Influence of aerobic training on neurohormonal and hemodynamic responses to head-up tilt test and on autonomic nervous activity at rest and after exercise in patients after bypass surgery

BACKGROUND: Little is known about the influence of aerobic training on the neurohormonal and hemodynamic responses to head-up tilt (HUT) and on autonomic balance at rest and after exercise in optimally treated, low risk post-coronary artery bypass grafting (CABG) patients. METHODS: One hundred male patients, mean age 56 ± 6 years, 3 months after CABG, were randomized to either 6-week training on cycloergometer, 3 times a week, at 70-80% of max tolerated heart rate (HR) (training group, n = 50) or to a control group (n = 50). At baseline and at the end of the study, all patients underwent: (1) cardiopulmonary exercise test with HR recovery (HRR) assessment; (2) 60% HUT during which HR, blood pressure (BP), stroke volume (SV by impedance cardiography) were monitored and blood samples were taken for determination of plasma catecholamines and ANP levels, and plasma renin activity; (3) assessment of HR variability (HRV) in the time and frequency domains at rest. RESULTS: During the final tests, HUT-induced changes in HR, BP, SV, cardiac output, total peripheral resistance, and noradrenaline were significantly lower in training group than in controls. In addition, after training faster post-exercise HRR, increased SDNN and a tendency towards an increase in the high frequency HRV power spectrum were found. CONCLUSIONS: Aerobic training improved neurohormonal and hemodynamic responses to head-up tilt test and favorably modified sympatho-vagal balance in low risk post-CABG patients.