Key result
Aerobic training reduces BNP ~34% in heart failure patients alongside broad neurohormonal improvements.
Why the study?
Patients with HF benefit from physical training and chronic neurohormonal activation detrimentally affects ventricular remodeling and prognosis, motivating evaluation of the effect of physical training on neurohormonal activation in HF.
Does a nine-month aerobic physical training program reduce neurohormonal activation (BNP, NT-proBNP, and norepinephrine) and improve functional capacity in patients with heart failure?
RCT (n=95)
Randomized
Does a nine-month aerobic physical training program reduce neurohormonal activation (BNP, NT-proBNP, and norepinephrine) and improve functional capacity in patients with heart failure?
p-value: p=<0.01
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Reversing neurohormonal activation by physical training adds to the current clinical practice a novel non-pharmacological aid. Out of 85 patients who completed the protocol, only the 44 randomized to the training program improved functional capacity, systolic function, and quality of life, in contrast to the controls. These beneficial effects were associated with a decrease in plasma level of BNP, NT-proBNP, and norepinephrine, only in the training group.”
“While an acute bout of exercise will lead to increases in both norepinephrine and BNP, with chronic training plasma concentrations of these factors diminish, suggesting that exercise training modulates beneficially activation of several neurohumoral pathways that reflect the severity of heart failure, and that following BNP concentrations may be one way of assuring that long term exercise training programs are having beneficial effects in individual patients. Pending is evidence from large randomized clinical trials that such short term changes will translate, over time, into mortality benefits for patients with chronic heart failure.”
“Although we can only hypothesize, we believe the physical training somehow improves hemodynamics, which favorably affects the neurohormonal balance. For instance, skeletal muscle in the patients who were training will require less oxygen to do the same work, and there will consequently be less stress on the heart.”
A nine-month aerobic training program in patients with heart failure improves functional capacity, systolic function, and quality of life while significantly reducing BNP, NT-proBNP, and norepinephrine levels.
Objectives We sought to evaluate the effect of physical training on neurohormonal activation in patients with heart failure (HF). Background Patients with HF benefit from physical training. Chronic neurohormonal activation has detrimental effects on ventricular remodeling and prognosis of patients with HF. Methods A total of 95 patients with HF were assigned randomly into two groups: 47 patients (group T) underwent a nine-month training program at 60% of the maximal oxygen uptake (VO2), whereas 48 patients did not (group C). The exercise load was adjusted during follow-up to achieve a progressive training effect. Plasma assay of B-type natriuretic peptide (BNP), amino-terminal pro-brain natriuretic peptide (NT-proBNP), norepinephrine, plasma renin activity, and aldosterone; quality-of-life questionnaire; echocardiogram; and cardiopulmonary stress test were performed upon enrollment and at the third and ninth month. Results A total of 85 patients completed the protocol (44 in group T, left ventricular ejection fraction [EF] 35 +/- 2%, mean +/- SEM; and 41 in group C, EF 32 +/- 2%, p = NS). At the ninth month, patients who underwent training showed an improvement in workload (+14%, p < 0.001), peak VO2 (+13%, p < 0.001), systolic function (EF +9%, p < 0.01), and quality of life. We noted that BNP, NT-proBNP, and norepinephrine values decreased after training (-34%, p < 0.01; -32%, p < 0.05; -26%, p < 0.01, respectively). Increase in peak VO2 with training correlated significantly with the decrease in both BNP/NT-proBNP level (p < 0.001 and p < 0.01, respectively). Patients who did not undergo training showed no changes. Conclusions Clinical benefits after physical training in patients with HF are associated with blunting of adrenergic overactivity and of natriuretic peptide overexpression.
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Passino et al. (2006) conducted an RCT in Heart failure (n=95). Aerobic physical training program vs. No training (control) was evaluated on Change in neurohormonal activation (BNP, NT-proBNP, and norepinephrine levels) (p=<0.01). A 9-month aerobic training program in heart failure patients significantly reduced BNP (-34%, p<0.01), NT-proBNP (-32%, p<0.05), and norepinephrine (-26%, p<0.01) while improving peak VO2 (+13%).
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