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Am J Physiol Heart Circ Physiol. 2015 Apr 15;308(8):H792-802. doi: 10.1152/ajpheart.00830.2014. Epub 2015 Feb 13.

Effects of exercise training on neurovascular control and skeletal myopathy in systolic heart failure.

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Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil; School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil; and
Departament of Medicine (Cardiology) and Physiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California.
Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil;


Neurohormonal excitation and dyspnea are the hallmarks of heart failure (HF) and have long been associated with poor prognosis in HF patients. Sympathetic nerve activity (SNA) and ventilatory equivalent of carbon dioxide (VE/VO2) are elevated in moderate HF patients and increased even further in severe HF patients. The increase in SNA in HF patients is present regardless of age, sex, and etiology of systolic dysfunction. Neurohormonal activation is the major mediator of the peripheral vasoconstriction characteristic of HF patients. In addition, reduction in peripheral blood flow increases muscle inflammation, oxidative stress, and protein degradation, which is the essence of the skeletal myopathy and exercise intolerance in HF. Here we discuss the beneficial effects of exercise training on resting SNA in patients with systolic HF and its central and peripheral mechanisms of control. Furthermore, we discuss the exercise-mediated improvement in peripheral vasoconstriction in patients with HF. We will also focus on the effects of exercise training on ventilatory responses. Finally, we review the effects of exercise training on features of the skeletal myopathy in HF. In summary, exercise training plays an important role in HF, working synergistically with pharmacological therapies to ameliorate these abnormalities in clinical practice.


exercise training; heart failure; skeletal myopathy; sympathetic nerve activity; vasoconstriction

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