Physical training in patients with stable chronic heart failure: effects on cardiorespiratory fitness and ultrastructural abnormalities of leg muscles

St. Vincentius-Krankenhauser Karlsruhe, Abteilung III-Kardiologie, Germany.

OBJECTIVES. The present study was designed to evaluate the effect of an ambulatory training program on ultrastructural morphology and the oxidative capacity of skeletal muscle and its relation to central and peripheral hemodynamic variables in patients with chronic heart failure. BACKGROUND. Clinical evidence supports the hypothesis that exercise intolerance in patients with chronic heart failure is not only a consequence of low cardiac output, but is also a result of alterations in oxidative metabolism of skeletal muscle. METHODS. Twenty-two patients were prospectively randomized either to a training group (mean [+/-SD] ejection fraction 26 +/- 9%, n = 12) participating in an ambulatory training program or to a physically inactive control group (ejection fraction 27 +/- 10%, n = 10). At baseline and after 6 months, patients underwent symptom-limited bicycle exercise testing, and central and peripheral hemodynamic variables were measured. Percutaneous needle biopsy samples of the vastus lateralis muscle were obtained at baseline and after 6 months. The ultrastructure of skeletal muscle was analyzed by ultrastructural morphometry. RESULTS. After 6 months, patients in the training group achieved an increase in oxygen uptake at the ventilatory threshold of 23% (from 0.86 +/- 0.2 to 1.07 +/- 0.2 liters/min, p < 0.01 vs. control group) and at peak exercise of 31% (from 1.49 +/- 0.4 to 1.95 +/- 0.4 liters/min, p < 0.01 vs. control group). There was no significant change in oxygen uptake at the ventilatory threshold and at peak exercise in the control group. The total volume density of mitochondria and volume density of cytochrome c oxidase-positive mitochondria increased significantly by 19% (from 4.7 +/- 1.5 to 5.6 +/- 1.5 vol%, p < 0.05 vs. control group) and by 41% (from 2.2 +/- 1.0 to 3.1 +/- 1.0 vol%, p < 0.05 vs. control group) after 6 months of regular physical exercise. Cardiac output at rest and at submaximal exercise remained unchanged but increased during maximal symptom-limited exercise from 11.9 +/- 4.0 to 14.1 +/- 3.3 liters/min in the training group (p < 0.05 vs. baseline; p = NS vs. control group). Peak leg oxygen consumption increased significantly by 45% (from 510 +/- 172 to 740 +/- 254 ml/min, p < 0.01 vs. control group). Changes in cytochrome c oxidase-positive mitochondria were significantly related to changes in oxygen uptake at the ventilatory threshold (r = 0.82, p < 0.0001) and at peak exercise (r = 0.87, p < 0.0001). CONCLUSIONS. Regular physical training increases maximal exercise tolerance and delays anaerobic metabolism during submaximal exercise in patients with stable chronic heart failure. Improved functional capacity is closely linked to an exercise-induced increase in the oxidative capacity of skeletal muscle.

This article has been cited by other articles:

				M.-K. Tai, J. C. Meininger, and L. Q. Frazier A Systematic Review of Exercise Interventions in Patients With Heart Failure Biol Res Nurs, October 1, 2008; 10(2): 156 - 182. [Abstract] [PDF]

				R. Belardinelli, F. Lacalaprice, C. Ventrella, L. Volpe, and E. Faccenda Waltz Dancing in Patients With Chronic Heart Failure: New Form of Exercise Training Circ Heart Fail, July 1, 2008; 1(2): 107 - 114. [Abstract] [Full Text] [PDF]

				T. J. Vittorio, R. Zolty, M. E. Kasper, R. M. Khandwalla, D. S. Hirsh, C.-H. Tseng, U. P. Jorde, and K. Ahuja Differential Effects of Carvedilol and Metoprolol Succinate on Plasma Norepinephrine Release and Peak Exercise Heart Rate in Subjects With Chronic Heart Failure Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2008; 13(1): 51 - 57. [Abstract] [PDF]

