Isolated Quadriceps Training Increases Maximal Exercise Capacity in Chronic Heart Failure

Esposito, Fabio; Reese, Van; Shabetai, Ralph; Wagner, Peter D.; Richardson, Russell S.

doi:10.1016/j.jacc.2011.06.025

Cited by 175Cardiovascular and exercise physiologyHeart Failure Treatment and ManagementSports Performance and Training

Isolated Quadriceps Training Increases Maximal Exercise Capacity in Chronic Heart Failure

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Esposito, Fabio, Reese, Van, Shabetai, Ralph, Wagner, Peter D., Richardson, Russell S.·2011·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2011.06.025PMC PMC3180857

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Abstract

Objectives This study sought to elucidate the mechanisms responsible for the benefits of small muscle mass exercise training in patients with chronic heart failure (CHF).Background How central cardiorespiratory and/or peripheral skeletal muscle factors are altered with small muscle mass training in CHF is unknown.Methods We studied muscle structure, and oxygen (O(2)) transport and metabolism at maximal cycle (whole-body) and knee-extensor exercise (KE) (small muscle mass) in 6 healthy controls and 6 patients with CHF who then performed 8 weeks of KE training (both legs, separately) and repeated these assessments.Results Pre-training cycling and KE peak leg O(2) uptake (Vo(2peak)) were ~17% and ~15% lower, respectively, in the patients compared with controls. Structurally, KE training increased quadriceps muscle capillarity and mitochondrial density by ~21% and ~25%, respectively. Functionally, despite not altering maximal cardiac output, KE training increased maximal O(2) delivery (~54%), arterial-venous O(2) difference (~10%), and muscle O(2) diffusive conductance (D(M)O(2)) (~39%) (assessed during KE), thereby increasing single-leg Vo(2peak) by ~53%, to a level exceeding that of the untrained controls. Post-training, during maximal cycling, O(2) delivery (~40%), arterial-venous O(2) difference (~15%), and D(M)O(2) (~52%) all increased, yielding an increase in Vo(2peak) of ~40%, matching the controls.Conclusions In the face of continued central limitations, clear improvements in muscle structure, peripheral convective and diffusive O(2) transport, and subsequently, O(2) utilization support the efficacy of local skeletal muscle training as a powerful approach to combat exercise intolerance in CHF.

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In both HFpEF and HFrEF, the peripheral contributions to improved peak VO2 with training appear to be attributable largely to improved skeletal muscle function.
“In both patients with HF with preserved ejection fraction and those with HFrEF, the peripheral contributions to improved peak V˙o2 with training appear to be attributable largely to improved skeletal muscle function (ie, increased percent skeletal muscle oxidative fibers, mitochondrial volume density, oxidative capacity, capillarity, and muscle blood flow).204–206”
From Prioritizing Functional Capacity as a Principal End Point for Therapies Oriented to Older Adults With Cardiovascular Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association (2017) · cites this paper as [205]

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Authors: Esposito, F., Reese, V., Shabetai, R., Wagner, P. D., & Richardson, R. S.
Affiliations: University of Milan (IT)
University of Utah (US)
University of California San Diego (US)
Corresponding author: Esposito, Fabio
ORCID: Esposito, Fabio
Reese, Van
Wagner, Peter D.
Richardson, Russell S.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2011-09
Volume: 58
Issue: 13
Pages: 1353-1362
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2011.06.025
PMC: PMC3180857
OpenAlex: W1948975945
Cited by: 175
References: 44
Citations by year: 2026: 13 · 2025: 6 · 2024: 10 · 2023: 11 · 2022: 15 · 2021: 18 · 2020: 13 · 2019: 17 · 2018: 11 · 2017: 13 · 2016: 13 · 2015: 12 · 2014: 9 · 2013: 6 · 2012: 7
FWCI: 19.65
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 684 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health, National Heart, Lung, and Blood Institute (HL 09183)
Tobacco-Related Disease Research Program (15RT-0100)
Topics: Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
Keywords: chronic heart failure, quadriceps, exercise capacity, oxygen transport, muscle capillarity, mitochondrial density, arteriovenous oxygen difference, exercise intolerance
MeSH terms: Biological Transport, Active, Biopsy, Blood Flow Velocity, Exercise Test, Follow-Up Studies, Cardiac Catheterization, Heart Failure, Humans, Male, Microscopy, Electron, Middle Aged, Mitochondria, Muscle, Oxygen, Oxygen Consumption, Severity of Illness Index, Stroke Volume, Exercise Tolerance, Disease Progression, Quadriceps Muscle

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Isolated Quadriceps Training Increases Maximal Exercise Capacity in Chronic Heart Failure

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