Effects of Exercise Training on Autonomic Function in Chronic Heart Failure: Systematic Review

Chung-Yin Hsu, Ping-Lun Hsieh, Shu-Fang Hsiao, Meng-Yueh Chien, Chung-Yin Hsu, Ping-Lun Hsieh, Shu-Fang Hsiao, Meng-Yueh Chien

Abstract

Objectives. Cardiac autonomic imbalance accompanies the progression of chronic heart failure (CHF). It is unclear whether exercise training could modulate autonomic control in CHF. This study aimed to review systematically the effects of exercise training on heart rate recovery (HRR) and heart rate variability (HRV) in patients with CHF. Methods. Literatures were systematically searched in electronic databases and relevant references. Only published randomized controlled trials (RCTs) focusing on exercise training for CHF were eligible for inclusion. Outcome measurements included HRR and HRV parameters. Results. Eight RCTs were eligible for inclusion and provided data on 280 participants (186 men). The participants were 52-70 years of age with New York Heart Association functional class II-III of CHF. Each study examined either aerobic or resistance exercise. Two trials addressed outcome of HRR and six HRV among these studies. Two RCTs showed that moderate aerobic exercise could improve HRR at 2 minutes after exercise training in CHF. Five of six RCTs demonstrated positive effects of exercise training on HRV which revealed the increments in high frequency (HF) and decrements in LF (low frequency)/HF ratio after training. Conclusion. Participation in an exercise training program has positive effects on cardiac autonomic balance in patients with CHF.

Figures

Figure 1
Figure 1
Trial flow diagram of this systemic review.

