title: Effects of short-term moderate exercise training on sexual function in male patients with chronic stable heart failure.
abstract: BACKGROUND
  Patients with chronic heart failure (CHF) have sexual dysfunction that impairs quality of life. Recent trials have demonstrated that exercise training (ET) improves quality of life (QOL) of CHF patients, but it is not established whether this benefit may be associated with an improvement in sexual dysfunction.
  
  
  OBJECTIVE
  To determine whether ET can improve sexual dysfunction in patients with CHF.
  
  
  METHODS
  We prospectively studied 59 male patients (57+/-9 years) with stable CHF in sinus rhythm and without prostatic disease. Patients were randomized into two groups. A group (T, n = 30) underwent supervised cycle ergometer ET at 60% of peak VO2, three times a week, 60 min each session, for 8 weeks. A group (NT, n = 29) was not exercised. Medications were not changed during the study. On study entry and at 8 weeks all patients underwent a symptom-limited cardiopulmonary exercise testing, brachial artery endothelium-dependent (ED) and endothelium-independent (EI) vasomotor responses, QOL and sexual activity profile assessment (SAP) by questionnaire.
  
  
  RESULTS
  At 8 weeks, no changes were observed in control patients. In trained patients, however, peak VO2 improved by 18% (P < 0.005) and was correlated with QOL (r = 0.80; P < 0.001). Flow-mediated dilation improved in trained patients (from 2.29+/-1.13% to 5.04+/-1.7%, P = 0.0001), while EI dilation (after 0.3 mg sublingual NTG) did not. In group T, all three domains (i.e. Domain 1=relationship with the partner; Domain 2 = quality of penile erection; Domain 3 = personal wellness) were significantly improved from baseline (total score patients: from 3.49+/-3.4 to 6.17+/-3.2, P < 0.001; partners: from 2.47+/-2.7 to 4.87+/-2.5, P < 0.001). Pre-post training change in SAP total score was correlated with changes in coronary risk profile (r = -0.49; P = 0.01), peak VO2 (r = 0.67; P < 0.001) and QOL (r = 0.73; P = 0.01). Multivariate analysis selected the improvement in ED-vasomotor response as the strongest independent predictor of SAP improvement (r = 0.63, P < 0.001).
  
  
  CONCLUSIONS
  In stable CHF, cycle ergometer ET significantly improves brachial artery endothelial dysfunction, suggesting a systemic effect of leg exercise. This benefit was correlated with improvements in sexual activity.
authors.affiliation: Lancisi Heart Institute, Via Rismondo, 5-60123 Ancona, Italy. r.belardinelli@fastnet.it
authors.forename: Romualdo
authors.initials: R
authors.lastname: Belardinelli
authors.forename: Francesca
authors.initials: F
authors.lastname: Lacalaprice
authors.forename: Ernesto
authors.initials: E
authors.lastname: Faccenda
authors.forename: Augusto
authors.initials: A
authors.lastname: Purcaro
authors.forename: GianPiero
authors.initials: G
authors.lastname: Perna
mesh_terms: D016022:Case-Control Studies; D002908:Chronic Disease; D004727:Endothelium / Q000098:blood supply; D005080:Exercise Test; D005081:Exercise Therapy; D006333:Heart Failure / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome