higher IL6, and lower 25OHD levels (all P<.05). Linear regression with the 6-minute walk distance as the dependent variable and independent variables of age, sex, percentage of free testosterone, DHEAS, 25OHD, intact PTH, hsCRP, IL6, cortisol/DHEAS ratio, and NTpro-BNP, revealed age, sex, 25OHD and hsCRP to be significant (coefficient of determination=53.5%). Ordinal logistic regression with the frailty phenotype and hormonal levels revealed that age, 25OHD, and hsCRP also predicted frailty status. CONCLUSION Twenty-five-hydroxyvitamin D and hsCRP levels may contribute to lower aerobic capacity and frailty in patients with heart failure. A longitudinal study will further define the role of 25OHD and hsCRP on muscle strength and functional decline.
Collapse
Affiliation(s)
- Rebecca S Boxer
- Department of Family Medicine, Case Western University Hospital, Cleveland, Ohio 44106, USA.
| | | | | | | | | |
Collapse
|
6
|
Abstract
Traditional explanations for the symptoms of fatigue and breathlessness experienced by patients with chronic heart failure (CHF) focus on how reduced cardiac output on exercise leads to impaired skeletal muscle blood supply, thus causing fatigue, and on how the requirement for a raised left ventricular filling pressure to maintain cardiac output results in reduced pulmonary diffusion owing to interstitial edema, thus causing breathlessness. However, indices of left ventricular function relate poorly to exercise capacity and symptoms, suggesting that the origin of symptoms may lie elsewhere. There is a specific heart failure myopathy that is present early in the condition which may contribute largely to the sensation of fatigue. Receptors present in skeletal muscle sensitive to work (ergoreceptors) are overactive in patients with CHF, presumably as a consequence of the myopathy, and their activity is related both to the ventilatory response to exercise and breathlessness, and to the sympathetic overactivity of CHF. In the present paper, we review the systemic consequences of left ventricular dysfunction to understand how they relate to the symptoms of heart failure.
Collapse
Affiliation(s)
- Klaus K Witte
- Academic Cardiology, Leeds General Infirmary, Great George Street, Leeds, UK.
| | | |
Collapse
|
7
|
Corrà U, Mezzani A, Giannuzzi P, Tavazzi L. Chronic heart failure–related myopathy and exercise training: a developing therapy for heart failure symptoms. Curr Probl Cardiol 2003; 28:521-47. [PMID: 14657840 DOI: 10.1016/j.cpcardiol.2003.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ugo Corrà
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Verona, Italy
| | | | | | | |
Collapse
|
8
|
Corrà U, Mezzani A, Giannuzzi P, Tavazzi L. Chronic heart failure-related myopathy and exercise training: A developing therapy for heart failure symptoms. Prog Cardiovasc Dis 2002; 45:157-72. [PMID: 12411976 DOI: 10.1053/pcad.2002.127490] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ugo Corrà
- Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Veruno, Cardiology Department, IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | | |
Collapse
|
9
|
Scott AC, Wensel R, Davos CH, Kemp M, Kaczmarek A, Hooper J, Coats AJS, Piepoli MF. Chemical mediators of the muscle ergoreflex in chronic heart failure: a putative role for prostaglandins in reflex ventilatory control. Circulation 2002; 106:214-20. [PMID: 12105161 DOI: 10.1161/01.cir.0000021603.36744.5e] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The overactivity of ergoreceptors (intramuscular afferents sensitive to products of skeletal muscle work) may be responsible for the abnormal responses to exercise and symptoms of exercise intolerance in chronic heart failure (CHF); however, little is known of the chemical nature of the stimuli involved. We investigated biochemical factors (H+, VCO2, VO2, HCO3, K+, phosphate, lactate, PGE2, PGF(1alpha), and bradykinin) potentially involved in ergoreceptor activation. METHODS AND RESULTS Sixteen stable patients with CHF (64.9+/-2.7 years, peak VO2 15.8+/-0.7 mL/kg per min) and 10 age-matched controls were studied. The ergoreceptor test involved two 5-minute handgrip exercises. On one occasion, the subjects recovered normally (control recovery), whereas on the other a posthandgrip regional circulatory occlusion was induced in the exercising arm, isolating the stimulation of the ergoreceptor after exercise. The ergoreflex was quantified as the difference in ventilation between the posthandgrip regional circulatory occlusion and the control recovery periods. During the protocol, the local muscular blood effluent concentrations of metabolic mediators were assessed. Patients had an ergoreflex effect on ventilation greater than controls (4.8+/-1.4 versus 0.4+/-0.1 L/min, P<0.01). During the ergoreflex test in patients, the following metabolites were elevated with respect to resting values in comparison with controls: PGE2 (3.7+/-0.7 versus 1.1+/-0.2 pg/mL), PGF(1alpha) (16.2+/-2.8 versus 7.2+/-1.2 pg/mL), and bradykinin (2.1+/-0.3 versus 1.0+/-0.1 pg/mL), P<0.05 for all comparisons. Only the increases in prostaglandins were predictors of the ergoreflex response (r>0.41, P<0.01). CONCLUSIONS Although multiple metabolites are concentrated in exercising muscle in CHF, only prostaglandins correlated with ergoreflex activity, suggesting these factors as potential triggers to the exaggerated ergoreflex, which is characteristic of CHF. This may have important implications for novel therapies to improve exercise tolerance.
Collapse
Affiliation(s)
- Adam C Scott
- National Heart & Lung Institute, and Royal Brompton Hospital, Imperial College School of Science, Technology and Medicine, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Shiotani I, Sato H, Sato H, Yokoyama H, Ohnishi Y, Hishida E, Kinjo K, Nakatani D, Kuzuya T, Hori M. Muscle pump-dependent self-perfusion mechanism in legs in normal subjects and patients with heart failure. J Appl Physiol (1985) 2002; 92:1647-54. [PMID: 11896033 DOI: 10.1152/japplphysiol.01096.2000] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Leg venous pressure markedly falls during upright exercise via a muscle pump effect, creating de novo perfusion pressure. We examined physiological roles of this mechanism in increasing femoral artery blood flow (FABF) and its alterations in chronic heart failure (CHF). In 10 normal subjects and 10 patients with CHF, standard hemodynamic variables, mean ankle vein pressure (MAVP), and FABF with Doppler techniques were obtained during graded upright bicycle exercise. To evaluate a nonspecific blood flow response, normal subjects also performed supine exercise. In normal subjects, MAVP rapidly declined by 45 mmHg and FABF correspondingly increased 5.3-fold without a systemic pressor response during 10 s of light upright exercise at 5 W. Approximately 67% of the blood flow response was attributed to the venous pressure drop-dependent mechanism. In CHF patients, MAVP declined by only 36 mmHg and FABF increased only 1.7-fold during the same upright exercise. The muscle venous pump has an ability to increase FABF at least threefold via the venous pressure drop-dependent mechanism. This mechanism is impaired in CHF patients.
Collapse
Affiliation(s)
- Issei Shiotani
- Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Franssen FME, Wouters EFM, Schols AMWJ. The contribution of starvation, deconditioning and ageing to the observed alterations in peripheral skeletal muscle in chronic organ diseases. Clin Nutr 2002; 21:1-14. [PMID: 11884007 DOI: 10.1054/clnu.2001.0485] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Muscle weakness and early fatigue are common symptoms of chronic organ diseases, like chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and chronic renal failure (CRF). It is becoming more and more clear that symptom intensities and exercise intolerance are related to muscle wasting and intrinsic alterations in peripheral skeletal muscle in these patient populations, while correlations with parameters of organ functioning are poor. Also, changes in muscle structure and function in COPD, CHF and CRF show much resemblance. Semi-starvation, reduced physical activity and ageing are external factors possibly confounding a direct relationship between the primary organ impairments and alterations in peripheral skeletal muscle and exercise capacity. Reducing the catabolic effects of the various contributing factors might improve muscle function and health status in chronic disease. In this review, we present a systematic overview of human studies on alterations in skeletal muscle function, morphology and energy metabolism in COPD, CHF, CRF and we compare the results with comparable studies in anorexia nervosa, disuse or inactivity and ageing. Unravelling the relative contributions of these external factors to the observed alterations in the various diseases may contribute to targeted intervention strategies to improve muscle function in selected groups of patients.
Collapse
Affiliation(s)
- F M E Franssen
- Department of Pulmonology, University Hospital Maastricht, The Netherlands
| | | | | |
Collapse
|
12
|
Piepoli MF, Scott AC, Capucci A, Coats AJ. Skeletal muscle training in chronic heart failure. ACTA PHYSIOLOGICA SCANDINAVICA 2001; 171:295-303. [PMID: 11412141 DOI: 10.1046/j.1365-201x.2001.00831.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients with heart failure are limited in their ability to tolerate exercise. Recent research has suggested that this limitation cannot be entirely attributed to cardiac or lung impairment but rather that changes in peripheral muscles may play an important role. There are objective similarities between heart failure and muscular deconditioning. Deficiencies in peripheral blood flow and skeletal muscle function, morphology, metabolism and function are present in both conditions. Moreover, an exaggerated activity of the receptors sensitive to exercise-derived metabolic signals (muscle ergoreceptors and peripheral and central chemoreceptors) leads to early and profound exercise-induced fatigue and dyspnoea. These muscle afferents contribute to the ventilatory, haemodynamic and autonomic responses to exercise both in physiological and pathological conditions, including chronic heart failure. Against this background, a skeletal muscle origin of symptoms in heart failure has been proposed. The protective effects of physical training have been described in many recent studies: training improves ventilatory control, skeletal muscle metabolism and autonomic nervous system activity. The exercise training appears to induce its beneficial effects on skeletal muscle both directly (on muscle function, histological and biochemical features) and indirectly (by reducing the activation of the muscle afferents). The metabolic mediators of these muscle afferents may become a potential target in the future therapy of heart failure symptoms.