References

    1. Roger V. L., Go A. S., Lloyd-Jones D. M., et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–e220. doi: 10.1161/CIR.0b013e31823ac046.
    1. Hunt S. A., Baker D. W., Chin M. H., et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: Executive summary. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee to revise the 1995 guidelines for the evaluation and management of heart failure) Circulation. 2001;104(24):2996–3007. doi: 10.1161/hc4901.102568.
    1. Kubo S. H., Rector T. S., Bank A. J., Williams R. E., Heifetz S. M. Endothelium-dependent vasodilation is attenuated in patients with heart failure. Circulation. 1991;84(4):1589–1596. doi: 10.1161/01.CIR.84.4.1589.
    1. Adamopoulos S., Parissis J. T., Kremastinos D. T. New aspects for the role of physical training in the management of patients with chronic heart failure. International Journal of Cardiology. 2003;90(1):1–14. doi: 10.1016/s0167-5273(02)00504-1.
    1. Kienzle M. G., Ferguson D. W., Birkett C. L., Myers G. A., Berg W. J., Mariano D. J. Clinical, hemodynamic and sympathetic neural correlates of heart rate variability in congestive heart failure. The American Journal of Cardiology. 1992;69(8):761–767. doi: 10.1016/0002-9149(92)90502-p.
    1. Samara M. A., Tang W. H. W. Heart failure with systolic dysfunction. In: Griffin B. P., Callahan T. D., Menon V., et al., editors. Manual of Cardiovascular Medicine. Philadelphia, Pa, USA: Lippincott Williams & Wilkins; 2013. p. p. 148.
    1. Nishime E. O., Cole C. R., Blackstone E. H., Pashkow F. J., Lauer M. S. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. The Journal of the American Medical Association. 2000;284(11):1392–1398. doi: 10.1001/jama.284.11.1392.
    1. Freeman J. V., Dewey F. E., Hadley D. M., Myers J., Froelicher V. F. Autonomic nervous system interaction with the cardiovascular system during exercise. Progress in Cardiovascular Diseases. 2006;48(5):342–362. doi: 10.1016/j.pcad.2005.11.003.
    1. Imai K., Sato H., Hori M., et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. Journal of the American College of Cardiology. 1994;24(6):1529–1535. doi: 10.1016/0735-1097(94)90150-3.
    1. Cole C. R., Blackstone E. H., Pashkow F. J., Snader C. E., Lauer M. S. Heart rate recovery immediately after exercise as a predictor of mortality. The New England Journal of Medicine. 1999;341(18):1351–1357. doi: 10.1056/nejm199910283411804.
    1. Arena R., Guazzi M., Myers J., Peberdy M. A. Prognostic value of heart rate recovery in patients with heart failure. American Heart Journal. 2006;151(4):851.e7–851.e13. doi: 10.1016/j.ahj.2005.09.012.
    1. Jae S. Y., Ahn E. S., Heffernan K. S., et al. Relation of heart rate recovery after exercise to C-reactive protein and white blood cell count. The American Journal of Cardiology. 2007;99(5):707–710. doi: 10.1016/j.amjcard.2006.09.121.
    1. Task Force European Society Cardiology of the of North American Society Pacing the of Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation. 1996;93(5):1043–1065. doi: 10.1161/01.cir.93.5.1043.
    1. Sheppard R. J., Racine N., Roof A., Ducharme A., Blanchet M., White M. Heart rate recovery—a potential marker of clinical outcomes in heart failure patients receiving beta-blocker therapy. Canadian Journal of Cardiology. 2007;23(14):1135–1138. doi: 10.1016/s0828-282x(07)70884-x.
    1. Goldberger J. J., Le F. K., Lahiri M., Kannankeril P. J., Ng J., Kadish A. H. Assessment of parasympathetic reactivation after exercise. American Journal of Physiology—Heart and Circulatory Physiology. 2006;290(6):H2446–H2452. doi: 10.1152/ajpheart.01118.2005.
    1. Nolan J., Batin P. D., Andrews R., et al. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-Heart) Circulation. 1998;98(15):1510–1516. doi: 10.1161/01.cir.98.15.1510.
    1. Dörr M., Halle M. Exercise training as a key component of heart failure therapy. Herz. 2015;40(2):206–214.
    1. Edelmann F., Gelbrich G., Dngen H.-D., et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. Journal of the American College of Cardiology. 2011;58(17):1780–1791. doi: 10.1016/j.jacc.2011.06.054.
    1. van Tol B. A. F., Huijsmans R. J., Kroon D. W., Schothorst M., Kwakkel G. Effects of exercise training on cardiac performance, exercise capacity and quality of life in patients with heart failure: a meta-analysis. European Journal of Heart Failure. 2006;8(8):841–850. doi: 10.1016/j.ejheart.2006.02.013.
    1. Davies E. J., Moxham T., Rees K., et al. Exercise Training for systolic heart failure: cochrane systematic review and meta-analysis. European Journal of Heart Failure. 2010;12(7):706–715. doi: 10.1093/eurjhf/hfq056.
    1. Dixon E. M., Kamath M. V., McCartney N., Fallen E. L. Neural regulation of heart rate variability in endurance athletes and sedentary controls. Cardiovascular Research. 1992;26(7):713–719. doi: 10.1093/cvr/26.7.713.
    1. Sandercock G. R. H., Grocott-Mason R., Brodie D. A. Changes in short-term measures of heart rate variability after eight weeks of cardiac rehabilitation. Clinical Autonomic Research. 2007;17(1):39–45. doi: 10.1007/s10286-007-0392-5.
    1. Myers J., Hadley D., Oswald U., et al. Effects of exercise training on heart rate recovery in patients with chronic heart failure. American Heart Journal. 2007;153(6):1056–1063. doi: 10.1016/j.ahj.2007.02.038.
    1. Yaylali Y. T., Fındıkoglu G., Yurtdas M., Konukcu S., Senol H. The effects of baseline heart rate recovery normality and exercise training protocol on heart rate recovery in patients with heart failure. The Anatolian Journal of Cardiology. 2015;15(9):727–734. doi: 10.5152/akd.2014.5710.
    1. Selig S. E., Carey M. F., Menzies D. G., et al. Moderate-intensity resistance exercise training in patients with chronic heart failure improves strength, endurance, heart rate variability, and forearm blood flow. Journal of Cardiac Failure. 2004;10(1):21–30. doi: 10.1016/S1071-9164(03)00583-9.
