title: Physical training enhances sympathetic and parasympathetic control of heart rate and peripheral vessels in chronic heart failure.
abstract: 1. Physical training has been proposed to increase vagal control of heart rate in chronic heart failure. We studied the effects of physical training on cardiovascular control in 6 moderate to severe heart failure (NYHA II-III) patients and 6 age matched normal controls in a randomized controlled cross over trial (Training vs Detraining). 2. Five weeks training (20 min/day, 5 days/week bicycle exercise) increased peak VO2 in both C (from 31.2 +/- 1.4 to 37.7 +/- 2.4 ml/kg/min p < 0.01) and CHF patients (from 12.16 +/- 2.2 to 14.13 +/- 2 ml/kg/min p < 0.05). The sympathovagal control of heart rate and sympathetic control of the resistance vessels was assessed by the power of the oscillations (LF:0.03-0.15 Hz index of sympathetic activity, HF: 0.18-0.35 Hz index of vagal activity) in RR interval, blood pressure (systolic and diastolic by Finapres) and respiration by autoregressive spectral analysis, during free and controlled breathing (15b/min), in order to increase vagal activity. 3. T increased heart rate vagal control both in C (LF/HF ratio fb to cb: (D) 1.73 +/- 0.35 to 1.19 +/- 0.43 p = NS: (T) 2.9 +/- 1.2 to 1.13 +/- 0.3 p < 0.05) and in CHF patients (LF/HF ratio fb to cb: (D) 2.05 +/- 0.56 to 1.24 +/- 0.21 p = NS; (T) 2.6 +/- 0.89 to 0.87 +/- 0.15 p < 0.05; and in cb HF%: 36.2 +/- 2.7 (D) to 46.2 +/- 4.8 (T) p < 0.05). Before T, the sympathetic modulation of peripheral vessels (% LF compared to total variability) was depressed in CHF vs C (SBP: 9 +/- 2 vs 42 +/- 12% p < 0.05; DBP: 29 +/- 7 vs 55 +/- 31%, p < 0.05), and increased significantly after T in CHF (SBP from 9 +/- 2 (D) to 19 +/- 5% (T) p < 0.05; DBP from 29 +/- 7 to 41 +/- 11% (T) p < 0.05). This suggests an overall increase of autonomic control, both vagal on the heart and sympathetic on the peripheral vessels, in CHF by physical training.
authors.affiliation: Department of Internal Medicine, Policlinico S Matteo, IRCCS, University of Pavia, I, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Radaelli
authors.forename: A J
authors.initials: AJ
authors.lastname: Coats
authors.forename: S
authors.initials: S
authors.lastname: Leuzzi
authors.forename: M
authors.initials: M
authors.lastname: Piepoli
authors.forename: T E
authors.initials: TE
authors.lastname: Meyer
authors.forename: A
authors.initials: A
authors.lastname: Calciati
authors.forename: G
authors.initials: G
authors.lastname: Finardi
authors.forename: L
authors.initials: L
authors.lastname: Bernardi
authors.forename: P
authors.initials: P
authors.lastname: Sleight
mesh_terms: D001341:Autonomic Nervous System / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D002908:Chronic Disease; D018592:Cross-Over Studies; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D012815:Signal Processing, Computer-Assisted; D013564:Sympathetic Nervous System / Q000503:physiopathology