Aerobic physical training improves skeletal muscle metabolism in heart failure patients

Abstract

Abstract Purpose To evaluate the efficiency of aerobic physical rehabilitation (PR), selected on the basis of lactate threshold achievement during cardiopulmonary exercising test (CPET), in heart failure patients with normal body mass index (BMI); to study metabolism changes in skeletal muscle fibers (MF) after PR. Methods 100 patients; heart failure with reduced ejection fraction (HFrEF), NYHA III, mean age 52±5.2 years, ejection fraction (EF) 27.3±4.2%, BMI 23.5±2.8 kg/m2. The original estimated CPET, exercise tolerance (ET), quality of life (QOL) and echocardiography (EchoCG). Effects of physical rehabilitation were estimated on the basis of peak oxygen uptake (VO2peak), EF, QOL and ET dynamics after 6 months of training. Shin muscle biopsy was performed at baseline and after 3–6 months of training programm. In muscle samples activity of lactate dehydrogenase (LDH), succinate dehydrogenase (SDG) and alkaline phosphatase (AP) was evaluated with plag-method. Data were statistically processed using software package Statistika, 9.0. Results After 6 months of physical training ET increased by 9.7±0.5 points and QOL improved by 24.8±3.5 points (p1,2 <0.05), EF increased by 10.5±2.3% and VO2 peak increased by 5.2±0.5 ml/min/kg (p3,4 <0.05). After 3–6 months of training AP activity increased by 24.2% (p<0.05). LDH activity in glycolytic MF decreased by 24.4%, in oxidative MF it decreased by only 6.0% (p1 <0.05, p2>0.05). SDG activity in glycolytic MF increased by 30% and in oxidative – by 20% (p1,2 <0.05). There was a positive relation between SDG activity and VO2 peak dynamics (r=0.6, p=0.04), increase in CPET parameters was associated with AP activity (r=0.5, p=0.05). Conclusion Aerobic physical training in stable HFrEF patients with normal BMI was effective in improving values of EF, VO2 peak, QOL and ET; Participating in the rehabilitation program decreased LDH activity in both oxidative and glycolytic muscle fibers; it also significantly increased AP activity and SDG activity in both oxidative and glycolytic MF. This may indicate a decrease in glycolytic metabolism activity and aerobic metabolism activation; The relation between the increase in exercise tolerance and endothelium condition marker (AP activity in muscle tissue), SDG activity and VO2 peak dynamics has been revealed. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): Project was partially funded by the Russian Science Foundation grant 16-15-1017