title: Isolated quadriceps training increases maximal exercise capacity in chronic heart failure: the role of skeletal muscle convective and diffusive oxygen transport.
abstract: OBJECTIVE
  This study sought to elucidate the mechanisms responsible for the benefits of small muscle mass exercise training in patients with chronic heart failure (CHF).
  
  
  BACKGROUND
  How central cardiorespiratory and/or peripheral skeletal muscle factors are altered with small muscle mass training in CHF is unknown.
  
  
  METHODS
  We studied muscle structure, and oxygen (O(2)) transport and metabolism at maximal cycle (whole-body) and knee-extensor exercise (KE) (small muscle mass) in 6 healthy controls and 6 patients with CHF who then performed 8 weeks of KE training (both legs, separately) and repeated these assessments.
  
  
  RESULTS
  Pre-training cycling and KE peak leg O(2) uptake (Vo(2peak)) were ~17% and ~15% lower, respectively, in the patients compared with controls. Structurally, KE training increased quadriceps muscle capillarity and mitochondrial density by ~21% and ~25%, respectively. Functionally, despite not altering maximal cardiac output, KE training increased maximal O(2) delivery (~54%), arterial-venous O(2) difference (~10%), and muscle O(2) diffusive conductance (D(M)O(2)) (~39%) (assessed during KE), thereby increasing single-leg Vo(2peak) by ~53%, to a level exceeding that of the untrained controls. Post-training, during maximal cycling, O(2) delivery (~40%), arterial-venous O(2) difference (~15%), and D(M)O(2) (~52%) all increased, yielding an increase in Vo(2peak) of ~40%, matching the controls.
  
  
  CONCLUSIONS
  In the face of continued central limitations, clear improvements in muscle structure, peripheral convective and diffusive O(2) transport, and subsequently, O(2) utilization support the efficacy of local skeletal muscle training as a powerful approach to combat exercise intolerance in CHF.
authors.affiliation: Department of Sport, Nutrition and Health Sciences, University of Milan, Milan, Italy. fabio.esposito@unimi.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Esposito
authors.forename: Van
authors.initials: V
authors.lastname: Reese
authors.forename: Ralph
authors.initials: R
authors.lastname: Shabetai
authors.forename: Peter D
authors.initials: PD
authors.lastname: Wagner
authors.forename: Russell S
authors.initials: RS
authors.lastname: Richardson
mesh_terms: D001693:Biological Transport, Active; D001706:Biopsy; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D018450:Disease Progression; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D008931:Mitochondria, Muscle / Q000378:metabolism / Q000648:ultrastructure; D010100:Oxygen / Q000378:metabolism*; D010101:Oxygen Consumption; D052097:Quadriceps Muscle / Q000378:metabolism / Q000503:physiopathology* / Q000648:ultrastructure; D012720:Severity of Illness Index; D013318:Stroke Volume
chemical_list: D010100:Oxygen