Neuroendocrine activation in heart failure is modified by endurance exercise training

OBJECTIVES The purpose of this study was to determine whether endurance exe rcise training could buffer neuroendocrine activity In chronic heart failur e patients. BACKGROUND Neuroendocrine activation is associated with poor long-term prog nosis in heart failure. There is growing consensus that exercise may be ben eficial by altering the clinical course of heart failure, but the mechanism s responsible for exercise-induced benefits are unclear. METHODS Nineteen heart failure patients (ischemic disease; New York Heart A ssociation [NYHA] class II or III) were randomly assigned to either a train ing group or to a control group. Exercise training consisted of supervised walking three times a week for 16 weeks at 40% to 70% of peak oxygen uptake . Medications were unchanged. Neurohormones were measured at study entry an d after 16 weeks. RESULTS The training group (n = 10; age = 61 +/- 6 years; EF = 30 +/- 6%) a nd control group (n = 9; age = 62 +/- 7 years; EF = 29 +/- 7%) did not diff er in clinical findings at study entry. Resting levels of angiotensin II, a ldosterone, vasopressin and atrial natriuretic peptide in the training and control groups did not differ at study entry (5.6 +/- 1.3 pg/ml; 158 +/- 38 pg/ml; 6.1 +/- 2.0 pg/ml; 37 +/- 8 pg/ml training group vs. 4.8 +/- 1.2; 1 46 +/- 23; 4.9 +/- 1.1; 35 +/- 10 control group). Peak exercise levels of a ngiotensin II, aldosterone, vasopressin and atrial natriuretic peptide in t he exercise and control groups did not differ at study entry. After 16 week s, rest and peak exercise hormone levels were unchanged in control patients . Peak exercise neurohormone levels were unchanged in the training group, b ut resting levels were significantly (p < 0.001) reduced (angiotensin -26%; aldosterone -32%; vasopressin -30%; atrial natriuretic peptide -27%). CONCLUSIONS Our data indicate that 16 weeks of endurance exercise training modified resting neuroendocrine hyperactivity in heart failure patients. Re duction in circulating neurohormones may have a beneficial impact on long-t erm prognosis. (J Am Coll Cardiol 1999;34:1170-5) (C) 1999 by the American College of Cardiology.