Elsevier

American Heart Journal

Volume 147, Issue 1, January 2004, Pages 100-105
American Heart Journal

Clinical investigation
Change in circulating cytokines after 2 forms of exercise training in chronic stable heart failure☆

https://doi.org/10.1016/j.ahj.2003.07.001Get rights and content

Abstract

Background

A proinflammatory state is recognized in chronic heart failure and the degree of immune activation corresponds to disease severity and prognosis. Training is known to improve symptoms in heart failure but less is known about the effects of specific forms of training on the proinflammatory state.

Methods

Forty-six patients with stable chronic heart failure underwent a home-based program of exercise training for 30 minutes a day, 5 days per week over a 6-week period. Twenty-four used a bicycle ergometer and 22 used an electrical muscle stimulator applied to quadriceps and gastrocnemius muscles. Tumour necrosis factor-α (TNF-α), TNF-α soluble receptors 1 and 2, interleukin 6, and C-reactive protein were measured before and after the training period.

Results

Significant improvements in markers of exercise performance were seen in both training groups. Soluble TNF-α receptor 2 levels decreased after training in the bike group only (2900 ± 1069 pg/mL to 2625 ± 821 pg/mL, P = .013). Trends towards a decrease in levels of TNF-α and soluble receptor 1 were also seen in the bike group only. No change in circulating inflammatory markers was observed after stimulator training.

Conclusions

Physical training improves exercise capacity for patients with chronic heart failure but degree of attenuation of the proinflammatory response may depend on the mode of training despite similar improvements in exercise capacity.

Section snippets

Study population

Forty-six subjects with stable chronic heart failure and New York Heart Association (NYHA) class II or III symptoms were recruited. Stability was defined as no alterations in medical therapy or change in symptoms of heart failure within 1 month and no myocardial infarction within 3 months of inclusion. Baseline characteristics are shown in Table I. All subjects had documented left ventricular systolic impairment on echocardiography and were on appropriate medical therapy that included

Results

Improvements in 6-minute walk test distance, treadmill exercise time, maximal quadriceps leg strength, and quadriceps fatigue index were observed in the group as a whole and when the groups were examined separately (Table II). One-way analysis of variance indicated that the mode of exercise training was unimportant in determining the degree of change seen. Improvement in quality of life score after training was observed for the whole group (P = .02) but not when the groups were considered

Discussion

Whilst the beneficial effects of physical training in chronic heart failure for markers of exercise performance,14, 15, 18 muscle metabolism,13 endothelial function,23, 24 and perhaps prognosis14 are documented, less is known about the effects of physical training on the proinflammatory state. Larsen et al have demonstrated modest reductions in circulating TNF-α after a 12-week training period25 and Adamopoulos et al have shown reduction in TNF-α, soluble TNF-α receptors 1 and 2, soluble IL-6

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    Supported by the British Heart Foundation.

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