The Effect of Aerobic Exercise on N-terminal pro B-type Natriuretic Peptide Expression and Cardiopulmonary Function in Patients with Chronic Heart Failure

Author : R. Maulana, A. Santoso, F. Alzahra’, M. F. Adda’i, V. B. Kusmanto
Upload Date : 19-04-2018

Background: Aerobic exercise reduces all-cause mortality and improves cardiovascular fitness in patients with chronic heart failure (CHF). NT-proBNP is the strongest predictors of morbidity and mortality in CHF. However, there were still limited evidence regarding the relationship between aerobic exercise and NT-proBNP, hence the more robust and larger evidence is really needed. This study aimed to investigate the impact of aerobic exercise on NT-proBNP levels and cardiopulmonary function in CHF patients.

Methods: Databases (EMBASE, PUBMED, Science Direct, Cochrane, Clinical Key, EBSCO, Springer, Scopus and ProQuest) were systematically searched for randomized controlled trials, which assess association of aerobic exercise intervention with NT-proBNP and cardiopulmonary function (VE/VCO2 slope, Peak VO2, maximal workload, and left ventricular ejection fraction (LVEF)) in chronic heart failure (CHF) patients. The databases were searched with predefined protocol regardless publication time and language restriction based on PRISMA guideline. Analysis was performed in RevMan 5.3 (fixed-effects and random-effects model based on heterogeneity test) to provide pooled measures for weighted mean differences (WMD) and 95% confidence interval (95% CIs).

Results: Eight randomized trials were enrolled including 229 cases and 197 controls. Aerobic exercise was statistically significant in lowering NT-proBNP (pg/ml) compared with control group (WMD = –463.87, 95%CI –675.17 to –252.57, p<0.0001, I2 = 96%). VE/VCO2 slope was also significantly reduced after aerobic exercise (WMD = –0.74, 95%CI –1.06 to –0.42, p<0.00001, I2 = 98%). Peak VO2 (ml/kg/min) was improved after aerobic exercise (WMD = 3.22, 95%CI 2.89 to 3.55, p<0.00001, I2 = 14%). Maximal workload (watt) of CHF patient was also increased following aerobic exercise (WMD = 22.88, 95%CI 18.57 to 27.19, p<0.00001, I2 = 76%). Furthermore, there is a significant improvement of LVEF (%), which evaluated by echocardiography in aerobic exercise group (WMD = 3.19, 95%CI 1.46 to 4.92, p=0.0003, I2 = 71%).

Conclusions: CHF patients who underwent aerobic exercise have significantly improved NT-proBNP levels, exercise capacity, and ventricular function. However, further studies including wider type of cardiopulmonary patients population is still needed in the future.

KEYWORDS : aerobic exercise, heart failure, NT-proBNP, VE/VCO2 slope, peak VO2 , maximal workload, LVEF

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