Exercise in the Management of Patients with Chronic Heart Failure

Keteyian, Steven J.

doi:10.1007/s11897-010-0002-z

Cited by 13 publications

(10 citation statements)

References 49 publications

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“…It is becoming increasingly accepted that ExT in CHF is safe and can increase survival, decrease complications, and abrogate increases in muscle sympathetic nerve activity 12–15 . However, the mechanism by which ExT exerts these beneficial effects in the CHF state and its effect on AT1R expression and signaling are not well understood.…”

Section: Introductionmentioning

confidence: 99%

Parallel Changes in Neuronal AT1R and GRK5 Expression Following Exercise Training in Heart Failure

et al. 2012

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Although exercise training (ExT) is an important therapeutic strategy for improving quality of life in patients with chronic heart failure (CHF), the central mechanisms by which ExT is beneficial are not well understood. The angiotensin II type 1 receptor (AT1R) plays a pivotal role in the development of CHF, and is upregulated in a number of tissues due in part to transcription factor nuclear factor kappa B (NF-κB). In addition, AT1R is marked for internalization and recycling via G protein coupled receptor kinase (GRK) phosphorylation. Because previous studies have shown that the beneficial effects of ExT in CHF rely on a reduction in Ang II, we hypothesized ExT would decrease AT1R, GRK5 and NF-κB protein expression in the paraventricular nucleus (PVN) and rostral ventrolateral medulla (RVLM) of CHF rats. Following infarction by coronary artery ligation, animals were exercised four weeks post-surgery on a treadmill at a final speed of 25 m/min for 60 minutes, 5 days/week for 6 weeks. Western blot analysis of PVN and RVLM micropunches revealed an upregulation of AT1R, GRK5 and NF-κB in the infarcted group that was reversed by ExT. Furthermore, the relative expression of phosphorylated AT1R and AT1R/GRK5 physical association was increased in the CHF sedentary group, and reversed by ExT. Overexpression of GRK5 in cultured CATH.a neurons blunted angiotensin II-mediated upregulation of AT1R and NF-κB; conversely, silencing of GRK5 exacerbated angiotensin II-mediated AT1R and NF-κB upregulation. Taken together, increased GRK5 may regulate AT1R expression in CHF, and ExT mitigates AT1R and its pathway components.

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Section: Introductionmentioning

confidence: 99%

Parallel Changes in Neuronal AT1R and GRK5 Expression Following Exercise Training in Heart Failure

et al. 2012

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“…the low functional capacity of the evaluated patients. Although the EPAP application is a therapeutic alternative which provides effects such as variation in intra-alveolar pressure, increase of functional residual capacity (FRC), redistribution of the extravascular liquid and decrease of intrapulmonary shunt 24,25 , its use in the 6'WT did not faithfully reflect the real physiological situation in hemodynamic and ventilator terms in this scenario. The 6'WT has the aim to evaluate both the functional status of the cardiovascular and/or respiratory system and the effects of a therapeutic and rehabilitation program 25,26 .…”

Section: Discussionmentioning

confidence: 99%

Efeitos da aplicação da EPAP (Expiratory Positive Airway Pressure) sobre a tolerância ao esforço em pacientes portadores de insuficiência cardíaca

Thofehrn

Coutinho

Daros

et al. 2013

Rev Bras Med Esporte

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Introduction: New therapeutic approaches that aim to improve the sensation of dyspnea and fatigue in patients with heart failure, as the application of expiratory positive airway pressure (EPAP) should be tested in an attempt to improve functional capacity and quality of life. Objective: To evaluate the effects of the use of EPAP during exercise in patients with heart failure functional class II and III (NYHA). Methods: Of 390 patients, 28 were selected with LVEF <40%. The six-minute walk test (6'WT) was performed three times with and without the EPAP, reflecting the greater distance in the analysis. The comparison between the data obtained was performed by paired t test or Wilcoxon test as the normality of the data. Results: The use of EPAP increased volume without significant minutes, but the perceived exertion was higher after the walk with the use of the mask when compared in the absence of a mask. There was significant increase in oxygen saturation compared with the group that did not use the mask. There was no improvement in distance walked in 6'WT with the use of EPAP. Conclusion: Use of EPAP mask increases the perception of ventilatory effort and work, but its applicability in routine cardiac rehabilitation programs based on our preliminary data is questionable.

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“…During a median follow-up time of 30 months, risks of all-cause mortality and hospitalization were reduced in the treatment arm, but these associations achieved statistical significance only after adjustment for several influencing variables [50]. Randomized trials that more closely monitored adherence to the study protocol consistently found benefits on outcome and hospitalization [51,52]. In contrast to the testosterone trials, none of the mentioned studies raised important safety concerns, and moderate exercise training is recommended in the heart failure guidelines of the European Society of Cardiology [53].…”

Section: Alternatives To Testosterone Administrationmentioning

confidence: 99%

Androgen Deficiency in Heart Failure

Güder

Allolio

Angermann

et al. 2011

Curr Heart Fail Rep

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Androgen deficiency is a hormonal disorder that is frequently observed in advanced chronic conditions. A reduction of androgen blood levels may be cause or consequence of the disease, or both. Typical symptoms, such as fatigue or muscle weakness, may be particularly aggravated in heart failure, and disease severity may be indirectly affected by low levels of androgen. Recently, androgen replacement therapy has been suggested as a new treatment option of heart failure symptoms, and placebo-controlled pilot trials showed a modest improvement of physical performance. However, testosterone replacement in elderly patients is not without risks, and the benefit-risk ratio for such adjunct treatment is unclear. This review focuses on the general effects of androgens on the cardiovascular system and outlines expected benefits and suspected side effects of testosterone replacement therapy in patients with heart failure.

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Exercise in the Management of Patients with Chronic Heart Failure

Cited by 13 publications

References 49 publications

Parallel Changes in Neuronal AT1R and GRK5 Expression Following Exercise Training in Heart Failure

Parallel Changes in Neuronal AT1R and GRK5 Expression Following Exercise Training in Heart Failure

Efeitos da aplicação da EPAP (Expiratory Positive Airway Pressure) sobre a tolerância ao esforço em pacientes portadores de insuficiência cardíaca

Androgen Deficiency in Heart Failure

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