Collapse
Affiliation(s)
- M F Piepoli
- Clinical Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, London, UK
| | | | | | | |
Collapse
|
13
|
Lunde PK, Sjaastad I, Schiøtz Thorud HM, Sejersted OM. Skeletal muscle disorders in heart failure. ACTA PHYSIOLOGICA SCANDINAVICA 2001; 171:277-94. [PMID: 11412140 DOI: 10.1046/j.1365-201x.2001.00830.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Heart failure is associated with reduction of exercise capacity that cannot be solely ascribed to reduced maximal oxygen uptake (VdotO2max). Therefore, research has focused on changes in skeletal muscle morphology, metabolism and function. Factors that can cause such changes in skeletal muscle comprise inactivity, malnutrition, constant or repeated episodes of inadequate oxygen delivery and prolonged exposure to altered neurohumoural stimuli. Most of these factors are not specific for the heart failure condition. On the other hand, heart failure is more than one clinical condition. Congestive heart failure (CHF) develops gradually as a result of deteriorating contractility of the viable myocardium, myocardial failure. Is it possible that development of this contractile deficit in the myocardium is paralleled by a corresponding contractile deficit of the skeletal muscles? This question cannot be answered today. Both patient studies and experimental studies support that there is a switch to a faster muscle phenotype and energy metabolism balance is more anaerobic. The muscle atrophy seen in many patients is not so evident in experimental studies. Few investigators have studied contractile function. Both fast twitch and slow twitch muscles seem to become slower, not faster as might be expected, and this is possibly linked to slower intracellular Ca2+ cycling. The neurohumoural stimuli that can cause this change are not known, but recently it has been reported that several cytokines are increased in CHF patients. Thus, the changes seen in skeletal muscles during CHF are partly secondary to inactivity, but the possibility remains that the contractility is altered because of intracellular changes of Ca2+ metabolism that are also seen in the myocardium.
Collapse
Affiliation(s)
- P K Lunde
- Institute for Experimental Medical Research, University of Oslo, Ullevaal Hospital, Oslo, Norway
| | | | | | | |
Collapse
|
14
|
Abstract
During the past 2 decades, heart transplantation has evolved from an experimental procedure to an accepted life-extending therapy for patients with endstage heart failure. However, with dramatic improvements in organ preservation, surgery and immunosuppressive drug management, short term survival is no longer the pivotal issue for most heart transplant recipients (HTR). Rather, a return to functional lifestyle with good quality of life is now the desired procedural outcome. To achieve this outcome, aggressive exercise rehabilitation is essential. HTR present unique exercise challenges. Preoperatively, most of these patients had chronic debilitating cardiac illness. Many HTR have had prolonged pretransplantation hospitalisation for inotropic support or a ventricular assist device. Decrements in peak oxygen consumption (VO2peak) and related cardiovascular parameters regress approximately 26% within the first 1 to 3 weeks of sustained bed rest. Consequently, extremely poor aerobic capacity and cardiac cachexia are not unusual occurrences in HTR who have required mechanical support or been confined to bed rest. Moreover, HTR must also contend with de novo exercise challenges conferred by chronic cardiac denervation and the multiple sequelae resulting from immunosuppression therapy. There is ample evidence that both endurance and resistance training are well tolerated in HTR. Moreover, there is growing clinical consensus that specific endurance and resistance training regimens in HTR can be efficacious adjunctive therapies in the prevention of immunosuppression-induced adverse effects and the reversal of pathophysiological consequences associated with cardiac denervation and antecedent heart failure. For example, some HTR who remain compliant during strenuous long term endurance training programmes achieve peak heart rate and VO2peak values late after transplantation that approach age-matched norms (up to approximately 95% of predicted). These benefits are not seen in HTR who do not participate in structured endurance exercise training. Rather, peak heart rate and VO2peak values in untrained HTR remain approximately 60 to 70% of predicted indefinitely. However, the mechanisms responsible for improved peak heart rate, VO2peak and total exercise time are not completely understood and require further investigation. Recent studies have also demonstrated that resistance exercise training may be an effective countermeasure for corticosteroid-induced osteoporosis and skeletal muscle myopathy. HTR who participate in specific resistance training programmes successfully restore bone mineral density (BMD) in both the axial and appendicular skeleton to pretransplantation levels, increase lean mass to levels greater than pretransplantation, and reduce body fat. In contrast, HTR who do not participate in resistance training lose approximately 15% BMD from the lumbar spine early in the postoperative period and experience further gradual reductions in BMD and muscle mass late after transplantation.
