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J Am Coll Cardiol, 2003; 42:861-868, doi:10.1016/S0735-1097(03)00848-9 © 2003 by the American College of Cardiology Foundation |
* Universität Leipzig, Herzzentrum GmbH, Klinik für Innere Medizin/Kardiologie, Leipzig, Germany
Klinik für Herzchirurgie, Leipzig, Germany
Universitätsspital Zürich, Dept. für Dermatologie, Zürich, Switzerland
Manuscript received January 16, 2003; revised manuscript received March 12, 2003, accepted March 20, 2003.
* Reprint requests and correspondence: Prof. Dr. med. R. Hambrecht, Universität Leipzig, Herzzentrum GmbH, Department of Internal Medicine/Cardiology, Strümpellstr. 39, 04289, Leipzig, Germany.
hamr{at}medizin.uni-leipzig.de
OBJECTIVES: The aim of this study was to assess the effects of regular physical exercise on local inflammatory parameters in the skeletal muscle of patients with chronic heart failure (CHF).
BACKGROUND: Inflammatory activation with increased serum cytokine levels and expression of inducible nitric oxide synthase (iNOS) in the myocardium and peripheral skeletal muscles has been described in CHF.
METHODS: Twenty male patients with stable CHF (left ventricular ejection fraction 25 ± 2%; age 54 ± 2 years) were randomized to a training group (n = 10) or a control group (n = 10). At baseline and after six months, serum samples and vastus lateralis muscle biopsies were obtained. Serum tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-1-beta levels were measured by enzyme-linked immunosorbent assay, local cytokine, and iNOS expression by real-time polymerase chain reaction.
RESULTS: Exercise training improved peak oxygen uptake by 29% in the training group (from 20.3 ± 1.0 to 26.1 ± 1.5 ml/kg · min; p < 0.001 vs. control group). While serum levels of TNF-alpha, IL-6, and IL-1-beta remained unaffected by training, local skeletal muscle TNF-alpha decreased from 1.9 ± 0.4 to 1.2 ± 0.3 relative U (p < 0.05 for change vs. control group), IL-6 from 71.3 ± 16.5 to 41.3 ± 8.8 relative U (p < 0.05 vs. begin), and IL-1-beta from 2.7 ± 1.1 to 1.4 ± 0.6 relative U (p = 0.02 vs. control group). Exercise training also reduced local iNOS expression by 52% (from 6.3 ± 1.2 to 3.0 ± 1.0 relative U; p = 0.007 vs. control group).
CONCLUSIONS: Exercise training significantly reduced the local expression of TNF-alpha, IL-1-beta, IL-6, and iNOS in the skeletal muscle of CHF patients. These local anti-inflammatory effects of exercise may attenuate the catabolic wasting process associated with the progression of CHF.
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