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

Figure 3

Effects of aerobic exercise training in counteracting heart failure-induced skeletal myopathy. Neurohumoral hyperactivity and reduced blood perfusion associated with heart failure contribute to skeletal myopathy, which is characterized by muscle prooxidant and inflammatory state associated with muscle contractile dysfunction and atrophy, exercise intolerance, and reduced quality of life. These responses are associated with impaired Ca²⁺ handling, reduced protein synthesis paralleled by increased proteolysis. Note that aerobic exercise training counteracts most of the features involved in skeletal myopathy (illustrated by filled arrows and ). ROS: reactive oxygen species, RYR: ryanodine receptor, DHPR: dihydropyridine receptor, and SERCA: sarcoplasmic reticulum Ca²⁺ ATPase.