Invest Clin 65(4): 406 - 417, 2024 https://doi.org/10.54817/IC.v65n4a01

Corresponding author: Huamei Yang. Department of Cardiovascular, Lujiang County Hospital of Traditional Chine-

se Medicine, Hefei, China. E-mail: 13943475960@163.com

Rehabilitation training effect guided

by cardiopulmonary fitness assessment

on NT-proBNP levels in patients with

chronic heart failure.

Huamei Yang

Department of Cardiovascular, Lujiang County Hospital of Traditional Chinese Medicine,

Hefei, China.

Keywords: cardiopulmonary fitness assessment; cardiopulmonary function; chronic

heart failure; plasma N-terminal B-type pronatriuretic peptide; rehabilitation

training.

Abstract. This study explored the impact of rehabilitation training guided by

cardiopulmonary fitness assessment on NT-proBNP levels in patients with chronic

heart failure (CHF). It was conducted on 220 chronic heart failure (CHF) patients

from March 2020 to February 2022. They were divided into a control and observa-

tion group. The control group received routine nursing, while the an observation

group underwent rehabilitation guided by a cardiopulmonary fitness assessment.

Changes in NT-proBNP levels, vascular endothelial function, and cardiopulmo-

nary function were compared between the groups at admission, eight, and 12

weeks later. Upon admission, the two groups had no statistically significant dif-

ference in NT-proBNP levels (p>0.05). However, after eight and 12 weeks of inter-

vention, both groups showed decreased NT-proBNP levels, with the observation

group exhibiting significantly lower levels than the control group (p<0.05). Simi-

larly, there was no significant difference between the groups initially (p>0.05)

in endothelial function comparison. However, after eight and 12 weeks, ET-1 and

Ang-II levels decreased in both groups, with the observation group showing sig-

nificantly lower levels than the control group (p<0.05). In terms of cardiopulmo-

nary function, there was no significant difference initially. However, after eight

and 12 weeks, Peak VO2, VO2 AT, and maximum exercise power increased in both

groups compared to before the intervention, with the observation group showing

significantly higher values than the control group (p<0.05). Additionally, the

VE/VCO2 slope decreased in both groups post-intervention, with the observation

group having a lower slope than the control group (p<0.05). Cardiopulmonary

fitness-guided rehabilitation objectively evaluates patients, formulates precise

plans, reduces NT-proBNP levels and inflammation, improves vascular endothelial

function, and is vital in secondary chronic heart failure prevention.

Cardiopulmonary tness on patients with chronic heart failure 407

Vol. 65(4): 406 - 417, 2024

Efecto del entrenamiento de rehabilitación guiado por la

evaluación de la aptitud cardiorrespiratoria en los niveles

de NT-proBNP en pacientes con insuficiencia cardíaca crónica.

Invest Clin 2024; 65 (4): 406 – 417

Palabras clave: evaluación de la aptitud cardiorrespiratoria; función cardiorrespiratoria;

insuficiencia cardíaca crónica; péptido natriurético tipo B terminal

plasmático; entrenamiento de rehabilitación.

Resumen. Este estudio tuvo como objetivo explorar el impacto del entrena-

miento de rehabilitación guiado por la evaluación de la aptitud cardiorrespiratoria

en los niveles de NT-proBNP en pacientes con insuficiencia cardíaca crónica (ICC).

El estudio se llevó a cabo con 220 pacientes de ICC desde marzo de 2020 hasta

febrero de 2022. Estos se dividieron en un grupo de control y un grupo de obser-

vación. El grupo de control recibió cuidados rutinarios, mientras que el grupo de

observación se sometió a rehabilitación guiada por una evaluación de la aptitud car-

diorrespiratoria. Se compararon los cambios en los niveles de NT-proBNP, la función

endotelial vascular y la función cardiorrespiratoria entre los grupos al ingreso, a las

8 y a las 12 semanas. Al ingreso, no hubo diferencias estadísticamente significativas

en el nivel de NT-proBNP entre los dos grupos (p>0,05). Sin embargo, después de 8

y 12 semanas de intervención, ambos grupos mostraron niveles disminuidos de NT-

proBNP en comparación con antes de la intervención, con el grupo de observación

exhibiendo niveles significativamente más bajos que el grupo de control (p<0,05).

