Resistance training improves vasoreactivity in end-stage heart failure patients on inotropic support.
OBJECTIVE
Peripheral vascular abnormalities contribute to compromised functional status in heart failure (HF) patients. The purpose of the present study was to test whether the intervention of moderate-intensity, resistance training could improve peripheral vascular responsiveness, that is, flow-mediated dilation (FMD) in HF.


METHODS
Baseline brachial artery FMD analysis (2 minutes of cuff occlusion and 5 minutes of reperfusion) was measured in HF patients on intravenous inotropic support (n = 9) awaiting cardiac transplantation. Unilateral, upper-body resistance exercises (moderate intensity, combination of isometric and isotonic exercises at 60%-80% of maximum) were performed 3 d/wk for 4 weeks. Follow-up FMD analysis was conducted after training. Central hemodynamics were defined via right-side-heart catheterization.


RESULTS
At baseline prior to training, HF patients elicited a significant hyperemic response 10 seconds following cuff occlusion (mean increase in blood flow: 194 ± 44 mL/min, P < .05). Despite this significant hyperemic response, HF patients demonstrated a mild, but paradoxical vasoconstriction of nearly 3% at 1-minute after cuff release. Four weeks of resistance training corrected the paradoxical vasoconstriction observed at baseline and resulted in vasodilatation (a positive increase in brachial artery diameter of 0.04 ± 0.04 mm, at 1 minute after cuff release; P < .05). Conversely, in a subset of 3 HF patients, studies in the untrained contralateral arm revealed no change in the FMD response.


CONCLUSIONS
Moderate-intensity upper-body resistance training improved brachial artery FMD in end-stage HF patients on inotropic support. The reversal of the paradoxical vasoconstrictive response to reactive hyperemia following 4 weeks of training may be secondary to local improvements in vascular endothelial function rather than a quantitative change in the reactive hyperemic stimulus.
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia 19104-4217, USA.
Abigail S
AS
Dean
Joseph R
JR
Libonati
Deborah
D
Madonna
Sarah J
SJ
Ratcliffe
Kenneth B
KB
Margulies
D000328:Adult; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004730:Endothelium, Vascular; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000534:rehabilitation*; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000534:rehabilitation*; D055070:Resistance Training; D014664:Vasodilation
D002316:Cardiotonic Agents