Heart Failure Reviews

, Volume 18, Issue 1, pp 65–77 | Cite as

Unraveling new mechanisms of exercise intolerance in chronic heart failure. Role of exercise training

  • Viviane M. ConraadsEmail author
  • Emeline M. Van Craenenbroeck
  • Catherine De Maeyer
  • An M. Van Berendoncks
  • Paul J. Beckers
  • Christiaan J. Vrints


Despite remarkable progress in the therapeutic approach of patients with chronic heart failure (CHF), exercise intolerance remains one of the hallmarks of the disease. During the past two decades, evidence has accumulated to underscore the key role of both endothelial dysfunction and skeletal muscle wasting in the process that gradually leads to physical incapacity. Whereas reverse ventricular remodeling has been attributed to aerobic exercise training, the vast majority of studies conducted in this specific patient population emphasize the reversal of peripheral abnormalities. In this review, we provide a general overview on underlying pathophysiological mechanisms. In addition, emphasis is put on recently identified pathways, which contribute to a deeper understanding of the main causes of exercise tolerance and the potential for reversal through exercise training. Recently, deficient bone marrow-related endothelial repair mechanisms have received considerable attention. Both acute exercise bouts, as well as exercise training, affect the mobilization of endothelial progenitor cells and their function. The observed changes following exercise training are believed to significantly contribute to improvement of peripheral endothelial function, as well as exercise capacity. With regard to skeletal muscle dysfunction and energy deprivation, adiponectin has been suggested to play a significant role. The demonstration of local skeletal muscle adiponectin resistance may provide an interesting and new link between the insulin resistant state and skeletal muscle wasting in CHF patients.


Chronic heart failure Exercise training Endothelial dysfunction Muscle wasting Endothelial progenitor cells Adiponectin 


Conflict of interest

Drs. C, VC, DM, VB, B and V have no conflicts of interest or financial ties to disclose in relation to this research paper.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Viviane M. Conraads
    • 1
    • 2
    Email author
  • Emeline M. Van Craenenbroeck
    • 1
    • 2
  • Catherine De Maeyer
    • 1
    • 2
  • An M. Van Berendoncks
    • 1
    • 2
  • Paul J. Beckers
    • 1
    • 2
  • Christiaan J. Vrints
    • 1
    • 2
  1. 1.Department of CardiologyAntwerp University HospitalEdegemBelgium
  2. 2.University of AntwerpAntwerpBelgium

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