De manera similar, en la comparación de la función endotelial, no hubo diferencias

significativas entre los grupos inicialmente (p>0,05), pero después de 8 y 12 sema-

nas, los niveles tanto de ET-1 como de Ang-II disminuyeron en ambos grupos, con el

grupo de observación mostrando niveles significativamente menores que el grupo

de control (p<0,05). En términos de función cardiorrespiratoria, no hubo diferen-

cia significativa inicialmente, pero después de 8 y 12 semanas, el pico de VO2, VO2

AT y la potencia máxima de ejercicio aumentaron en ambos grupos en comparación

con antes de la intervención, con el grupo de observación mostrando valores signi-

ficativamente más altos que el grupo de control (p<0,05). Además, la pendiente

VE/VCO2 disminuyó en ambos grupos después de la intervención, con el grupo de

observación teniendo una pendiente más baja que el grupo de control (p<0,05). La

rehabilitación guiada por la aptitud cardiorrespiratoria evalúa objetivamente a los

pacientes, formula planes precisos, reduce los niveles de NT-proBNP y la inflama-

ción, mejora la función endotelial vascular y es vital en la prevención secundaria de

la insuficiencia cardíaca crónica.

Received: 10-12-2023 Accepted: 15-04-2024

INTRODUCTION

Chronic heart failure (CHF) is a series

of compensatory reactive diseases caused by

weakened myocardial contraction caused by

myocardial disease and the inability of car-

diac output to meet the metabolic needs of

the body 1, 2. The prevalence of CHF varies

globally, with an estimated 64 million people

affected worldwide 3. The condition is more

408 Yang

Investigación Clínica 65(4): 2024

common in older adults, with a higher preva-

lence in men than women 4.

Patients with CHF typically present

with signs and symptoms such as dyspnea,

fatigue, reduced exercise tolerance, and flu-

id retention, manifesting as pulmonary con-

gestion and peripheral edema. As the condi-

tion progresses, it can lead to a decline in

quality of life and functional capacity 1.

The diagnosis of CHF relies on a com-

bination of clinical assessment, biomarkers,

and imaging techniques 5. N-terminal pro-b-

type natriuretic peptide (NT-proBNP) is an

essential biomarker in the diagnosis and

management of CHF, reflecting the degree of

ventricular stress and providing prognostic

information 6, 7. Echocardiography remains

the primary imaging modality for assessing

cardiac function and structure 8.

Cardiopulmonary exercise testing

(CPET) is valuable in evaluating cardiopul-

monary fitness and functional capacity in

CHF patients. It assists in the precise assess-

ment of the severity of CHF, prognosis pre-

diction, and tailoring individualized treat-

ment strategies, including rehabilitation

programs 9. CPET measures various param-

eters, including oxygen consumption (VO2),

carbon dioxide production, and ventilatory

efficiency, providing a comprehensive evalu-

ation of the cardiovascular, pulmonary, and

muscular systems during exercises 10, 11.

Rehabilitation training in the context

of CHF has emerged as a necessary adjunc-

tive therapy to improve functional capacity

and quality of life, and potentially reduce

hospital readmission rates. Rehabilitation

programs are tailored to the individual and

often involve aerobic exercise, resistance

training, and respiratory exercises guided

by cardiopulmonary fitness assessments 12.

These assessments, which include cardio-

pulmonary exercise testing (CPET), provide

valuable information on the patient’s func-

tional limitations and responses to physical

stress 13.

A study by Bozkurt et al. showed that

cardiac rehabilitation (CR) is beneficial in

patients with HF and is recommended as a

Class 1A indication in HF practice guide-

lines 12 Another study conducted by Wang et

al. showed that CPET for patients with CHF

increases heart and lung function, improves

exercise endurance, decreases NT-proBNP

and hscTnT levels, and improves patients’

quality of life 14.

The necessity of conducting the pres-

ent study stems from the need to under-

stand better the relationship between reha-

bilitation training and NT-proBNP levels in

patients with CHF. Since few studies have

been conducted in this field, it is necessary

to conduct the present study to investigate

the effect of rehabilitation exercise guided

by assessment of cardiopulmonary fitness on

NT-proBNP levels in patients with CHF.

MATERIALS AND METHODS

General information

Two hundred twenty patients with CHF

treated in our hospital from March 2020

to February 2022 were chosen as samples.

