Effects of Exercise Interventions on Peripheral Vascular Endothelial Vasoreactivity in Patients with Heart Failure with Reduced Ejection Fraction

Abstract

Changes in vascular function, such as endothelial dysfunction are linked to the progression of heart failure (HF) and poorer outcomes, such as increased hospitalisations. Exercise training may positively influence endothelial function in HF patients with reduced ejection fraction. The aim of this manuscript is to summarise HF studies evaluating the influence of exercise training on endothelial function as measured by flow mediated vasodilation as a primary outcome and to provide recommendations for future research studies designed to improve peripheral vascular function in HF. Databases were searched for studies published between 1995 and December 2011. Two reviewers determined eligibility and extracted information on study characteristics and quality, exercise interventions, and endothelial function. Eleven articles (N = 318 HF participants with an ejection fraction <40%) were eligible for full review. Aerobic, resistance, or combined exercise training improved endothelium-dependent vasodilation as measured by ultrasound or plethysmography. There is less evidence supporting improvement in endothelium-independent function with exercise training. Sample sizes were small and predominantly male. Future research is needed to address the best mode and optimal dose of exercise for all patients with HF including women and subgroups with specific co-morbidities.

Study of endothelial function response to exercise training in hypertensive individuals (SEFRET): study protocol for a randomized controlled trial

“…Regular exercise promotes changes in cholesterol levels and its subfractions; accelerates the removal of chylomicrons and low-density lipoproteins from circulation; increases the release of NO that seems to generate increased expression of eNOS [ 26 ]; increases the number of circulating EPCs in healthy individuals [ 27 ], as well as in individuals with established cardiovascular disease [ 28 ]; and improves plasma glucose [ 29 ], which has a direct link to impaired endothelial function [ 30 ]. This assumption is consistent with findings in healthy individuals [ 31 ], individuals with diabetes mellitus type 2 [ 32 ], and patients with cardiovascular conditions [ 33 ], showing that exercise training improved vascular function and overall health.…”

Mechanisms of the Improvement in Peak VO2 With Exercise Training in Heart Failure With Reduced or Preserved Ejection Fraction

“…Several different combinations of exercise modality (aerobic, resistance, and combined training) and duration (typically 4-16 weeks) have been effective in improving vascular function. Importantly, the effect of exercise on vascular function is independent of NYHA class or HF aetiology [50]. Most studies in HFrEF have focussed on the impact of aerobic cycle exercise ($60-70% VO 2peak ) on conduit artery and stimulated vascular responsiveness (acetylcholine [ACh] and sodium nitroprusside [SNP]).…”

Resveratrol Treatment of Mice With Pressure-Overload–Induced Heart Failure Improves Diastolic Function and Cardiac Energy Metabolism

“…Because abnormalities in vascular and endothelial function have been proposed to be important contributors to impaired aerobic capacity and the development and progression of HF, 32,33 we assessed whether resveratrol may indirectly increase physical activity via its ability to improve vascular function 9,34-36 and ultimately increase oxygen perfusion to the heart and skeletal muscle. Using flow-mediated dilation of the left femoral artery, 36 we show that mice with established HF failed to increase femoral artery flow velocity compared with sham animals after 5 minutes of ischemia ( Figure 6B).…”