Aerobic training decreases B-type natriuretic peptide expression and adrenergic activation in patients with heart failure

J Am Coll Cardiol. 2006 May 2;47(9):1835-9. doi: 10.1016/j.jacc.2005.12.050. Epub 2006 Apr 19.


Objectives: We sought to evaluate the effect of physical training on neurohormonal activation in patients with heart failure (HF).

Background: Patients with HF benefit from physical training. Chronic neurohormonal activation has detrimental effects on ventricular remodeling and prognosis of patients with HF.

Methods: A total of 95 patients with HF were assigned randomly into two groups: 47 patients (group T) underwent a nine-month training program at 60% of the maximal oxygen uptake (VO2), whereas 48 patients did not (group C). The exercise load was adjusted during follow-up to achieve a progressive training effect. Plasma assay of B-type natriuretic peptide (BNP), amino-terminal pro-brain natriuretic peptide (NT-proBNP), norepinephrine, plasma renin activity, and aldosterone; quality-of-life questionnaire; echocardiogram; and cardiopulmonary stress test were performed upon enrollment and at the third and ninth month.

Results: A total of 85 patients completed the protocol (44 in group T, left ventricular ejection fraction [EF] 35 +/- 2%, mean +/- SEM; and 41 in group C, EF 32 +/- 2%, p = NS). At the ninth month, patients who underwent training showed an improvement in workload (+14%, p < 0.001), peak VO2 (+13%, p < 0.001), systolic function (EF +9%, p < 0.01), and quality of life. We noted that BNP, NT-proBNP, and norepinephrine values decreased after training (-34%, p < 0.01; -32%, p < 0.05; -26%, p < 0.01, respectively). Increase in peak VO2 with training correlated significantly with the decrease in both BNP/NT-proBNP level (p < 0.001 and p < 0.01, respectively). Patients who did not undergo training showed no changes.

Conclusions: Clinical benefits after physical training in patients with HF are associated with blunting of adrenergic overactivity and of natriuretic peptide overexpression.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aldosterone / blood
  • Echocardiography
  • Exercise Test
  • Exercise Therapy*
  • Exercise Tolerance
  • Female
  • Heart Failure / blood*
  • Heart Failure / diagnostic imaging
  • Heart Failure / physiopathology
  • Heart Failure / rehabilitation
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood*
  • Neurotransmitter Agents / blood*
  • Norepinephrine / blood
  • Peptide Fragments / blood
  • Quality of Life
  • Renin / blood
  • Stroke Volume
  • Sympathetic Nervous System / physiopathology


  • Neurotransmitter Agents
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Aldosterone
  • Renin
  • Norepinephrine