Aerobic Exercise and Pharmacological Therapies for Skeletal Myopathy in Heart Failure: Similarities and Differences

Figure 4

Similarities and differences between aerobic exercise training and neurohumoral blockade in heart failure-induced skeletal myopathy. Skeletal myopathy in heart failure plays a major role in exercise intolerance. Neurohumoral hyperactivity is associated with the pathogenesis of heart failure and also affects skeletal muscle by increasing inflammatory response and oxidative stress and decreasing muscle perfusion. In this perspective, neurohumoral blockade has an important indirect effect on attenuating skeletal myopathy by improving cardiac function and reducing neurohumoral hyperactivity (thick solid lines and ⊥). The efficacy of direct effects of β-blockade and renin angiotensin aldosterone system inhibition on skeletal muscle still need to be clarified, as exercise intolerance remains in heart failure patients (thin solid lines and ⊥), mainly the ones under β-blocker therapy (dashed lines and ⊥). In contrast, aerobic exercise training has been considered the most effective strategy to counteract skeletal myopathy and to improve exercise tolerance in heart failure. Therefore, combined neurohumoral inhibition and aerobic exercise training are of great clinical interest in heart failure therapy.