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CLINICAL RESEARCH: HEART FAILURE

Aerobic Training Decreases B-Type Natriuretic Peptide Expression and Adrenergic Activation in Patients With Heart Failure

Claudio Passino, MD^_*,,_*, Silvia Severino, MS^_*, Roberta Poletti, MD^_*, Massimo F. Piepoli, MD, Chiara Mammini, MD^_*, Aldo Clerico, MD^_*,, Alessandra Gabutti, MD^_*, Guido Nassi, MS^_* and Michele Emdin, MD, PhD^_*

^_* Cardiovascular Medicine Department, CNR Institute of Clinical Physiology, Pisa, Italy
Scuba Superiore S. Anna, Pisa, Italy
G. da Saliceto Hospital, Piacenza, Italy.

Manuscript received September 21, 2005; revised manuscript received December 5, 2005, accepted December 13, 2005.

^_* Reprint requests and correspondence: Dr. Claudio Passino, CNR Institute of Clinical Physiology, Via Moruzzi 1, 56124 Pisa, Italy. (Email: passino{at}ifc.cnr.it).

OBJECTIVES: We sought to evaluate the effect of physical training on neurohormonal activation in patients with heart failure (HF).

BACKGROUND: Patients with HF benefit from physical training. Chronic neurohormonal activation has detrimental effects on ventricular remodeling and prognosis of patients with HF.

METHODS: A total of 95 patients with HF were assigned randomly into two groups: 47 patients (group T) underwent a nine-month training program at 60% of the maximal oxygen uptake (VO₂), whereas 48 patients did not (group C). The exercise load was adjusted during follow-up to achieve a progressive training effect. Plasma assay of B-type natriuretic peptide (BNP), amino-terminal pro-brain natriuretic peptide (NT-proBNP), norepinephrine, plasma renin activity, and aldosterone; quality-of-life questionnaire; echocardiogram; and cardiopulmonary stress test were performed upon enrollment and at the third and ninth month.

RESULTS: A total of 85 patients completed the protocol (44 in group T, left ventricular ejection fraction [EF] 35 ± 2%, mean ± SEM; and 41 in group C, EF 32 ± 2%, p = NS). At the ninth month, patients who underwent training showed an improvement in workload (+14%, p < 0.001), peak VO₂ (+13%, p < 0.001), systolic function (EF +9%, p < 0.01), and quality of life. We noted that BNP, NT-proBNP, and norepinephrine values decreased after training (–34%, p < 0.01; –32%, p < 0.05; –26%, p < 0.01, respectively). Increase in peak VO₂ with training correlated significantly with the decrease in both BNP/NT-proBNP level (p < 0.001 and p < 0.01, respectively). Patients who did not undergo training showed no changes.

CONCLUSIONS: Clinical benefits after physical training in patients with HF are associated with blunting of adrenergic overactivity and of natriuretic peptide overexpression.

Abbreviations and Acronyms   BNP = B-type natriuretic peptide   CPT = cardiopulmonary stress test   EF = ejection fraction   HF = heart failure   NT-proBNP = amino-terminal pro-brain natriuretic peptide   NYHA = New York Heart Association   QOL = quality of life   VE/VCO2 = ventilation/carbon dioxide production ratio   VO2 = oxygen uptake

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