Key result
Combined inspiratory muscle training and aerobic exercise training caused no additive effects on muscle sympathetic nerve activity reduction compared to aerobic exercise training alone in patients with heart failure with reduced ejection fraction.
Why the study?
It was hypothesized that combining inspiratory muscle training with aerobic exercise training would have more pronounced effects on muscle sympathetic nerve activity and forearm blood flow in HFrEF than aerobic exercise training alone.
Does combined inspiratory muscle training and aerobic exercise training improve neurovascular control compared to aerobic exercise training alone in patients with HFrEF?
RCT (n=42)
Single-blind
Randomly assigned
No
Does combined inspiratory muscle training and aerobic exercise training improve neurovascular control compared to aerobic exercise training alone in patients with HFrEF?
Adding inspiratory muscle training to aerobic exercise training does not provide additive benefits on neurovascular control in HFrEF patients, possibly because most lacked baseline inspiratory muscle weakness.
No additive neurovascular benefit from combining inspiratory muscle training with aerobic exercise in HFrEF; supports aerobic training alone for sympathetic modulation.
Aims We tested the hypothesis that the effects of combined inspiratory muscle training and aerobic exercise training (IMT + AET) on muscle sympathetic nerve activity (MSNA) and forearm blood flow in patients with heart failure with reduced ejection fraction are more pronounced than the effects of AET alone. Methods and results Patients aged 30–70 years, New York Heart Association Functional Class II-III, and left ventricular ejection fraction ≤40% were randomly assigned to four groups: IMT (n = 11), AET (n = 12), IMT + AET (n = 9), and non-training (NT; n = 10). MSNA was recorded using microneurography. Forearm blood flow was measured by venous occlusion plethysmography and inspiratory muscle strength by maximal inspiratory pressure. IMT consisted of 30 min sessions, five times a week, for 4 months. Moderate AET consisted of 60 min sessions, three times a week for 4 months. AET (−10 ± 2 bursts/min, P = 0.03) and IMT + AET (−13 ± 4 bursts/min, P = 0.007) reduced MSNA. These responses in MSNA were not different between AET and IMT + AET groups. IMT (0.22 ± 0.08 mL/min/100 mL, P = 0.03), AET (0.27 ± 0.09 mL/min/100 mL, P = 0.01), and IMT + AET (0.35 ± 0.12 mL/min/100 mL, P = 0.008) increased forearm blood flow. No differences were found between groups. AET (3 ± 1 mL/kg/min, P = 0.006) and IMT + AET (4 ± 1 mL/kg/min, P = 0.001) increased peak oxygen consumption. These responses were similar between these groups. IMT (20 ± 3 cmH2O, P = 0.005) and IMT + AET (18 ± 3 cmH2O, P = 0.01) increased maximal inspiratory pressure. No significant changes were observed in the NT group. Conclusions IMT + AET causes no additive effects on neurovascular control in patients with heart failure with reduced ejection fraction compared with AET alone. These findings may be, in part, because few patients had inspiratory muscle weakness.
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Trevizan et al. (2021) conducted an RCT in Heart failure with reduced ejection fraction (HFrEF) (n=42). Combined inspiratory muscle training and aerobic exercise training (IMT + AET) vs. Aerobic exercise training (AET) alone was evaluated on Change in muscle sympathetic nerve activity (MSNA) burst frequency (bursts/min). Combined inspiratory muscle training and aerobic exercise training caused no additive effects on muscle sympathetic nerve activity reduction compared to aerobic exercise training alone in patients with heart failure with reduced ejection fraction.
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