				M. J. Haykowsky, Y. Liang, D. Pechter, L. W. Jones, F. A. McAlister, and A. M. Clark A Meta-Analysis of the Effect of Exercise Training on Left Ventricular Remodeling in Heart Failure Patients: The Benefit Depends on the Type of Training Performed J. Am. Coll. Cardiol., June 19, 2007; 49(24): 2329 - 2336. [Abstract] [Full Text] [PDF]

				R. Ventura-Clapier, B. Mettauer, and X. Bigard Beneficial effects of endurance training on cardiac and skeletal muscle energy metabolism in heart failure Cardiovasc Res, January 1, 2007; 73(1): 10 - 18. [Abstract] [Full Text] [PDF]

				J A Laukkanen, S Kurl, J T Salonen, T A Lakka, and R Rauramaa Peak oxygen pulse during exercise as a predictor for coronary heart disease and all cause death Heart, September 1, 2006; 92(9): 1219 - 1224. [Abstract] [Full Text] [PDF]

				A. Linke, V. Adams, P. C. Schulze, S. Erbs, S. Gielen, E. Fiehn, S. Mobius-Winkler, A. Schubert, G. Schuler, and R. Hambrecht Antioxidative Effects of Exercise Training in Patients With Chronic Heart Failure: Increase in Radical Scavenger Enzyme Activity in Skeletal Muscle Circulation, April 12, 2005; 111(14): 1763 - 1770. [Abstract] [Full Text] [PDF]

				F. J. Meyer, D. Lossnitzer, A. V. Kristen, A. M. Schoene, W. Kubler, H. A. Katus, and M. M. Borst Respiratory muscle dysfunction in idiopathic pulmonary arterial hypertension Eur. Respir. J., January 1, 2005; 25(1): 125 - 130. [Abstract] [Full Text] [PDF]

				J. A. Laukkanen, S. Kurl, R. Salonen, R. Rauramaa, and J. T. Salonen The predictive value of cardiorespiratory fitness for cardiovascular events in men with various risk profiles: a prospective population-based cohort study Eur. Heart J., August 2, 2004; 25(16): 1428 - 1437. [Abstract] [Full Text] [PDF]

				W T. Cade, L. Peralta, and R. E Keyser Aerobic Exercise Dysfunction in Human Immunodeficiency Virus: A Potential Link to Physical Disability Physical Therapy, July 1, 2004; 84(7): 655 - 664. [Full Text] [PDF]

				Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH) BMJ, January 24, 2004; 328(7433): 189. [Abstract] [Full Text] [PDF]

				M. J. Nuhr, D. Pette, R. Berger, M. Quittan, R. Crevenna, M. Huelsman, G. F. Wiesinger, P. Moser, V. Fialka-Moser, and R. Pacher Beneficial effects of chronic low-frequency stimulation of thigh muscles in patients with advanced chronic heart failure Eur. Heart J., January 2, 2004; 25(2): 136 - 143. [Abstract] [Full Text] [PDF]

				P. Giannuzzi, P. L. Temporelli, U. Corra, and L. Tavazzi Antiremodeling Effect of Long-Term Exercise Training in Patients With Stable Chronic Heart Failure: Results of the Exercise in Left Ventricular Dysfunction and Chronic Heart Failure (ELVD-CHF) Trial Circulation, August 5, 2003; 108(5): 554 - 559. [Abstract] [Full Text] [PDF]

				K. J. Stewart, D. Badenhop, P. H. Brubaker, S. J. Keteyian, and M. King Cardiac Rehabilitation Following Percutaneous Revascularization, Heart Transplant, Heart Valve Surgery, and for Chronic Heart Failure Chest, June 1, 2003; 123(6): 2104 - 2111. [Abstract] [Full Text] [PDF]

				S. Harris, J. P LeMaitre, G. Mackenzie, K. A.A Fox, and M. A Denvir A randomised study of home-based electrical stimulation of the legs and conventional bicycle exercise training for patients with chronic heart failure Eur. Heart J., May 1, 2003; 24(9): 871 - 878. [Abstract] [Full Text] [PDF]

