Exercise training in patients with chronic heart failure improves endothelial function predominantly in the trained extremities

The present study investigates whether lower-limb dominant exercise training in patients with chronic heart failure (CHF) improves endothelial function primarily in the trained lower extremities or equally in the upper and lower extremities. Twenty-eight patients with CHF were randomized to the exercise or control group. The exercise group underwent cycle ergometer training for 3 months while controls continued an inactive sedentary lifestyle. Exercise capacity (6-min walk test) and flow-mediated vasodilation in the brachial and posterior tibial arteries were evaluated. After 3 months, walking performance increased only in the exercise group (488 +/- 16 to 501 +/- 14 m [control]; 497 +/- 23 to 567 +/- 39m [exercise, p < 0.05]). The flow-mediated vasodilation in the brachial arteries did not change in either group (4.2 +/- 0.5 to 4.5 +/- 0.4% [control]; 4.3 +/- 0.5 to 4.6 +/- 0.4% [exercise]) but that in the posterior tibial arteries increased only in the exercise group (4.1 +/- 0.5 to 4.1 +/- 0.3% [control]; 3.6 +/- 0.3 to 6.4 +/- 0.6% [exercise, p < 0.01]). Cycle ergometer training improved flow-mediated vasodilation in the trained lower limbs, but not in the untrained upper limbs. Exercise training appears to correct endothelial dysfunction predominantly by a local effect in the trained extremities.