Collapse
Affiliation(s)
- R W Braith
- College of Health and Human Performance, and College of Medicine (Division of Cardiology), University of Florida, Gainesville 32611, USA.
| | | |
Collapse
|
15
|
Gosker HR, Wouters EF, van der Vusse GJ, Schols AM. Skeletal muscle dysfunction in chronic obstructive pulmonary disease and chronic heart failure: underlying mechanisms and therapy perspectives. Am J Clin Nutr 2000; 71:1033-47. [PMID: 10799364 DOI: 10.1093/ajcn/71.5.1033] [Citation(s) in RCA: 247] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Low exercise tolerance has a large influence on health status in chronic obstructive pulmonary disease and chronic heart failure. In addition to primary organ dysfunction, impaired skeletal muscle performance is a strong predictor of low exercise capacity. There are striking similarities between both disorders with respect to the muscular alterations underlying the impairment. However, different alterations occur in different muscle types. Histologic and metabolic data show that peripheral muscles undergo a shift from oxidative to glycolytic energy metabolism, whereas the opposite is observed in the diaphragm. These findings are in line with the notion that peripheral and diaphragm muscle are limited mainly by endurance and strength capacity, respectively. In both diseases, muscular impairment is multifactorially determined; hypoxia, oxidative stress, disuse, medication, nutritional depletion, and systemic inflammation may contribute to the observed muscle abnormalities and each factor has its own potential for innovative treatment approaches.
Collapse
Affiliation(s)
- H R Gosker
- Departments of Pulmonology and Physiology, Maastricht University, Maastricht, Netherlands.
| | | | | | | |
Collapse
|
16
|
Kiilavuori K, Näveri H, Salmi T, Härkönen M. The effect of physical training on skeletal muscle in patients with chronic heart failure. Eur J Heart Fail 2000; 2:53-63. [PMID: 10742704 DOI: 10.1016/s1388-9842(00)00058-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND The improvement of exercise capacity in patients with chronic heart failure (CHF) by physical training has been connected with reversal of the abnormalities in muscle fiber distribution and with the reduced activity of the enzymes of oxidative metabolism in skeletal muscle. However, the change in fiber type distribution induced by training is controversial and in previous studies the activities of the rate-limiting enzymes of the metabolic pathways have not been measured. AIMS To examine the effect of dynamic training on percentage distribution of muscle fibers, on activities of the rate-limiting enzymes of the metabolic pathways and on electrophysiology in skeletal muscle. METHODS A total of 27 patients with stable CHF (NYHA class II-III) were randomized to a training (N=12) or a control (N=15) group. The training group exercised on a bicycle ergometer for 30 min three times a week for 3 months using a load corresponding to 50-60% of their peak oxygen consumption. This was followed by a 3-month training period at home according to personal instructions. The control group did not change its physical activities. We studied muscle histology and measured the activities of the rate-limiting enzymes of anaerobic glycolysis (phosphofructokinase, PFK), glycogenolysis (phosphorylase), citric acid cycle (alpha-ketoglurate dehydrogenase, KGDH) and fatty acid oxidation (carnitinepalmitoyl transferase I and II, CPT I and II) from biopsies of the vastus lateralis muscle at baseline and after 3 and 6 months. Muscle strength and strength endurance with surface EMG and macro EMG of the right knee extensors were also determined. RESULTS Exercise capacity, particularly submaximal, improved in the training group. The activity of PFK rose significantly but that of the other enzymes did not when compared with the change in the controls. Training had no effect on the percentage distribution of slow-twitch and fast-twitch muscle fibers or on capillary density around these fibers in skeletal muscle. Maximum voluntary force, strength endurance and the function of motor units remained unaffected. CONCLUSIONS Dynamic training results in improved exercise endurance in CHF. In skeletal muscle, the capacity of anaerobic glycolysis is increased but that of the citric acid cycle and fatty acid oxidation is not. Furthermore, the improvement in exercise endurance seems to be independent of changes in the percentage distribution of muscle fibers, capillarity or electrophysiological factors.
Collapse
Affiliation(s)
- K Kiilavuori
- Department of Medicine, Division of Cardiology, Helsinki University Central Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland
| | | | | | | |
Collapse
|