				I. L. Pina, C. S. Apstein, G. J. Balady, R. Belardinelli, B. R. Chaitman, B. D. Duscha, B. J. Fletcher, J. L. Fleg, J. N. Myers, and M. J. Sullivan Exercise and Heart Failure: A Statement From the American Heart Association Committee on Exercise, Rehabilitation, and Prevention Circulation, March 4, 2003; 107(8): 1210 - 1225. [Full Text] [PDF]

				A. Beniaminovitz, C. C. Lang, J. LaManca, and D. M. Mancini Selective low-level leg muscle training alleviates dyspnea in patients with heart failure J. Am. Coll. Cardiol., November 6, 2002; 40(9): 1602 - 1608. [Abstract] [Full Text] [PDF]

				E. De Sousa, P. Lechene, D. Fortin, B. N'Guessan, S. Belmadani, X. Bigard, V. Veksler, and R. Ventura-Clapier Cardiac and skeletal muscle energy metabolism in heart failure: beneficial effects of voluntary activity Cardiovasc Res, November 1, 2002; 56(2): 260 - 268. [Abstract] [Full Text] [PDF]

				C. Cheetham, D. Green, J. Collis, L. Dembo, and G. O'Driscoll Effect of aerobic and resistance exercise on central hemodynamic responses in severe chronic heart failure J Appl Physiol, July 1, 2002; 93(1): 175 - 180. [Abstract] [Full Text] [PDF]

				R. Hambrecht, P. C. Schulze, S. Gielen, A. Linke, S. Mobius-Winkler, J. Yu, J.u. Kratzsch, G. Baldauf, M. W. Busse, A. Schubert, et al. Reduction of insulin-like growth factor-I expression in the skeletal muscle of noncachectic patients with chronic heart failure J. Am. Coll. Cardiol., April 3, 2002; 39(7): 1175 - 1181. [Abstract] [Full Text] [PDF]

				A. J S Coats HEART FAILURE: What causes the symptoms of heart failure? Heart, November 1, 2001; 86(5): 574 - 578. [Full Text] [PDF]

				G. F. Fletcher, G. J. Balady, E. A. Amsterdam, B. Chaitman, R. Eckel, J. Fleg, V. F. Froelicher, A. S. Leon, I. L. Pina, R. Rodney, et al. Exercise Standards for Testing and Training: A Statement for Healthcare Professionals From the American Heart Association Circulation, October 2, 2001; 104(14): 1694 - 1740. [Full Text] [PDF]

				B. Mettauer, J. Zoll, H. Sanchez, E. Lampert, F. Ribera, V. Veksler, X. Bigard, P. Mateo, E. Epailly, J. Lonsdorfer, et al. Oxidative capacity of skeletal muscle in heart failure patients versus sedentary or active control subjects J. Am. Coll. Cardiol., October 1, 2001; 38(4): 947 - 954. [Abstract] [Full Text] [PDF]

				J. Myers, R. Gianrossi, J. Schwitter, D. Wagner, and P. Dubach Effect of Exercise Training on Postexercise Oxygen Uptake Kinetics in Patients With Reduced Ventricular Function Chest, October 1, 2001; 120(4): 1206 - 1211. [Abstract] [Full Text] [PDF]

				P. A. Ades Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease N. Engl. J. Med., September 20, 2001; 345(12): 892 - 902. [Full Text] [PDF]

				T Iwase, N Nagaya, M Ando, T Satoh, F Sakamaki, S Kyotani, H Takaki, Y Goto, Y Ohkita, M Uematsu, et al. Acute and chronic effects of surgical thromboendarterectomy on exercise capacity and ventilatory efficiency in patients with chronic thromboembolic pulmonary hypertension Heart, August 1, 2001; 86(2): 188 - 192. [Abstract] [Full Text] [PDF]

				M. Cicoira, L. Zanolla, L. Franceschini, A. Rossi, G. Golia, M. Zamboni, P. Tosoni, and P. Zardini Skeletal muscle mass independently predicts peak oxygen consumption and ventilatory response during exercise in noncachectic patients with chronic heart failure J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2080 - 2085. [Abstract] [Full Text] [PDF]

