Effect of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure.
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.


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.
Gademan
Maaike G J
MG
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Swenne
Cees A
CA
Verwey
Harriette F
HF
van der Laarse
Arnoud
A
Maan
Arie C
AC
van de Vooren
Hedde
H
van Pelt
Johannes
J
van Exel
Henk J
HJ
Lucas
Caroline M H B
CM
Cleuren
Ger V J
GV
Somer
Soeresh
S
Schalij
Martin J
MJ
van der Wall
Ernst E
EE
D001120:Arginine / Q000378:metabolism; D001342:Autonomic Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D017704:Baroreflex; D002395:Catecholamines / Q000378:metabolism; D002908:Chronic Disease; D016232:Endothelins / Q000378:metabolism; D005081:Exercise Therapy; D006333:Heart Failure / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D018377:Neurotransmitter Agents / Q000378:metabolism*; D012084:Renin-Angiotensin System; D016896:Treatment Outcome; D014667:Vasopressins / Q000378:metabolism
D002395:Catecholamines; D016232:Endothelins; D018377:Neurotransmitter Agents; D014667:Vasopressins; D020097:Natriuretic Peptide, Brain; D001120:Arginine