TY - JOUR
T1 - Revisiting the physiological effects of exercise training on autonomic regulation and chemoreflex control in heart failure
T2 - Does ejection fraction matter?
AU - Andrade, David C.
AU - Arce-Alvarez, Alexis
AU - Toledo, Camilo
AU - Díaz, Hugo S.
AU - Lucero, Claudia
AU - Quintanilla, Rodrigo A.
AU - Schultz, Harold D.
AU - Marcus, Noah J.
AU - Amann, Markus
AU - Del Rio, Rodrigo
N1 - Funding Information:
This work was supported by Fondo de Desarrollo Científico y Tec-nológico Fondecyt 1140275 and Fondecyt 1180172 (to R. Del Rio). D. C. Andrade was supported by National Fund for Scientific and Technological Development of Chile 2015-21251230). M. Amann was supported by National Heart, Lung, and Blood Institute Grant HL-116579 and Veterans Affairs Award System Grant E1572P. N. J. Marcus was supported by National Heart, Lung, and Blood Institute Grant HL-138600-01.
PY - 2018/3
Y1 - 2018/3
N2 - Heart failure (HF) is a global public health problem that, independent of its etiology [reduced (HFrEF) or preserved ejection fraction (HFpEF)], is characterized by functional impairments of cardiac function, chemoreflex hypersensitivity, baroreflex sensitivity (BRS) impairment, and abnormal autonomic regulation, all of which contribute to increased morbidity and mortality. Exercise training (ExT) has been identified as a nonpharmacological therapy capable of restoring normal autonomic function and improving survival in patients with HFrEF. Improvements in autonomic function after ExT are correlated with restoration of normal peripheral chemoreflex sensitivity and BRS in HFrEF. To date, few studies have addressed the effects of ExT on chemoreflex control, BRS, and cardiac autonomic control in HFpEF; however, there are some studies that have suggested that ExT has a beneficial effect on cardiac autonomic control. The beneficial effects of ExT on cardiac function and autonomic control in HF may have important implications for functional capacity in addition to their obvious importance to survival. Recent studies have suggested that the peripheral chemoreflex may also play an important role in attenuating exercise intolerance in HFrEF patients. The role of the central/peripheral chemoreflex, if any, in mediating exercise intolerance in HFpEF has not been investigated. The present review focuses on recent studies that address primary pathophysiological mechanisms of HF (HFrEF and HFpEF) and the potential avenues by which ExT exerts its beneficial effects.
AB - Heart failure (HF) is a global public health problem that, independent of its etiology [reduced (HFrEF) or preserved ejection fraction (HFpEF)], is characterized by functional impairments of cardiac function, chemoreflex hypersensitivity, baroreflex sensitivity (BRS) impairment, and abnormal autonomic regulation, all of which contribute to increased morbidity and mortality. Exercise training (ExT) has been identified as a nonpharmacological therapy capable of restoring normal autonomic function and improving survival in patients with HFrEF. Improvements in autonomic function after ExT are correlated with restoration of normal peripheral chemoreflex sensitivity and BRS in HFrEF. To date, few studies have addressed the effects of ExT on chemoreflex control, BRS, and cardiac autonomic control in HFpEF; however, there are some studies that have suggested that ExT has a beneficial effect on cardiac autonomic control. The beneficial effects of ExT on cardiac function and autonomic control in HF may have important implications for functional capacity in addition to their obvious importance to survival. Recent studies have suggested that the peripheral chemoreflex may also play an important role in attenuating exercise intolerance in HFrEF patients. The role of the central/peripheral chemoreflex, if any, in mediating exercise intolerance in HFpEF has not been investigated. The present review focuses on recent studies that address primary pathophysiological mechanisms of HF (HFrEF and HFpEF) and the potential avenues by which ExT exerts its beneficial effects.
KW - Autonomic control
KW - Chemoreflex drive
KW - Exercise training
KW - Heart failure
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U2 - 10.1152/ajpheart.00407.2017
DO - 10.1152/ajpheart.00407.2017
M3 - Review article
C2 - 29167119
AN - SCOPUS:85043783849
VL - 314
SP - H464-H474
JO - American Journal of Physiology - Renal Physiology
JF - American Journal of Physiology - Renal Physiology
SN - 0363-6127
IS - 3
ER -