The sample size calculation formula is

n1=n2=2[(μα+μβ) σ/δ]2, of which σ denotes

the overall standard deviation, δ is the mean

difference between the two samples, and

n1=n2 represents the sample size of the

control group (C) and the observation group

(O), respectively, α= 0.05, β= 0.10. Accord-

ing to the t-limit table, μα=1.96, μβ=1.28,

the sample size n1=n2=92 was calculated,

taking into account the 20% loss of follow-up

rate, and the required sample size was at least

(92+92)/(1+20%)≈220. Finally, the sample

size n1=n2=110 was determined. There

were no statistically significant differences

between the data in both groups of patients,

as shown in Table 1. This study obtained the

consent of patients and their families and was

approved by the Ethics Committee.

Inclusion and exclusion criteria

Inclusion criteria: ① Patients meeting

the relevant diagnostic criteria in the 2018

NICE Guidelines for the Diagnosis and Man-

Cardiopulmonary tness on patients with chronic heart failure 409

Vol. 65(4): 406 - 417, 2024

agement of Adult Chronic Heart Failure15;

② Patients showing fatigue dyspnea, up-

right breathing, anorexia, epigastrium pain,

pleural effusion or ascites in severe cases16;

③ New York Heart Association Cardiac

Function Classification I-II; ④ Patients with

stable condition for ≥ 1 month; ⑤ First on-

set; ⑥ Age from 30 to 85 years old.

Exclusion criteria: ① Patients having

myocardial infarction, hypertrophic obstruc-

tive cardiomyopathy, aortic valve stenosis and

acute myocarditis in recent three months;

② Patients with substantial lesions of essen-

tial organs, such as heart, lungs, and kidneys;

③ Patients with chronic obstructive pulmo-

nary disease or pulmonary heart disease;

④ Patients with intermittent claudication,

limb dysfunction, or inability to take care of

themselves; ⑤ Patients with malignant ar-

rhythmia and unstable angina pectoris; ⑥

Patients with electrolyte disorders; ⑦ Pa-

tients with a high degree of atrioventricular

block. The two groups of general data were

balanced with no statistically significant dif-

ference (p>0.05), as shown below.

Research method

Group C implemented routine nursing

measures: (1) Exercise: The amount of exer-

cise was determined based on the patient’s

heart function grading. It was generally rec-

ommended that patients with heart function

level II should appropriately limit physical ac-

tivity, not affect physical labor and household

chores, and increase nap time. Strict physi-

cal activity restrictions were required for pa-

tients with heart function level III. Patients

can get out of bed and move around, but gen-

eral physical labor was limited. (2) Diet: Low

salt and low-fat diet, with a sodium intake of

less than 2.5 g/d, and strict restrictions on

foods, such as sausages, canned goods, and

seafood. Patients with severe heart failure

had a daily fluid volume of 1.5-2.0 liters. (3)

Medication care: When patients take diuret-

ics, their blood potassium content should be

monitored to avoid hypokalemia. For digitalis

preparations, attention should be paid to ob-

serving the patient’s appetite, palpitations,

and vision. If the patient’s pulse was less than

60 beats per minute, administration was dis-

continued and reported to the doctor. Group

O implemented rehabilitation training under

the guidance of cardiopulmonary fitness as-

sessment with the following steps.

Cardiopulmonary fitness assessment

Cardiopulmonary function testing was

performed using the MasterScreen CPX pul-

monary function testing system (CEPT). The

first choice was to complete a full set of static

pulmonary function tests in the sitting posi-

tion, guide the patient to sit on the power

bike and record non-invasive blood, 12 lead

ECG, oxygen saturation, gas exchange, and

other indicators. Patients should rest for 3

Table 1

General information comparison.

Project Gender Age

(Years)

Left

ventricular

Ejection

Fraction (%)

Complications New York Heart

Function Classification

M F Hyperlipidemia Diabetes Hypertension III

Group C

(n=110)

61(55.45)

49(44.55)*

63.67±9.26**

42.79±2.09

26(23.64)

38(34.55)

46(41.82)

63(57.27)

47(42.73)

Group O

(n=110)

65(59.09)

45(40.91)*

62.95±8.55**

43.14±2.36

22(20.00)

43(39.09)

45(40.91)

68(61.82)

42(38.18)

χ2/t0.297 0.641 1.181 0.653 0.472

p#0.586 0.522 0.239 0.721 0.492

C: control group, O: observation group. Data are expressed as *frequency (%), ** mean ± SD: # p t-test (Indepen-

dent Samples t-test) and chi-square χ2.

