The role of exercise training on cardiovascular peptides in patients with heart failure: A systematic review and meta-analysis

Background: The purpose of this systematic review & meta-analysis was to determine the roles of aerobic, resistance or concurrent exercises vs. control (CON) group on B-type natriuretic peptide (BNP) and N-terminal-pro hormone BNP (NT-proBNP) in patients with heart failure. Methods: The electronic databases of PubMed, Scopus, Web of Science, and Google Scholar were searched up to May 2022 for aerobic vs. CON, resistance vs. CON, and concurrent vs. CON studies on circulating (serum or plasma) levels of BNP and NT-proBNP in patients with heart failure. Non-randomized or randomized controlled trial studies were included. Standardized mean difference (SMD) and 95% confidence intervals (95% CIs) were calculated. This systematic review & meta-analysis was registered in PROSPERO at the University of York with the registration number CRD42021271632. Results: A total of 28 articles (37 intervention arms), 26 aerobic intervention arms, 3 resistance intervention arms, and 8 concurrent intervention arms were included. A total of 2563 participants (exercise groups = 1350 and CON groups = 1213) were included. Exercise training significantly decreased NT-proBNP marker -0.229 (SMD and 95% CI: 0.386 to -0.071), p = 0.005, irrespective of overweight/obesity status. Analysis of subgroup by type of exercise training revealed that there was a significant reduction in the NT-proBNP marker for aerobic exercise group compared to the CON group -0.336 (SMD and 95% CI: 0.555 to -0.105), p = 0.004, whereas concurrent exercise did not show significant changes in the NT-proBNP marker -0.134 (SMD and 95% CI: 0.350 to 0.083), p = 0.227. In addition, exercise training did not significantly change the BNP marker -0.122 (SMD and 95% CI: 0.322 to 0.079), p = 0.235. Conclusions: The results suggested that exercise training, especially aerobic exercise can be improved the NT-proBNP concentrations in patients with HF (irrespective of overweight/obesity status), which may be a sign of positive physiological adaptations to aerobic exercise.