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[Obesity Discussion]

Why Exercise Helps Heart Failure Patients
29 Apr 2006

Aerobic training is associated with a reversal of abnormal hormonal patterns that underlie many of the debilitating symptoms of heart failure, according to a new study in the May 2, 2006, issue of the Journal of the American College of Cardiology.

"A feasible home-based and progressively adjusted aerobic training strategy is able to overcome the limitation of pharmacological treatment in antagonizing neurohormonal activation in heart failure patients, likely contributing to a significant improvement in quality of life, and possibly to the positive prognostic effects," said Claudio Passino, M.D. from the CNR Institute of Clinical Physiology in Pisa, Italy.

It is well-known that exercise training helps many heart failure patients feel better and improves their ability to function more normally. This study indicates that aerobic training may produce these benefits by reversing the abnormal production of certain neurohormones that result in many of the severe symptoms of heart failure.

After a heart attack or other cardiac event, the body responds by increasing the production of B-type natriuretic peptide (BNP). This neurohormonal activation, as it is called, helps the heart continue to pump blood in the short run by constricting blood vessel and retaining sodium in cardiac cells.

"This neurohormonal imbalance becomes detrimental on the long-term, promoting left ventricular fibrosis, dilatation, arrhythmias, peripheral tissue hypoperfusion, edemas, and thus leading to a symptomatic disease with dyspnea and fatigue," Dr. Passino said.

Previous studies indicated that patients with higher levels of B-type natriuretic peptide have poorer prognoses. Drug treatments are often unable to adequately reverse the neurohormonal activation.

Since physical activity often helps heart failure patients, the researchers wanted to find out what effect aerobic training has on the neurohormonal imbalance. They randomized heart failure patients into two groups. The treatment group consisted of 47 patients who entered a nine-month aerobic training program that progressively increased the amount of work the patients were able to perform. The control group of 48 patients received standard heart failure treatments, but no physical training.

The 44 patients who completed the training program improved their fitness and said their quality of life was better than the 41 patients who completed the control group arm of the study. But in addition, the patients who worked out had decreased levels of three key hormones, B-type natriuretic peptide (BNP), amino-terminal pro-brain natriuretic peptide (NT-proBNP), and norepinephrine.

Dr. Passino said the results indicate that aerobic training may be able to restore neurohormonal balance in a way that may improve on current drug therapies.

"Reversing neurohormonal activation by physical training adds to the current clinical practice a novel non-pharmacological aid. Out of 85 patients who completed the protocol, only the 44 randomized to the training program improved functional capacity, systolic function, and quality of life, in contrast to the controls. These beneficial effects were associated with a decrease in plasma level of BNP, NT-proBNP, and norepinephrine, only in the training group," he said.

In addition, he said that the measurements of neurohormonal activation used in this study may be a useful way for physicians to assess the effect of training in their patients.

John Floras, M.D., D.Phil., F.R.C.P.C. from the University of Toronto in Canada, who was not connected with this study, said the results provide additional evidence of the benefits of exercise for selected heart failure patients, while offering fresh insight into how training works to provide those benefits.

"While an acute bout of exercise will lead to increases in both norepinephrine and BNP, with chronic training plasma concentrations of these factors diminish, suggesting that exercise training modulates beneficially activation of several neurohumoral pathways that reflect the severity of heart failure, and that following BNP concentrations may be one way of assuring that long term exercise training programs are having beneficial effects in individual patients. Pending is evidence from large randomized clinical trials that such short term changes will translate, over time, into mortality benefits for patients with chronic heart failure," Dr. Floras said.

Article

[yuliyasha]

Very nice. I'd prefer biofeedback of any kind instead of drugs...and fitness program is one of them. Um, cardio work-out also strengthens myocardial muscles and improves oxygenation and expansion of lungs. People with CHF (chronic hear failure) often suffer from sortness of breath and pulmonary decompensation, which makes person even more fatigue and sick. To avoid MI (myocardial infarction) or stoke, my patients encouraged to do active range of motion exercises and breathing exercises to improve oxygenation and circulation of the body.
The physical exercise also triggers release of natural endorphins such as epinephrine and norepinephrine, adrenalin...They improve client's energy levels and emotional well-being. That's what makes you want to go back and work out even if you're sore --feeling of satisfaction and stress relief.

[Irving]

Originally Posted by yuliyasha

Very nice. I'd prefer biofeedback of any kind instead of drugs...and fitness program is one of them. Um, cardio work-out also strengthens myocardial muscles and improves oxygenation and expansion of lungs. People with CHF (chronic hear failure) often suffer from sortness of breath and pulmonary decompensation, which makes person even more fatigue and sick. To avoid MI (myocardial infarction) or stoke, my patients encouraged to do active range of motion exercises and breathing exercises to improve oxygenation and circulation of the body.
The physical exercise also triggers release of natural endorphins such as epinephrine and norepinephrine, adrenalin...They improve client's energy levels and emotional well-being. That's what makes you want to go back and work out even if you're sore --feeling of satisfaction and stress relief.

How soon are patients with chronic heart failure encouraged to being moving around actively? I would think they would want to wait a while before getting back to exercising, and then once you do start exercising, how hard can you eventually push yourself? Like nothing ever happened or is it expected that one should take it a little easier for the rest of their lives?

[yuliyasha]

Well, I think it depends on if the heart failure was managed early on or if the person already developed complications. If the client doesn't have complications and manages well by using pharmaceuticals such as beta blockers, calcium channel blockers, Ace inhibitors and diuretics, he or she might begin mild exercise program. Of course you won't be expecting for them to run marathon or workout at the gym every day. BUT, simple breathing and walking exercises, biofeedback, yoga, palate, etc. Those exercise programs are very good.
If the person develops shortness of breath adn exhaustion early on into the program, that means his or her heart failure is not managed properly. Usually doctors recommend walking. You don't want the client to sit in a chair all day or even worse lay in bed...Activity helps circulation to reach lower body as well and prevents pressure ulcers, loss of muscle mass and respiratory deficiencies. Of course the doctor decides on exercise program and it definitely varies among professionals. People with heart failure are under strict blood pressure control and input/output control. That means you want to make sure balance fluid intake with urinary output to prevent dehydration/overhydration. And when you exercise, there's an option to control your heart rate. The key to initial exercise is to start slow with warm up and finish with lighter, slower movements. This will reduce fluctuations in blood pressure and eart rate.
Well, I can talk for hours, but I think you got general idea