				N. de Jonge, H. Kirkels, J. R. Lahpor, C. Klopping, E. J. Hulzebos, A. Brutel de la Riviere, and E. O. Robles de Medina Exercise performance in patients with end-stage heart failure after implantation of a left ventricular assist device and after heart transplantation: An outlook for permanent assisting? J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1794 - 1799. [Abstract] [Full Text] [PDF]

				A.I Larsen, T Aarsland, M Kristiansen, A Haugland, and K Dickstein Assessing the effect of exercise training in men with heart failure. Comparison of maximal, submaximal and endurance exercise protocols Eur. Heart J., April 2, 2001; 22(8): 684 - 692. [Abstract] [PDF]

				A. Linke, N. Schoene, S. Gielen, J.u. Hofer, S. Erbs, G. Schuler, and R. Hambrecht Endothelial dysfunction in patients with chronic heart failure: systemic effects of lower-limb exercise training J. Am. Coll. Cardiol., February 1, 2001; 37(2): 392 - 397. [Abstract] [Full Text] [PDF]

				Recommendations for exercise training in chronic heart failure patients Eur. Heart J., January 2, 2001; 22(2): 125 - 135. [PDF]

				B. D Duscha, B. H Annex, S. J Keteyian, H. J. Green, M. J. Sullivan, G. P. Samsa, C. A. Brawner, F. H. Schachat, and W. E. Kraus Differences in skeletal muscle between men and women with chronic heart failure J Appl Physiol, January 1, 2001; 90(1): 280 - 286. [Abstract] [Full Text] [PDF]

				R. Hambrecht, S. Gielen, A. Linke, E. Fiehn, J. Yu, C. Walther, N. Schoene, and G. Schuler Effects of Exercise Training on Left Ventricular Function and Peripheral Resistance in Patients With Chronic Heart Failure: A Randomized Trial JAMA, June 21, 2000; 283(23): 3095 - 3101. [Abstract] [Full Text] [PDF]

				A. Maiorana, G. O'Driscoll, C. Cheetham, J. Collis, C. Goodman, S. Rankin, R. Taylor, and D. Green Combined aerobic and resistance exercise training improves functional capacity and strength in CHF J Appl Physiol, May 1, 2000; 88(5): 1565 - 1570. [Abstract] [Full Text] [PDF]

				N G Mahon, S Sharma, P M Elliott, M K Baig, M W Norman, S Barbeyto, and W J McKenna Abnormal cardiopulmonary exercise variables in asymptomatic relatives of patients with dilated cardiomyopathy who have left ventricular enlargement Heart, May 1, 2000; 83(5): 511 - 517. [Abstract] [Full Text]

				C. Opasich, N. Ambrosino, G. Felicetti, R. Aquilani, E. Pasini, D. Bergitto, A. Mazza, F. Cobelli, and L. Tavazzi Heart failure-related myopathy. Clinical and pathophysiological insights Eur. Heart J., August 2, 1999; 20(16): 1191 - 1200. [Abstract] [PDF]

				K. Meyer Exercise training in chronic heart failure: is it really safe? Eur. Heart J., June 2, 1999; 20(12): 851 - 853. [PDF]

				R. Tyni-Lenne, E. Jansson, and C. Sylven Female-related skeletal muscle phenotype in patients with moderate chronic heart failure before and after dynamic exercise training Cardiovasc Res, April 1, 1999; 42(1): 99 - 103. [Abstract] [Full Text] [PDF]

				A. J. S. Coats Exercise Training for Heart Failure : Coming of Age Circulation, March 9, 1999; 99(9): 1138 - 1140. [Full Text] [PDF]

				R. Belardinelli, D. Georgiou, G. Cianci, and A. Purcaro Randomized, Controlled Trial of Long-Term Moderate Exercise Training in Chronic Heart Failure : Effects on Functional Capacity, Quality of Life, and Clinical Outcome Circulation, March 9, 1999; 99(9): 1173 - 1182. [Abstract] [Full Text] [PDF]

				K. Kiilavuori, H. Naveri, H. Leinonen, and M. Harkonen The effect of physical training on hormonal status and exertional hormonal response in patients with chronic congestive heart failure Eur. Heart J., March 2, 1999; 20(6): 456 - 464. [Abstract] [PDF]

