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Exercise intolerance, a key symptom of chronic heart failure, has been linked to peripheral derangements, and marked endothelial dysfunction (i. e. the inability of endothelium to mediate a proper vasodilatatory response to physiologic stimuli) has been postulated to be one of the main causes. We hypothesized that supervised aerobic leg training improves endothelial function in the upper limb vessels.
In our prospective study, 24 patients (3 women, 21 men, aged 50−80 years) with chronic heart failure were randomized to a control or a training group, which attended one-hour training sessions 3 times a week for 8 weeks. Before and after the training period, clinical and biochemical parameters, exercise capacity as well as endothelial dysfunction were determined. Endothelial dysfunction was assessed by high-resolution ultrasound measurements of brachial artery diameter and peak flow velocity at rest, after reactive hyperemia (causing flow-mediated endothelium-dependent dilation), and after gylceriltrinitrate administration (causing endothelium-independent vasodilatation).
Endothelium-dependent vasodilatation improved in training patients from 4.2 ±2.1% (mean ± standard deviation) to 7.7 ±2.3% (p<0.05), while the control group patient showed no significant change. Exercise capacity increased in the training group from 5.21 ± 1.13 to 6.88 ±1.29 metabolic equivalents, and double product (systolic blood pressure x heart rate at maximal exercise capacity) improved from a median value of 16.73 (1st−3rd quartile range 15.9−18.53) to 18.25 (range 16.57−21.67) mm Hgx min-1 x 103 (p<0.05), while both parameters remained unchanged in the control group. Body mass index, systolic and diastolic blood pressure, heart rate, and blood lipid levels did not change significantly in either group. Endothelium-dependent vasodilatation was negatively correlated with heart rate (r = −0.22, p < 0.05), and the change in endothelium-dependent vasodilatation in the control group was correlated with changes in exercise capacity (r = 0.34, p<0.05).
Our findings suggest that eight-week aerobic leg training improves brachial artery flow-mediated vasodilatation. Since leg training improved brachial artery endothelial function, it can be assumed that systemic effects of training on skeletal muscle vasculatrure are involved.