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Impact of short-term physical training on functional capacity, natriuretic peptids and endothelin in heart failure patients with diabetes mellitus
1University of Nis, Medical Faculty, Institute of Cardiology Niska Banja - Nis - Serbia
European Journal of Heart Failure
The positive effects of physical training in patients (pts) with chronic heart failure (CHF) are reflected in improving exercise tolerance, reduce symptoms and less hospitalization, increasing survival and improving quality of life. It has been confirmed that CHF is 2-3 times higher in patients with diabetes mellitus (DM), than for those who do not have DM. Aim: To evaluate the effects of short-term physical training on physical exercise tolerance and level of markers of neuro-humoral activation and endothelial function, in CHF pts with diabetes mellitus type 2. Patients and method: The study involved 20 pts (14 males), mean age 62.3 ± 5.7 years, mean EF 36.75 ± 3.34%, NYHA II and III, with DM type 2, and 32 compatible non-diabetic pts with CHF who were assigned to a control group. The mean duration of DM in study group was 10.2 ± 3.6 years. All patients were included in three-week rehabilitation program at the residential center, based on strictly controlled and individually prescribed physical training. Before and after rehabilitation, all patients were underwent exercise stress test, and from the veins blood samples, biochemical parameters, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) an endothelin (ET) were determined. Results: At the end of rehabilitation, the concentration of neuropeptides, ANP and BNP, were significantly higher compared to the baseline values, in both groups, in a group of diabetics pts and in non-diabetic group, also. (ANP p = 0.018; BNP p = 0.042). In the group of diabetic pts, there was significantly higher value of BNP compared to the control group after rehabilitation (p = 0.032), while there was no significant difference in the values of ANP (ns), between two groups. In contrast, the concentration of ET, after rehabilitation was lower in both groups, but the statistically significance was only in the group of diabetic pts (p = 0.035). In both groups, exercise tolerance was improved (p<0.005) as well as quality of life assessed by Minnesota Living With Heart Failure Questionnaire (p<0.005). Conclusion: Opposite to long, short-term exercise training induced transitory increase of ANP and BNP, and decrease of endothelin in diabetic CHF pts after cardiac rehabilitation. These effects are associated with improvement of exercise tolerance and quality of life.
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