				R. Hambrecht, V. Adams, S. Gielen, A. Linke, S. Mobius-Winkler, J. Yu, J. Niebauer, H. Jiang, E. Fiehn, and G. Schuler Exercise intolerance in patients with chronic heart failure and increased expression of inducible nitric oxide synthase in the skeletal muscle J. Am. Coll. Cardiol., January 1, 1999; 33(1): 174 - 179. [Abstract] [Full Text] [PDF]

				R. Hambrecht, E. Fiehn, C. Weigl, S. Gielen, C. Hamann, R. Kaiser, J. Yu, V. Adams, J. Niebauer, and G. Schuler Regular Physical Exercise Corrects Endothelial Dysfunction and Improves Exercise Capacity in Patients With Chronic Heart Failure Circulation, December 15, 1998; 98(24): 2709 - 2715. [Abstract] [Full Text] [PDF]

				K M Webb-Peploe, M Y Henein, A J S Coats, and D G Gibson Echo derived variables predicting exercise tolerance in patients with dilated and poorly functioning left ventricle Heart, December 1, 1998; 80(6): 565 - 569. [Abstract] [Full Text]

				E. Lampert, B. Mettauer, H. Hoppeler, A. Charloux, A. Charpentier, and J. Lonsdorfer Skeletal muscle response to short endurance training in heart transplant recipients J. Am. Coll. Cardiol., August 1, 1998; 32(2): 420 - 426. [Abstract] [Full Text] [PDF]

				P. Giannuzzi, P. L. Temporelli, U. Corra, M. Gattone, A. Giordano, L. Tavazzi, and f. t. E. S. Group Attenuation of Unfavorable Remodeling by Exercise Training in Postinfarction Patients With Left Ventricular Dysfunction : Results of the Exercise in Left Ventricular Dysfunction (ELVD) Trial* Circulation, September 16, 1997; 96(6): 1790 - 1797. [Abstract] [Full Text]

				O. M. HIJAZI, M. RAMANATHAN, A. S. ESTRERA, R. M. PESHOCK, and C. C. W. HSIA Fixed Maximal Stroke Index in Patients after Pneumonectomy Am. J. Respir. Crit. Care Med., May 1, 1997; 157(5): 1623 - 1629. [Abstract] [Full Text]

				P. Dubach, J. Myers, G. Dziekan, U. Goebbels, W. Reinhart, P. Vogt, R. Ratti, P. Muller, R. Miettunen, and P. Buser Effect of Exercise Training on Myocardial Remodeling in Patients With Reduced Left Ventricular Function After Myocardial Infarction : Application of Magnetic Resonance Imaging Circulation, April 15, 1997; 95(8): 2060 - 2067. [Abstract] [Full Text]

				L. Demopoulos, M. Yeh, M. Gentilucci, M. Testa, R. Bijou, S. D. Katz, D. Mancini, M. Jones, and T. H. LeJemtel Nonselective ß-Adrenergic Blockade With Carvedilol Does Not Hinder the Benefits of Exercise Training in Patients With Congestive Heart Failure Circulation, April 1, 1997; 95(7): 1764 - 1767. [Abstract] [Full Text]

				C. C. Lang, D. B. Chomsky, G. Rayos, T. K. Yeoh, and J. R. Wilson Skeletal muscle mass and exercise performance in stable ambulatory patients with heart failure J Appl Physiol, January 1, 1997; 82(1): 257 - 261. [Abstract] [Full Text] [PDF]

				J. R. Wilson, J. Groves, and G. Rayos Circulatory Status and Response to Cardiac Rehabilitation in Patients With Heart Failure Circulation, October 1, 1996; 94(7): 1567 - 1572. [Abstract] [Full Text]

				G. F. Fletcher, G. Balady, S. N. Blair, J. Blumenthal, C. Caspersen, B. Chaitman, S. Epstein, E. S. S. Froelicher, V. F. Froelicher, I. L. Pina, et al. Statement on Exercise: Benefits and Recommendations for Physical Activity Programs for All Americans: A Statement for Health Professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association Circulation, August 15, 1996; 94(4): 857 - 862. [Full Text]