Review
Systematic review of the effect of aerobic and resistance exercise training on systemic brain natriuretic peptide (BNP) and N-terminal BNP expression in heart failure patients

https://doi.org/10.1016/j.ijcard.2009.07.004Get rights and content

Abstract

Background

BNP and the N-terminal portion (NT-pro-BNP) have emerged as powerful tools in the diagnosis and prognosis of heart failure on acute presentation. The aim of this work was to systematically review the effect of exercise training on BNP and NT-pro-BNP levels in patients with left ventricular dysfunction.

Methods

A systematic search was conducted of Medline (Ovid) (1950–July 2008), Embase.com (1974–current), Cochrane Central Register of Controlled Trials, CINAHL (1981–current) and Web of Science (2000–current) to identify randomized controlled trials of aerobic and/or resistance exercise training in heart failure patients that measured BNP and/or pro-BNP. Primary outcome measures were changes in BNP and NT-pro-BNP. Secondary outcomes were changes in functional capacity and energy expenditure, measures of study quality were also recorded.

Results

Nine randomized controlled studies measuring BNP or NT-pro-BNP met our eligibility criteria. Exercise training had a favourable effect on BNP (mean difference − 79 pg/ml 95% C.I. − 141 to − 17 pg/ml, P = 0.01) and NT-pro-BNP (mean difference − 621 pg/ml, 95% C.I. − 844 to − 398 pg/ml, P = < 0.00001). Moreover the trials that showed a significant change in NT-pro-BNP all had a weekly exercise energy expenditure of more than 400 Kcal.

Conclusion

Data from nine published studies, suggest exercise training has a favorable effect on BNP and NT-pro-BNP in heart failure patients.

Section snippets

Exercise training/therapy and heart failure

Exercise therapy appears to provide a range of benefits to people with chronic heart failure (CHF), including reduced mortality and hospitalization [1], improved functional capacity [2], quality of life [3], cardiac [4] and blood vessel function [5]. Some evidence also exists for pro-inflammatory cytokine expression modulation [6]. Various methods of physical therapy have been utilized to improve the clinical status of heart failure patients. In addition to traditional aerobic or resistance

Search strategy

Potential studies were identified by a systematic review librarian (ST). The search was conducted of Medline (Ovid) (1950–July 2008), Embase.com (1974–current), Cochrane Central Register of Controlled Trials, CINAHL (1981–current) and Web of Science (2000–current). The search strategy included a mix of MeSH and free text terms for the key concepts heart failure, exercise training and brain natriuretic peptide and these were combined with a sensitive search strategy to identify randomized

Study characteristics

To date nine randomized, controlled studies meeting our eligibility criteria, with an aggregate number of 463 subjects (250 exercise participants and 213 controls) have been published [11], [14], [15], [16], [19], [20], [21], [22], [23]. One additional study, meeting eligibility criteria, was excluded as primary outcome data was unavailable [24]. Five studies measured BNP, six measured NT-pro-BNP and two studies measured both NT-pro and BNP. Exercise program and study participant

Analyses

Nine published studies, with an aggregate number of over 400 subjects have examined the effect of exercise training on BNP and NT-pro-BNP in heart failure patients. Analyses of the BNP and the N-terminal branch of BNP demonstrated overall reductions in these markers of heart failure severity following exercise training. Statistical significance of these changes remained after conducting sensitivity analyses.

Exercise program parameters

All but one study utilized cycling as the exercise mode at moderate (60–70% of peak VO2)

Acknowledgements

This study was funded by the Department of Health and Aging PHCRED program at Bond University. The authors would like to thank Sarah Thorning for conducting the literature search.

The authors would also like to acknowledge that this manuscript complies with the Principles of Ethical Publishing in the International Journal of Cardiology [28].

References (28)

  • R. Hambrecht et al.

    Correction of endothelial dysfunction in chronic heart failure: additional effects of exercise training and oral l-arginine supplementation

    J Am Coll Cardiol

    (2000)
  • S. Adamopoulos et al.

    Physical training modulates proinflammatory cytokines and the soluble Fas/soluble Fas ligand system in patients with chronic heart failure

    J Am Coll Cardiol

    (2002)
  • I.D. Laoutaris et al.

    Effects of inspiratory muscle training on autonomic activity, endothelial vasodilator function, and N-terminal pro-brain natriuretic peptide levels in chronic heart failure

    J Cardiopulm Rehabil Prev

    (2008)
  • T. Meyer et al.

    Can serum NT-proBNP detect changes of functional capacity in patients with chronic heart failure?

    Z Kardiol

    (2004)
  • Cited by (44)

    • Exercise for chronic heart failure

      2022, Exercise to Prevent and Manage Chronic Disease Across the Lifespan
    • The role of exercise training on cardiovascular peptides in patients with heart failure: A systematic review and meta-analysis

      2022, Current Research in Physiology
      Citation Excerpt :

      A number of studies have reported that aerobic exercise intervention (Fu et al., 2013; Yeh et al., 2004; Abolahrari-Shirazi et al., 2018; Giallauria et al., 2006-a; Giallauria et al., 2008; Maria-Sarullo et al., 2006; Masterson-Creber et al., 2015; Melo et al., 2019; Wisløff et al., 2007) and as well as concurrent or combined aerobic and resistance interventions (Abolahrari-Shirazi et al., 2018; Adamopoulos et al., 2014; Conraads et al., 2004) can reduce serum levels of BNP and NT-proBNP in patients with HF compared to the control group, while other studies have reported no change (Karavidas et al., 2008; Kawauchi et al., 2017; Kobayashi et al., 2003; Yeh et al., 2011; Ahmad et al., 2014; Aksoy et al., 2015; Eleuteri et al., 2013; Giallauria et al., 2006-b; Marco et al., 2013; Nilsson et al., 2010; Prescott et al., 2009; Sandri et al., 2012; Van Berendoncks et al., 2010). In this regard, there is the systematic review and meta-analysis-based evidence supporting a favorable effect in serum levels of BNP (Smart and Steele, 2010; Smart et al., 2012) and NT-proBNP (Smart and Steele, 2010; Smart et al., 2012; Pearson et al., 2018) in patients with HF. It seems that the roles of aerobic (Fu et al., 2013; Yeh et al., 2004; Abolahrari-Shirazi et al., 2018; Giallauria et al., 2006-a; Giallauria et al., 2008; Maria-Sarullo et al., 2006; Masterson-Creber et al., 2015; Wisløff et al., 2007), resistance (Karavidas et al., 2008) and/or concurrent (Abolahrari-Shirazi et al., 2018; Adamopoulos et al., 2014; Conraads et al., 2004) interventions on serum levels of BNP and NT-proBNP have contradictory results in HF patients compared to the control group.

    • Effect of exercise training on endothelial function in heart failure patients: A systematic review meta-analysis

      2017, International Journal of Cardiology
      Citation Excerpt :

      Exercise intolerance is a hallmark characteristic of HF, interfering with activities of daily living and consequently having a negative effect on a patient's quality of life [2]. Exercise training is now considered an effective adjunct treatment in heart failure and the consistent benefits of exercise training on a range of outcomes [3–8] have led to a class IA level recommendation in stable HF patients [1]. While the mechanisms underlying exercise intolerance are complex [2,9,10], they are generally considered multifactorial, of which endothelial dysfunction (ED) is one factor [9].

    View all citing articles on Scopus
    View full text