Effects of home-based exercise training on neurovascular control in patients with heart failure

Background: The effect of home-based exercise training on neurovascular control in heart failure patients is unknown. Aims: To test the hypothesis that home-based training would maintain the reduction in muscle sympathetic nerve activity (MSNA) and forearm vascular resistance (FVR) acquired after supervised training. Methods and results: Twenty-nine patients (54 +/- 1.9 years, EF < 40%) were randomised into two groups: untrained control (n = 12) and exercise trained (n = 17). Both groups underwent assessment of Quality of Life (QoL), MSNA, and forearm blood flow. The exercise group underwent a 4-month supervised training program followed by 4 months of home-based training. After the initial 4 months of training, patients in the exercise group showed a significant increase in peak VO2 and reduction in NISNA, compared to the untrained group, but this was not maintained during 4 months of home-based training. In contrast, the decrease in FVR (56 +/- 3 vs. 46 +/- 4 vs. 40 +/- 2 U, p =0.008) and the improvement in QOL that were achieved during supervised training were maintained during home-based training. Conclusions: Home-based training following supervised training is a safe strategy to maintain improvements in QoL and reduction in FVR in chronic heart failure patients, but is an inadequate strategy to maintain fitness as estimated by peak VO2 or reduction in neurchumoral activation. (c) 2006 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.