Effects of exercise interventions on peripheral vascular endothelial vasoreactivity in patients with heart failure with reduced ejection fraction

Abstract

Changes in vascular function, such as endothelial dysfunction are linked to the progression of heart failure (HF) and poorer outcomes, such as increased hospitalisations. Exercise training may positively influence endothelial function in HF patients with reduced ejection fraction. The aim of this manuscript is to summarise HF studies evaluating the influence of exercise training on endothelial function as measured by flow mediated vasodilation as a primary outcome and to provide recommendations for future research studies designed to improve peripheral vascular function in HF. Databases were searched for studies published between 1995 and December 2011. Two reviewers determined eligibility and extracted information on study characteristics and quality, exercise interventions, and endothelial function. Eleven articles (N=318 HF participants with an ejection fraction <40%) were eligible for full review. Aerobic, resistance, or combined exercise training improved endothelium-dependent vasodilation as measured by ultrasound or plethysmography. There is less evidence supporting improvement in endothelium-independent function with exercise training. Sample sizes were small and predominantly male. Future research is needed to address the best mode and optimal dose of exercise for all patients with HF including women and subgroups with specific co-morbidities.

Figure 1

The summary of the literature search and selection process.

Figure 2

Graphical plot of representation of Table 1 study data. Values (symbols) are percent change (pre-exercise values – post exercise values/baseline values) and were calculated using data values reported for each of the studies summarised in Table 1, with the exception of Belardinelli et al. [19], Wisløff et al. [21] and Dean et al. [23] studies. The results from the former studies were not included since data was reported in figures. Also the percent change value for the Kobayashi et al. study reflects those found using the tibial artery. Numbers in parentheses designate study reference number and *changes were significant.