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Resistance Training Improves Vasoreactivity in End-Stage Heart Failure Patients on Inotropic Support.
MedLine Citation:
PMID:  21263349     Owner:  NLM     Status:  Publisher    
PURPOSE:: Peripheral vascular abnormalities contribute to compromised functional status in heart failure (HF) patients. The purpose of the present study was to test whether the intervention of moderate-intensity, resistance training could improve peripheral vascular responsiveness, that is, flow-mediated dilation (FMD) in HF. METHODS:: Baseline brachial artery FMD analysis (2 minutes of cuff occlusion and 5 minutes of reperfusion) was measured in HF patients on intravenous inotropic support (n = 9) awaiting cardiac transplantation. Unilateral, upper-body resistance exercises (moderate intensity, combination of isometric and isotonic exercises at 60%-80% of maximum) were performed 3 d/wk for 4 weeks. Follow-up FMD analysis was conducted after training. Central hemodynamics were defined via right-side-heart catheterization. RESULTS:: At baseline prior to training, HF patients elicited a significant hyperemic response 10 seconds following cuff occlusion (mean increase in blood flow: 194 ± 44 mL/min, P <.05). Despite this significant hyperemic response, HF patients demonstrated a mild, but paradoxical vasoconstriction of nearly 3% at 1-minute after cuff release. Four weeks of resistance training corrected the paradoxical vasoconstriction observed at baseline and resulted in vasodilatation (a positive increase in brachial artery diameter of 0.04 ± 0.04 mm, at 1 minute after cuff release; P <.05). Conversely, in a subset of 3 HF patients, studies in the untrained contralateral arm revealed no change in the FMD response. CONCLUSION:: Moderate-intensity upper-body resistance training improved brachial artery FMD in end-stage HF patients on inotropic support. The reversal of the paradoxical vasoconstrictive response to reactive hyperemia following 4 weeks of training may be secondary to local improvements in vascular endothelial function rather than a quantitative change in the reactive hyperemic stimulus.
Abigail S Dean; Joseph R Libonati; Deborah Madonna; Sarah J Ratcliffe; Kenneth B Margulies
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-21
Journal Detail:
Title:  The Journal of cardiovascular nursing     Volume:  -     ISSN:  1550-5049     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703516     Medline TA:  J Cardiovasc Nurs     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Abigail S. Dean, MEd, PhD Postdoctoral Fellow, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia. Joseph R. Libonati, PhD Assistant Professor, Biobehavioral and Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia. Deborah Madonna, BSN Coordinator, Cardiac Rehabilitation Cardiomyopathy and Transplant, Cardiovascular Research Center, Temple University School of Medicine, Philadelphia, Pennsylvania. Sarah J. Ratcliffe, PhD Assistant Professor of Biostatistics, Department of Biostatistics, University of Pennsylvania School of Medicine, Philadelphia. Kenneth B. Margulies, MD Professor of Medicine, Research and Fellowship Director Heart Failure and Transplant Program, Cardiovascular Institute, University of Pennsylvania School of Medicine, Philadelphia.
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