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Fitness, Exercise for Seniors
Study May Explain Why Exercise Helps Heart Failure
Patients
Training program may reverse underlying
abnormalities more effectively than drug treatment
April 27, 2006 - Aerobic training is generally
accepted as a path to feeling and functioning better for heart failure
patients. A new study says this works because of a reversal of abnormal hormonal patterns that underlie many of the
debilitating symptoms of heart failure.
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"A feasible home-based and progressively adjusted aerobic training
strategy is able to overcome the limitation of pharmacological treatment
in antagonizing neurohormonal (see definition below) 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.
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What is "neurohormonal?"
Any
hormone produced by neurosecretory cells,
usually in the
brain. Neurohormonal activity is
distinguished from that of classical
neurotransmitters as it can have effects on
cells distant from the source of the hormone. -
Wikipedia
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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.
The study appears in the
May 2, 2006, issue of the Journal of the American College of Cardiology.
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