title: Stretching Exercises Improve Vascular Endothelial Dysfunction Through Attenuation of Oxidative Stress in Chronic Heart Failure Patients With an Implantable Cardioverter Defibrillator.
abstract: OBJECTIVE
  Endurance training improves oxidative stress and vascular endothelial dysfunction in patients with chronic heart failure (CHF). However, patients with CHF and an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) often avoid endurance training for fear of ICD shock. Recent studies have reported that stretching exercises enhance antioxidant activity and improve vascular responses. Therefore, we aimed to assess the effects of 4 weeks of stretching exercises on oxidative stress and vascular endothelial function in patients with CHF with an ICD or CRT-D.
  
  
  METHODS
  Fifty sedentary patients with CHF (78% males; mean age = 70 ± 9 years; left ventricular ejection fraction = 26% ± 8%) with an ICD or CRT-D were randomly divided into a group that performed 4 weeks of stretching exercises (stretching group) and a group that continued a sedentary lifestyle (control group). We compared the reactive hyperemia peripheral arterial tonometry (RH-PAT) index and blood parameters, such as von Willebrand factor (vWF), malondialdehyde-modified low-density lipoprotein cholesterol (MDA-LDL), reactive oxygen species (ROS), high-sensitivity C-reactive protein, pentraxin 3, and fibrinogen between the 2 groups before and after the 4-week study period.
  
  
  RESULTS
  In the stretching group, a significant increase in the RH-PAT index and significant decreases in vWF, MDA-LDL, ROS, and fibrinogen concentrations were observed after the study compared with before (all P < .05). No significant changes were observed in the control group.
  
  
  CONCLUSIONS
  Four weeks of stretching exercises improved vascular endothelial dysfunction through attenuation of oxidative stress in sedentary patients with CHF with an ICD or CRT-D.
authors.affiliation: Department of Angiology and Cardiology, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan (Drs Kato, Kamada, Masuda, and Shimizu, Messrs Tanaka and Kamekawa, and Ms Akiyama); Department of Rehabilitation (Dr Kato), Division of Cardiology (Drs Ogano and Tanabe), and Department of Cardiovascular Surgery (Drs Takagi and Umemoto), Shizuoka Medical Center, Shizuoka, Japan; Faculty of Health Science, Tokoha University, Shizuoka, Japan (Dr Kato); Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee (Dr Hotta); and School of Health Sciences, Toyohashi SOZO University, Toyohashi, Japan (Dr Tabata).
authors.forename: Michitaka
authors.initials: M
authors.lastname: Kato
authors.forename: Takashi
authors.initials: T
authors.lastname: Masuda
authors.forename: Michio
authors.initials: M
authors.lastname: Ogano
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hotta
authors.forename: Hisato
authors.initials: H
authors.lastname: Takagi
authors.forename: Shinya
authors.initials: S
authors.lastname: Tanaka
authors.forename: Yumi
authors.initials: Y
authors.lastname: Kamada
authors.forename: Ayako
authors.initials: A
authors.lastname: Akiyama
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kamekawa
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Shimizu
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.forename: Jun
authors.initials: J
authors.lastname: Tanabe
authors.forename: Takuya
authors.initials: T
authors.lastname: Umemoto
mesh_terms: D000368:Aged; D002908:Chronic Disease; D017147:Defibrillators, Implantable; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D052580:Muscle Stretching Exercises / Q000379:methods*; D018384:Oxidative Stress / Q000502:physiology*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*