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Chronic vascular inflammation may trigger ischemic events whereas regular physical exercise training (ET) has shown to be cardioprotective in patients with coronary artery disease (CAD). We investigated the impact of 2 years regular ET versus percutaneous intervention (PCI) on chronic inflammation and cardiovascular events.A total of 101 male patients with stable CAD and an indication for revascularization were prospectively randomized to regular ET (n=51) or PCI with stentimplantation (n=50). High-sensitive C-reactive protein and interleukin-6, exercise capacity and ischemic endpoints were analyzed at baseline and after 2 years. At 2 years maximal oxygen consumption (VO2 max) increased by 10% in the ET group (23.3+/-0.6 to 25.7+/-1.0 ml O2/kg/min; P=0.0171 versus baseline) versus 7% in the PCI group (22.3+/-0.8 to 23.9+/-1.2 ml O2/kg/min; P=0.4248). In a subgroup of patients, high-sensitive C-reactive protein levels and interleukin-6 levels were significantly reduced after ET by 41 and 18%, respectively, whereas no relevant changes were observed in the PCI group. Event-free survival rates after 24 months were 78% (ET) versus 62% (PCI) (P=0.039).In patients with stable coronary artery disease, regular physical exercise is associated with a reduction of inflammatory markers and ischemic events.

Background Chronic heart failure (CHF) is associated with progressive muscle atrophy and reduced local expression of insulin-like growth factor I (IGF-I). Design The present study was designed to test the hypothesis that the local deficiency of IGF-I in the skeletal muscle of patients with CHF would respond to a 6-months aerobic training intervention. Therefore, 18 patients [mean age 52.4 (SD 4.8) years, left ventricular ejection function (LVEF) 27 (SD 6)%] were prospectively randomized to either 6 months of training or sedentary lifestyle. Methods Serum levels of growth hormone (GH) were measured by immunofluorometric assay, IGF-I by competitive solid phase immunoassay. IGF-I expression was assessed in vastus lateralis biopsies by real-time PCR. Results Exercise training led to a significant increase in peak oxygen uptake by 26% [from 20.3 (SD 3.3) ml/kg per min to 25.5 (SD 5.7) ml/kg per min, P=0.003 versus control]. Local expression of IGF-I increased significantly after exercise training by 81% [from 6.3 (SE 0.8) to 11.4 (SE 1.4) relative units, P=0.007 versus control] while IGF-I receptor expression was reduced by 33% [from 20.0 (SE 2.1) to 13.8 (SE 1.7) relative units, P=0.008 versus control]. Serum growth hormone (GH) rose modestly from 0.12 (SE 0.07) to 0.65 (SE 0.37) ng/ml in the training group ( P=0.043 versus baseline), however, this change was not significant compared to the control group ( P=0.848). IGF-I serum levels remained virtually unchanged. Conclusions Exercise training improves local IGF-I expression without significant changes of systemic parameters of the GH/IGF-I axis. These findings indicate that exercise training has the therapeutic potential to attenuate peripheral skeletal muscle alterations in particular with respect to local IGF-I expression in patients with moderate CHF.

Exercise intolerance and early muscle fatigue are key symptoms in patients with chronic heart failure (CHF). In advanced stages of the disease, profound metabolic abnormalities have been described finally leading to a catabolic state with progressive loss of muscle bulk. The aim of this study was to investigate morphological, functional and electromyographical parameters of the skeletal muscle in CHF.We included 17 patients with CHF and 12 age-matched healthy controls (left ventricular ejection fraction 25+/-2 versus 68+/-1%, body mass index 26.6+/-0.8 versus 28.0+/-1.0 kg/m2; P=NS) in this study. Cross-sectional area (CSA) of the thigh was assessed by computed tomography. Under electromyographical control, maximal and submaximal (30%) isometric strength as well as the relative decrease of muscle strength of the quadriceps muscle over a period of 20 s were determined.Patients with CHF showed a significant reduction of muscle CSA (134.8+/-5.3 versus 165.2+/-7.4 cm2, P=0.002) as compared with healthy controls. The maximal quadriceps muscle strength was found to be significantly reduced in patients with CHF (226.7+/-22.3 versus 286.9+/-17.1 N, P0.05) who also exhibited a higher extent of muscular fatigability (-2.18+/-0.33 versus -0.54+/-0.20 N/s, P0.01). Electromyographic activity at 30% submaximal contraction showed a lower increase in patients with CHF (66+/-22 versus 114+/-36%; P0.05) indicating impaired muscle fibre recruitment. Furthermore, a significant correlation between muscular fatigability and reduced electromyographic activity was found in CHF (r=0.84; P0.001).Our findings demonstrate an impaired electromyographic activity and muscular function in patients with CHF suggesting a new pathomechanism contributing to functional abnormalities of the skeletal muscle in advanced stages of this disease.