410 Yang

Investigación Clínica 65(4): 2024

minutes first, then warm up without load at a

cycling rate of 60 r/min for 3 minutes. Based

on the patient’s gender, age, and functional

status, the bicycle power increase rate was set

to 20-30 W/min, so the patient could reach

the symptom-limiting maximum exercise tar-

get within 10 minutes. The patient’s maxi-

mum motor power and Peak VO2, VO2 AT,

maximum exercise time, and VE/VCO2 sleep

were recorded during the recovery period.

A high-load intensity exercise pre-

scription was accurately formulated based

on CEPT results: 50% power=[(anaerobic

threshold measurement power - power in-

crease rate) × 0.75)/2], and medical-grade

precision power waste trucks were selected

for training tools. (1) Stretching exercise:

The patient performed muscle stretching ex-

ercises before using the bike trainer. Neck

extension: Hands were placed on hips, waist

and back were straightened, and the head

was slightly extended upwards. Neck stretch-

ing left and right: Seated in a sitting posi-

tion, the patient’s head was tilted left and

right to the left, repeated 3 times. Baby

position: Assume a kneeling and standing

position with legs spread wider than shoul-

der-width apart, then sit the hips towards

the heels, lean the body forward, and touch

the ground with their upper limbs from the

front to the forehead. Maintain this stance

for five seconds and repeat the exercise five

times. Baby hugging posture: Patient sitting

position: Keep the waist and back straight,

stretch one thigh to the chest, keep the

knee level with the same elbow socket, and

the foot level with the opposite elbow sock-

et. Maintain this position for 10 seconds and

complete two sides into a group of 5 groups.

(2) Car riding exercise: Warm up without

power for 2 minutes, exercise for 30 minutes

at 50% power intensity, with a speed of 60

revolutions per minute. If the speed cannot

be maintained during the exercise, it is nec-

essary to reverse without power and rest for

1 minute before continuing the exercise. Af-

ter completing 30 minutes of exercise, enter

the recovery period and run the car without

power for 5 minutes. The exercise frequency

is 5d/week for 8 weeks (2 months).

Exercise precautions: During exercise,

relevant vital indicator monitoring instru-

ments were equipped, such as blood pressure,

heart rate, and pulse oxygen saturation.

Indication of exercise termination: ①

The target heart rate was achieved; ② Patients

having difficulty breathing, noticeable short-

ness of breath, pale complexion, as well as

damp and cold skin; ③ Patients having central

nervous system symptoms, such as dizziness,

sensory abnormalities, ataxia, and visual im-

pairments occur; ④ As the power increased,

blood pressure decreased by>10mmHg or

continuous baseline blood pressure or sys-

tolic blood pressure>220mmHg, diastolic

blood pressure>115mmHg; ⑤ Patients hav-

ing severe arrhythmia, persistent ventricular

tachycardia, and rapid atrial fibrillation; ⑥

Patients requested to stop exercising.

Outcome measures

NT-proBNP: 5mL of patients’ venous

blood was collected upon admission, and af-

ter 8 weeks and 12 weeks. After centrifuga-

tion, serum was stored at -80°C, and the NT-

proBNP level was determined by automatic

electrochemiluminescence immunoassay.

The reagent kits were all purchased from

Shanghai Zhenma Industrial Co., Ltd., and

the operation process was strictly carried

out following the instructions.

Vascular endothelial function: 10mL

of fasting venous blood was collected from

patients upon admission, 8 weeks later, and

12 weeks later. After centrifugation, the se-

rum was stored in a refrigerator at -80°C.

The serum levels of endothelin-1 (ET-1) and

angiopoietin-II (Ang-II) were measured us-

ing ELISA. The reagent kits were all pur-

chased from Shanghai Hengyuan Biotech-

nology Co., Ltd, and the operation process

followed the instructions.

Cardiopulmonary function: CPET was

conducted using the MasterScreen CPX pul-

monary function testing system produced by

company Yeger (German) upon admission, 8

Cardiopulmonary tness on patients with chronic heart failure 411

Vol. 65(4): 406 - 417, 2024

weeks later, and 12 weeks later. Basic patient

information was collected, and the patient

was asked to wear a mask after 5 minutes of

rest. The electrocardiogram lead wire and

electrode were connected, and the cuff was

tied. Then, the patient started the measure-

ment and the results were recorded. This in-

cluded 50% peak oxygen consumption (Peak

VO2), anaerobic threshold oxygen consump-

tion (VO2 AT), maximum exercise power, and

carbon dioxide ventilation equivalent slope

(VE/VCO2 slope) 17.

Statistical methods

EpiData software was applied to estab-

lish a database, and two people ensured the

accuracy of data input through parallel in-

put. The research collected data was statis-

tically analyzed using the IBM® SPSS soft-

ware (version 26.0), ±SD represents data,

and inter-group comparisons were conduct-

ed using sample t-tests. The counting data is

expressed as frequency or percentage, using

c2. Multiple data sets were analyzed using re-

peated variance measures, with p<0.05 indi-

cating statistical differences.

Ethical considerations

Ethical approval was obtained before

the commencement of the study. Informed

consent was obtained from all participants

before their inclusion in the study. The study

protocol ensured the privacy and confidenti-

ality of patient information. The study com-

plied with relevant data protection regula-

tions and the Declaration of Helsinki.

RESULTS

NT-proBNP comparison of two groups

Upon admission, there was no statisti-

cally significant difference in the levels of NT-

proBNP between the two groups (p>0.05).

After 8 and 12 weeks of intervention, the

levels of NT-proBNP in the two groups were

lower than those before the intervention,

and those of the observation group were low-

er than those of the control group (p<0.05)

(Table 2). The two groups’ change curves of

NT-proBNP levels showed a downward trend.

Endothelial function levels comparison

between the two groups of blood vessels

Upon admission, there was no statistically

significant difference in endothelial function lev-

els between the two groups (p>0.05). After 8 and

12 weeks of intervention, the levels of ET-1 and

Ang-II in both groups were lower than those be-

fore the intervention, and those of the observation

group were lower than those of the control group

(p<0.05) (Table 3). The levels of ET-1 and Ang-II

in the two groups showed a downward trend.

Cardiopulmonary function comparison

of the two groups

Upon admission, there was no statistically

significant difference in cardiopulmonary func-

tion between the two groups (p>0.05). After 8

and 12 weeks of intervention, peak VO2, VO2 AT,

and maximum exercise power in both groups

were higher than those before the intervention,

and those of the observation group were higher

than those of the control group (p<0.05) (Table

4). The VE/VCO2 slope in both groups was low-

Table 2

NT-proBNP Comparison of two groups.

Group NT-proBNP(ng/mL)

Upon admission 8 Weeks 12 Weeks

C* (n=110) 380.41±39.56** 357.31±41.74 316.15±38.63

O* (n=110) 383.49±42.07 322.65±38.96 292.51±35.34

t 0.559 6.389 4.736

p#0.577 <0.001 <0.001

N-terminal pro-b-type natriuretic peptide (NT-proBNP) *C: control group, O: observational group. **Mean±SD,

# p t-test (Independent Samples t Test).

412 Yang

Investigación Clínica 65(4): 2024

er than that before the intervention, and that of

the observation group was lower than that of the

control group (p<0.05) (Table 5). The peak VO2,

VO2 AT, and maximum exercise power of the two

groups showed an upward trend, while the VE/

VCO2 slope showed a downward trend.

DISCUSSION

NT-proBNP, as an important biochemi-

cal CHF marker, predicts CFH development

and progression and can accurately deter-

mine its severity 18. Results showed no sta-

Table 3

Endothelial function levels comparison

Group

ET-1 (ng/L)

Upon admission 8 Weeks 12 Weeks

C* (n=110) 23.82±4.07** 22.18±3.44 19.77±4.23

O* (n=110) 23.92±3.99 20.28±4.05 18.03±3.49

t0.184 3.750 3.328

pP#0.854 <0.001 0.001

Group Ang -II (ng/L)

Upon admission 8 Weeks 12 Weeks

C* (n=110) 109.70±12.24** 104.29±12.37 99.12±11.55

O* (n=110) 107.09±11.50 98.61±12.49 91.30±12.79

t1.630 3.389 4.759

p#0.105 0.001 <0.001

ET-1: endothelin-1 , Ang-II: angiotensin II *C: control group, O: observational group. **Mean±SD, # p t-test (Inde-

pendent Samples t Test).

Table 4

Cardiopulmonary function comparison of the two groups.

Group

Peak VO2[mL/(min·kg)]

Upon admission 8 Weeks 12 Weeks

C* (n=110) 17.24±1.34** 17.72±1.57 18.35±1.43

O* (n=110) 17.15±1.39 18.69±1.72 19.09±1.54

t0.489 4.369 3.691

p#0.625 0.001 <0.001

Group VO2 AT[mL/(min·kg)]

Upon admission 8 Weeks 12 Weeks

C* (n=110) 9.25±1.15** 9.90±1.37 10.47±1.49

O* (n=110) 9.45±1.47 10.47±1.25 11.09±1.68

t1.124 3.224 2.896

p#0.262 0.002 0.004

*C: control group, O: observational group. **Mean±SD, # p t-test (Independent Samples t Test).

Cardiopulmonary tness on patients with chronic heart failure 413

Vol. 65(4): 406 - 417, 2024

tistically significant difference in NT-proBNP

level upon admission (p>0.05). After 8 and

12 weeks of intervention, NT-proBNP levels

were lower than before and much lower in

Group O (p<0.05). The repeated analysis

of variance results showed group, time, and

interaction effects between the two groups

(p<0.05). Rehabilitation training guided by

cardiopulmonary fitness assessment reduces

NT-proBNP levels in CHF patients. The rea-

son is that as an essential part of secondary

prevention of heart failure, exercise rehabili-

tation is recommended as Class 1 in the man-

agement guidelines of the American Heart

Association and is valued by patients and cli-

nicians 19. High-intensity exercise is the core

of rehabilitation training, and exercise inten-

sity is related to patient safety and treatment

effects. The conventional exercise intensity

system is determined based on the patient’s

heart rate; however, currently, the commonly

used drugs in clinical practice for heart fail-

ure patients are β Receptor blockers. There-

fore, determining exercise intensity based on

heart rate poses significant safety risks, so it

is imperative to develop reasonable intensity

exercise rehabilitation training based on the

patient’s exercise endurance 20,21. After the

stimulation of the synthesis of brain natri-

uretic peptide precursor by myocardial cells,

the brain natriuretic peptide precursor pro-

tease decomposes into NT-proBNP and the

bioactive hormone brain natriuretic peptide,

which then enters the bloodstream, leading

to an increase in the content of NT-proBNP in

the blood. Rehabilitation training guided by

cardiopulmonary fitness assessment can in-

crease glucose oxidation, improve substrate

utilization and mitochondrial respiratory

oxidation ability, reduce oxidative stress, de-

lay myocardial fibrosis, stabilize myocardial

cell contraction rhythm, reduce myocardial

cell stimulation, and lower blood NT-proBNP

levels.

Results showed no statistically signifi-

cant difference in endothelial function level

upon admission (p>0.05). After 8 and 12

weeks of intervention, the ET-1 and Ang II

levels in both groups were lower than before

the intervention and much lower in Group

O (p<0.05). Repeated analysis of variance

results showed group, time, and interaction

effects between the two groups (p<0.05).

This is similar to the research results of Pa-

pathanasiou et al. 22,23. CHF may cause an in-

crease in the excitability of renin-angioten-

sin-aldosterone and the sympathetic nervous

system, stimulate inflammation and oxida-

Table 5

Cardiopulmonary function comparison of the two groups.

Group Maximum Motion Power

Upon admission 8 Weeks 12 Weeks

C* (n=110) 104.87±13.73** 108.84±13.49 112.64±12.92

O* (n=110) 103.83±13.26 113.94±12.19 120.34±12.28

t0.572 2.942 4.531

p#0.568 0.004 <0.001

Group VE/VCO2 slop (%)

Upon admission 8 Weeks 12 Weeks

C (n=110) 33.70±3.64** 31.23±3.53 30.32±3.37

O (n=110) 33.28±3.45 29.91±3.37 28.50±3.15

t0.878 2.837 4.138

p#0.381 0.005 <0.001

*C: control group, O: observational group. **Mean±SD, # p-value t test (Independent Samples t Test).

