Effect of exercise therapy on established and emerging circulating biomarkers in patients with heart failure: a systematic review and meta-analysis

Abstract

BackgroundBiomarkers are important in the diagnosis, risk stratification and management of patients with heart failure (HF). The established biomarkers of myocardial stretch, brain natriuretic peptide (BNP) and amino (N) portion of BNP (NT-proBNP) have been extensively studied, and early analyses have demonstrated response to exercise training. Several other biomarkers have been identified over the last decade and may provide valuable and complementary information which may guide treatment strategies, including exercise therapy.MethodsA systematic search of PubMed, EMBASE and Cochrane Trials Register to 31 October 2017 was conducted for exercise-based rehabilitation trials in HF. Randomised and controlled trials that reported biomarkers, BNP, NT-proBNP, soluble ST2, galectin-3, mid-regional atrial natriuretic peptide, mid-regional adrenomedullin and copeptin, were included.ResultsForty-three studies were included in the systematic review, with 27 studies suitable for meta-analyses. Data pooling was only possible for NT-proBNP and BNP. Meta-analyses of conventional training studies demonstrated a statistically significant improvement in NT-proBNP (pmol/L); mean difference (MD) −32.80 (95% CI −56.19 to −9.42), p=0.006 and in BNP (pmol/L); MD −17.17 (95% CI −29.56 to −4.78), p=0.007. Pooled data of non-conventional training failed to demonstrate any statistically significant improvements.ConclusionPooled data indicated a favourable effect of conventional exercise therapy on the established biomarkers, NT-proBNP and BNP; however, this was in contrast to a number of studies that could not be pooled. Limited evidence exists as to the effect of exercise training on emerging biomarkers.

Effect of Home-Based High-Intensity Interval Training in Patients With Lacunar Stroke: A Randomized Controlled Trial

“…Endothelial biomarkers, ICAM-1, VCAM-1 (68, 69), VEGF (70, 71) were all shown to decrease in patients with cardiovascular risk factors, whereas there was insufficient evidence on the efficacy of exercise on E-selectin. Cardiovascular biomarkers (pro-ADM, pro-ANP) were shown to decrease in patients with heart failure (72, 73), and limited literature is available on the efficacy of exercise on Copeptin. We found only minor changes in the assessed biomarkers without clinical relevance between the groups.…”

The role of cardiac rehabilitation using exercise to decrease natriuretic peptide levels in non-surgical patients: a systematic review

“…Our review differs from the two previous systematic reviews which have examined NP levels in non-surgical patients after exercise therapy (Pearson et al 2018; Smart and Steele 2010). These reviews also found that NP levels were reduced after exercise therapy, with a high heterogeneity in the response.…”

“…These reviews also found that NP levels were reduced after exercise therapy, with a high heterogeneity in the response. The strength of our review is that it updates the previous reviews (Smart and Steele 2010) with more trials and only includes RCTs with aerobic exercise programmes (Pearson et al 2018). We did not consider trials examining yoga, stretching, Tai chi, functional electrical stimulation, or inspiratory muscle training (Pearson et al 2018).…”

Impact of exercise training on cardiotoxicity and cardiac health outcomes in women with breast cancer anthracycline chemotherapy: a study protocol for a randomized controlled trial

“…In adults with CVD without cancer, exercise training is recognized as an important approach in cardiac rehabilitation [16]. Particularly, two meta-analyses have shown favorable effects of exercise on attenuation of N-terminal pro-brain natriuretic peptide (NT-proBNP) [17] and mitigation of LV remodeling [18] in patients with heart failure. Also, in the oncological setting, it has become clear that exercise is a safe and effective supportive therapy in the management of several treatment-related side effects and in improving overall physical fitness [19, 20].…”