    1. Murad K., Brubaker P. H., Fitzgerald D. M., et al. Exercise training improves heart rate variability in older patients with heart failure: a randomized, controlled, single-blinded trial. Congestive Heart Failure. 2012;18(4):192–197. doi: 10.1111/j.1751-7133.2011.00282.x.
    1. Ricca-Mallada R., Migliaro E. R., Piskorski J., Guzik P. Exercise training slows down heart rate and improves deceleration and acceleration capacity in patients with heart failure. Journal of Electrocardiology. 2012;45(3):214–219. doi: 10.1016/j.jelectrocard.2012.01.002.
    1. Kiilavuori K., Toivonen L., Näveri H., Leinonen H. Reversal of autonomic derangements by physical training in chronic heart failure assessed by heart rate variability. European Heart Journal. 1995;16(4):490–495.
    1. Yeh G. Y., Wayne P. M., Phillips R. S. Tai Chi exercise in patients with chronic heart failure. Medicine and Sport Science. 2008;52:195–208. doi: 10.1159/000134300.
    1. Cider Å., Tygesson H., Hedberg M., Seligman L., Wennerblom B., Sunnerhagen K. S. Peripheral muscle training in patients with clinical signs of heart failure. Scandinavian Journal of Rehabilitation Medicine. 1997;29(2):121–127.
    1. Dimopoulos S., Anastasiou-Nana M., Sakellariou D., et al. Effects of exercise rehabilitation program on heart rate recovery in patients with chronic heart failure. European Journal of Cardiovascular Prevention & Rehabilitation. 2006;13(1):67–73. doi: 10.1097/00149831-200602000-00010.
    1. Iellamo F., Manzi V., Caminiti G., et al. Dose-response relationship of baroreflex sensitivity and heart rate variability to individually-tailored exercise training in patients with heart failure. International Journal of Cardiology. 2013;166(2):334–339. doi: 10.1016/j.ijcard.2011.10.082.
    1. Koufaki P., Mercer T. H., George K. P., Nolan J. Low-volume high-intensity interval training vs. continuous aerobic cycling in patients with chronic heart failure: a pragmatic randomised clinical trial of feasibility and effectiveness. Journal of Rehabilitation Medicine. 2014;46(4):348–356. doi: 10.2340/16501977-1278.
    1. Dobšák P., Tomandl J., Spinarova L., et al. Effects of neuromuscular electrical stimulation and aerobic exercise training on arterial stiffness and autonomic functions in patients with chronic heart failure. Artificial Organs. 2012;36(10):920–930. doi: 10.1111/j.1525-1594.2012.01474.x.
    1. Larsen A. I., Gjesdal K., Hall C., Aukrust P., Aarsland T., Dickstein K. Effect of exercise training in patients with heart failure: a pilot study on autonomic balance assessed by heart rate variability. European Journal of Cardiovascular Prevention and Rehabilitation. 2004;11(2):162–167. doi: 10.1097/.
    1. Pietilä M., Malminiemi K., Vesalainen R., et al. Exercise training in chronic heart failure: beneficial effects on cardiac 11C-hydroxyephedrine PET, autonomic nervous control, and ventricular repolarization. Journal of Nuclear Medicine. 2002;43(6):773–779.
    1. Adamopoulos S., Ponikowski P., Cerquetani E., et al. Circadian pattern of heart rate variability in chronic heart failure patients: effects of physical training. European Heart Journal. 1995;16(10):1380–1386.
    1. Radaelli A., Coats A. J. S., Leuzzi S., et al. Physical training enhances sympathetic and parasympathetic control of heart rate and peripheral vessels in chronic heart failure. Clinical Science. 1996;91(supplement 1):92–94. doi: 10.1042/cs0910092supp.
    1. Buchheit M., Papelier Y., Laursen P. B., Ahmaidi S. Noninvasive assessment of cardiac parasympathetic function: postexercise heart rate recovery or heart rate variability? The American Journal of Physiology—Heart and Circulatory Physiology. 2007;293(1):H8–H10. doi: 10.1152/ajpheart.00335.2007.
    1. Shetler K., Marcus R., Froelicher V. F., et al. Heart rate recovery: validation and methodologic issues. Journal of the American College of Cardiology. 2001;38(7):1980–1987. doi: 10.1016/s0735-1097(01)01652-7.
    1. Desai M. Y., De la Peña-Almaguer, E., Mannting F. Abnormal heart rate recovery after exercise as a reflection of an abnormal chronotropic response. The American Journal of Cardiology. 2001;87(10):1164–1169. doi: 10.1016/s0002-9149(01)01487-4.
    1. La Rovere M. T., Bigger J. T., Jr., Marcus F. I., Mortara A., Schwartz P. J. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. The Lancet. 1998;351(9101):478–484. doi: 10.1016/s0140-6736(97)11144-8.
    1. Moak J. P., Goldstein D. S., Eldadah B. A., et al. Supine low-frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation. Heart Rhythm. 2007;4(12):1523–1529. doi: 10.1016/j.hrthm.2007.07.019.
    1. Cygankiewicz I., Zareba W. Heart rate variability. Handbook of Clinical Neurology. 2013;117(3):379–393. doi: 10.1016/b978-0-444-53491-0.00031-6.
    1. Routledge F. S., Campbell T. S., McFetridge-Durdle J. A., Bacon S. L. Improvements in heart rate variability with exercise therapy. Canadian Journal of Cardiology. 2010;26(6):303–312. doi: 10.1016/S0828-282X(10)70395-0.
    1. Kingwell B. A. Nitric oxide as a metabolic regulator during exercise: effects of training in health and disease. Clinical and Experimental Pharmacology and Physiology. 2000;27(4):239–250. doi: 10.1046/j.1440-1681.2000.03232.x.
    1. Townend J. N., Al-Ani M., West J. N., Littler W. A., Coote J. H. Modulation of cardiac autonomic control in humans by angiotensin II. Hypertension. 1995;25(6):1270–1275. doi: 10.1161/01.hyp.25.6.1270.
    1. Jüttler E., Tarabin V., Schwaninger M. Interleukin-6 (IL-6): a possible neuromodulator induced by neuronal activity. Neuroscientist. 2002;8(3):268–275. doi: 10.1177/1073858402008003012.
    1. Ruzek M. C., Miller A. H., Opal S. M., Pearce B. D., Biron C. A. Characterization of early cytokine responses and an interleukin (IL)-6-dependent pathway of endogenous glucocorticoid induction during murine cytomegalovirus infection. The Journal of Experimental Medicine. 1997;185(7):1185–1192. doi: 10.1084/jem.185.7.1185.

Source: PubMed

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