The effect of physical training on hormonal status and exertional hormonalresponse in patients with chronic congestive heart failure

Background Physical training improves exercise capacity in patients with ch ronic heart failure. It decreases plasma noradrenaline at rest, which may b e prognostically favourable. The effect on atrial natriuretic peptide, anot her prognostic factor, and on catabolic and anabolic hormones remains unkno wn. Furthermore, to our knowledge, the contribution of exertional hormonal responses to the improved exercise capacity has not been evaluated. Methods 27 patients with stable chronic heart failure (New York Heart Assoc iation class II-III) were randomized to training (n = 12) and control (n = 15) groups. The training group exercised on a bicycle ergometer for 30 min three times a week for 3 months. The load corresponded to 50-60%, of their peak oxygen consumption. For the next 3 months they exercised at home accor ding to personal instructions. The control group did not change its physica l activities. The levels of hormones regulating the cardiovascular system a nd metabolism were determined at rest and after graded maximal exercise and during exercise with constant submaximal workload. Results Submaximal exercise capacity increased significantly and peak oxyge n consumption tended to improve by 12% in the training group. The plasma no radrenaline at rest tended to decrease by 19%. The plasma level of N-termin al pro atrial natriuretic peptide did not change. Serum cortisol, a catabol ic hormone, was normal at baseline and remained unchanged. The serum levels of anabolic hormones, growth hormone and insulin, as well as dehydroepiand rosteronesulfate and free testosterone were within a normal range at baseli ne. They were not altered by training. The dehydroepiandrosteronesulfate/co rtisol, and the free testosterone/cortisol ratios. reflecting anabolic/cata bolic balance, did not change, either. Training resulted in a higher peak n oradrenaline response during graded maximal exercise. The rise in serum cor tisol during exercise tended to attenuate. Conclusion Physical training, which improves exercise capacity, does not ha ve an unfavourable effect on anabolic/catabolic balance or neurohumoral act ivation in patients with congestive: heart failure. It decreases plasma nor adrenaline at rest. Minor changes in hormonal responses during exercise eme rged after physical training which unlikely contribute to the improved exer cise capacity.