Department of Physiology & Biophysics, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil.
Department of Biodynamics of Human Body Movement, School of Physical Education and Sport, University of Sao Paulo, Sao Paulo, Brazil.
Adv Exp Med Biol. 2017;999:181-206. doi: 10.1007/978-981-10-4307-9_11.
Heart Failure (HF), a common end point for many cardiovascular diseases, is a syndrome with a very poor prognosis. Although clinical trials in HF have achieved important outcomes in reducing mortality, little is known about functional mechanisms conditioning health improvement in HF patients. In parallel with clinical studies, basic science has been providing important discoveries to understand the mechanisms underlying the pathophysiology of HF, as well as to identify potential targets for the treatment of this syndrome. In spite of being the end-point of cardiovascular derangements caused by different etiologies, autonomic dysfunction, sympathetic hyperactivity, oxidative stress, inflammation and hormonal activation are common factors involved in the progression of this syndrome. Together these causal factors create a closed link between three important organs: brain, heart and the skeletal muscle. In the past few years, we and other groups have studied the beneficial effects of aerobic exercise training as a safe therapy to avoid the progression of HF. As summarized in this chapter, exercise training, a non-pharmacological tool without side effects, corrects most of the HF-induced neurohormonal and local dysfunctions within the brain, heart and skeletal muscles. These adaptive responses reverse oxidative stress, reduce inflammation, ameliorate neurohormonal control and improve both cardiovascular and skeletal muscle function, thus increasing the quality of life and reducing patients' morbimortality.
心力衰竭（HF）是许多心血管疾病的共同终点，是一种预后极差的综合征。尽管 HF 的临床试验在降低死亡率方面取得了重要成果，但对于改善 HF 患者健康状况的功能机制知之甚少。与临床研究并行的是，基础科学一直在提供重要的发现，以了解 HF 病理生理学的机制，并确定治疗这种综合征的潜在靶点。尽管自主神经功能障碍、交感神经活性亢进、氧化应激、炎症和激素激活是导致不同病因引起的心血管紊乱的共同因素，但它们是导致这种综合征进展的共同因素。这些因果因素共同构成了大脑、心脏和骨骼肌这三个重要器官之间的紧密联系。在过去的几年中，我们和其他小组研究了有氧运动训练作为一种安全疗法的有益效果，以避免 HF 的进展。如本章所述，运动训练是一种无副作用的非药物治疗方法，可以纠正大脑、心脏和骨骼肌中大多数由 HF 引起的神经激素和局部功能障碍。这些适应性反应可逆转氧化应激、减轻炎症、改善神经激素控制，并改善心血管和骨骼肌功能，从而提高生活质量并降低患者的发病率和死亡率。
