title: Individual patient meta-analysis of exercise training effects on systemic brain natriuretic peptide expression in heart failure.
abstract: BACKGROUND
  Brain natriuretic peptide (BNP) predicts exercise performance and exercise training may modulate BNP and its N-terminal portion (NT-pro-BNP), we therefore conducted an individual patient analysis of exercise training effects on BNP and NT-pro-BNP.
  
  
  OBJECTIVE
  To use an individual patient meta-analysis to relate changes in BNP, NT-pro-BNP, and peak VO(2); to link these changes to volume parameters of exercise training programmes (intensity etc.); and to identify patient characteristics likely to lead to greater improvements in BNP, NT-pro-BNP, and peak VO(2).
  
  
  METHODS
  Individual patient meta-analysis.
  
  
  METHODS
  A systematic search was conducted of Medline (Ovid), Embase.com, Cochrane Central Register of Controlled Trials, and CINAHL (until July 2008) to identify randomized controlled trials of aerobic and/or resistance exercise training in systolic heart failure patients measuring BNP and/or NT-pro-BNP. Primary outcome measures were change in BNP, NT-pro-BNP, and peak VO2. Subanalyses were conducted to identify (1) patient groups that benefit most and (2) exercise programme parameters enhancing favourable changes in primary outcome measures.
  
  
  RESULTS
  Ten randomized controlled studies measuring BNP or NT-pro-BNP met eligibility criteria, authors provided individual patient data for 565 patients (313 exercise and 252 controls). Exercise training had favourable effects on BNP (-28.3%, p < 0.0001), NT-pro-BNP (-37.4%, p = < 0.0001), and peak VO(2) (17.8%, p < 0.0001). The analysis showed a significant change in primary outcome measures; moreover, change in BNP (r = -0.31, p < 0.0001) and NT-pro-BNP (r = -0.22, p < 0.0001) were correlated with peak VO(2) change.
  
  
  CONCLUSIONS
  Exercise training has favourable effects on BNP, NT-pro-BNP, and peak VO(2) in heart failure patients and BNP/NT-pro-BNP changes were correlated with peak VO(2) changes.
authors.affiliation: Bond University, Faculty of Health Science and Medicine, Varsity Lakes, Robina, Queensland 4229, Australia. nsmart@bond.edu.au
authors.forename: N A
authors.initials: NA
authors.lastname: Smart
authors.forename: T
authors.initials: T
authors.lastname: Meyer
authors.forename: J A
authors.initials: JA
authors.lastname: Butterfield
authors.forename: S C
authors.initials: SC
authors.lastname: Faddy
authors.forename: C
authors.initials: C
authors.lastname: Passino
authors.forename: G
authors.initials: G
authors.lastname: Malfatto
authors.forename: S
authors.initials: S
authors.lastname: Jonsdottir
authors.forename: F
authors.initials: F
authors.lastname: Sarullo
authors.forename: U
authors.initials: U
authors.lastname: Wisloff
authors.forename: C
authors.initials: C
authors.lastname: Vigorito
authors.forename: F
authors.initials: F
authors.lastname: Giallauria
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010101:Oxygen Consumption; D010446:Peptide Fragments / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain