Reduced neurohormone activation in patients with HF after aerobic physical training

Passino C et al. (2006) Aerobic training decreases B-type natriuretic peptide expression and adrenergic activation in patients with heart failure. J Am Coll Cardiol 47: 1835–1839

Activation of neurohormones, such as brain natriuretic peptide (BNP), is associated with heart failure (HF). Although aerobic physical training can improve exercise tolerance in patients with HF, its influence on BNP secretion is unclear. In a prospective, randomized study of 95 patients with HF, Passino et al. assessed the effects of a progressive physical training program on neurohormonal activity.

Patients with impaired left ventricular systolic function (ejection fraction <45%) and exercise capacity (peak oxygen uptake <25 ml min⁻¹ kg⁻¹) were included in the study. Forty-seven patients were assigned to a training program, which involved cycling for 30 min at least three times weekly, with monitoring of heart rate to maintain a value corresponding to 65% of peak oxygen uptake; the remainder continued with their normal lifestyle. Neurohormone assays and cardiopulmonary stress tests were done at enrollment, and at 3 months and 9 months of follow-up. Patients also underwent echocardiography examinations and rated their quality of life according to the Minnesota Living With Heart Failure Questionnaire.

Over 9 months, the training group showed improvements in peak oxygen uptake (+13%, P <0.001), systolic function (ejection fraction +9%, P <0.01), and quality of life, and reduced activation of BNP, amino-terminal proBNP and norepinephrine (−34%, P <0.01; −32%, P <0.05; and −26%, P <0.01, respectively). The authors conclude that aerobic training can antagonize neurohormone activation in patients with HF and that it might be useful to assay for levels of BNP and amino-terminal proBNP in patients who undertake a physical training program.