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European Heart Journal 2004 25(20):1797-1805; doi:10.1016/j.ehj.2004.07.022
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Combined endurance/resistance training reduces NT-proBNP levels in patients with chronic heart failure

Viviane M. Conraadsa,*, Paul Beckersa, Johan Vaesa, Manuella Martinb, Viviane Van Hoofc, Cathérine De Maeyera, Nadine Possemiersa, Floris L. Wuytsd and Christiaan J. Vrintsa

a Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
b Laboratory of Hormones, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
c Laboratory of Biochemistry, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
d Department of Medical Statistics, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium

Received December 23, 2003; revised July 12, 2004; accepted July 15, 2004 * Corresponding author. Tel.: +32 3 821 46 72; fax: +32 3 825 08 48 (E-mail: viviane.conraads{at}uza.be).

AIMS: This study was designed to evaluate the effects of combined endurance/resistance training on NT-proBNP levels in patients with chronic heart failure (CHF).

The safety of resistive weight training for patients with CHF is questioned. Possible detrimental effects include an increase in ventricular diastolic pressure and secondary unfavourable remodelling. Circulating levels of the N-terminal fragment of brain natriuretic peptide (NT-proBNP) reflect left ventricular diastolic wall stress and are strongly related to mortality and treatment success in CHF.

METHODS AND RESULTS: In this study, 27 consecutive patients with stable CHF and left ventricular ejection fraction (LVEF) <35% were enrolled in a 4 months non-randomized combined endurance/resistance training programe. Blood sampling for measurement of NT-proBNP, functional assessment, cardiopulmonary exercise testing, echocardiography and radionuclide angiography were performed at entry and after 4 months.

After 4 months, exercise training caused a significant reduction in circulating concentrations of NT-proBNP (2124±97 pg/ml before, 1635±04 pg/ml after training, p=0.046, interaction), whereas no changes were observed in an untrained heart failure control group. NYHA functional class (p=0.02, interaction), maximal (peak VO2: p=0.035, interaction; maximal workload: p<0.00001, interaction) and submaximal (workload at anaerobic threshold: p=0.001, interaction; rate–pressure product at anaerobic threshold: p=0.001, interaction) exercise parameters as well as work efficiency (Wattmax/VO2peak: p=0.0001, interaction) were significantly improved. In addition, a decrease in left ventricular end-systolic diameter was observed in the trained heart failure group (p=0.016).

CONCLUSION: Four months of combined endurance/resistance training significantly reduced circulating levels of NT-proBNP in patients with CHF, without evidence of adverse remodelling. Exercise training might offer additional non-pharmacological modulation of the activated neurohormonal pathways in the setting of CHF.


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