title: Effect of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure.
abstract: 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.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Maaike G J
authors.initials: MG
authors.lastname: Gademan
authors.forename: Cees A
authors.initials: CA
authors.lastname: Swenne
authors.forename: Harriette F
authors.initials: HF
authors.lastname: Verwey
authors.forename: Arnoud
authors.initials: A
authors.lastname: van der Laarse
authors.forename: Arie C
authors.initials: AC
authors.lastname: Maan
authors.forename: Hedde
authors.initials: H
authors.lastname: van de Vooren
authors.forename: Johannes
authors.initials: J
authors.lastname: van Pelt
authors.forename: Henk J
authors.initials: HJ
authors.lastname: van Exel
authors.forename: Caroline M H B
authors.initials: CM
authors.lastname: Lucas
authors.forename: Ger V J
authors.initials: GV
authors.lastname: Cleuren
authors.forename: Soeresh
authors.initials: S
authors.lastname: Somer
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
mesh_terms: 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
chemical_list: D002395:Catecholamines; D016232:Endothelins; D018377:Neurotransmitter Agents; D014667:Vasopressins; D020097:Natriuretic Peptide, Brain; D001120:Arginine