414 Yang

Investigación Clínica 65(4): 2024

tive stress reactions, and subsequently cause

dysfunction of vascular endothelial function.

Meanwhile, vascular endothelial dysfunction

can lead to increased cardiac load, myocar-

dial ischemia exacerbation, and vicious cycle

formation 24,25. ET-1 is mainly synthesized and

secreted by endothelial cells. When myocardi-

al cells are damaged, endothelial cells accel-

erate the synthesis of a large amount of ET-1.

This may be related to the fact that rehabili-

tation training guided by cardiopulmonary

fitness assessment can reduce the concentra-

tion of catecholamines in the blood, reduce

the stimulation of inflammatory and oxidative

stress reactions on vascular endothelium, and

protect vascular endothelial function 26,27.

The research results also showed no sta-

tistically significant difference in cardiopul-

monary function upon admission (p>0.05).

After 8 and 12 weeks of intervention, Peak VO2,

VO2 AT, and maximum exercise power in both

groups were higher than before and much high-

er in Group O (p<0.05). The VE/VCO2 slope

was lower than before the intervention and

much lower in Group O (p<0.05). Repeated

analysis of variance results showed group, time,

and interaction effects between the two groups

(p<0.05). This is similar to the research re-

sults of Turri Silva and others 28. Rehabilitation

training guided by cardiopulmonary fitness as-

sessment can help improve the cardiovascular

function of CHF patients. CPET can accurately

evaluate the exercise ability of subjects, objec-

tively evaluate their exercise endurance and

cardiac reserve function, and provide a reliable

basis for developing rehabilitation training

for heart failure patients. CPET evaluated this

study, and a 50% anaerobic threshold exercise

intensity was selected to avoid lactic acid ac-

cumulation caused by prolonged aerobic me-

tabolism and systemic muscle soreness. Mod-

erate and mild exercise can inhibit excessive

vasoconstriction, improve the elastic reserve

capacity of blood vessels, regulate myocardial

metabolism, improve cardiac contractile func-

tion, and improve cardiopulmonary function.

In conclusion, the findings of this study

demonstrate significant improvements in

NT-proBNP levels, endothelial function, and

cardiopulmonary function. The results re-

vealed a notable decrease in NT-proBNP lev-

els after 8 and 12 weeks of intervention, par-

ticularly in the observation group, indicating

the effectiveness of rehabilitation training in

reducing NT-proBNP levels in CHF patients.

Furthermore, improvements in endothelial

function, as evidenced by lower levels of ET-1

and Ang II after the intervention period,

suggest that rehabilitation training guided

by cardiopulmonary fitness assessment can

mitigate vascular endothelial dysfunction

associated with CHF. Additionally, enhance-

ments in cardiopulmonary function, includ-

ing increased Peak VO2, VO2 AT, maximum

exercise power, and decreased VE/VCO2

slope, highlight the positive impact of this

intervention on cardiovascular function.

These results underscore the importance

of tailored rehabilitation programs based

on cardiopulmonary fitness assessment for

improving outcomes in CHF patients by en-

hancing NT-proBNP levels, endothelial func-

tion, and cardiopulmonary performance.

Limitations

The study encountered several limita-

tions. Firstly, the sample size of 220 patients

may not adequately represent the general

population, potentially limiting the robust-

ness of the results. Secondly, including pa-

tients with chronic heart failure could in-

troduce selection bias, thus challenging the

study’s applicability to the broader popula-

tion. Additionally, 8 to 12 weeks might not

have been sufficiently long to observe sig-

nificant changes in specific outcomes. Fi-

nally, the study focused on NT-proBNP levels,

endothelial function, and cardiopulmonary

function, but other relevant outcomes could

have been included to provide a more com-

prehensive understanding of the effects of

the intervention.

ACKNOWLEDGMENTS

None.

Cardiopulmonary tness on patients with chronic heart failure 415

Vol. 65(4): 406 - 417, 2024

Authors’ ORCID number

• Huamei Yang: 0009-0000-3737-8419

Contributions of authors

The author was involved in data collec-

tion, article design, interpretation of results,

review, and manuscript preparation.

Conflict of competence

The author declares no conflict of interest.

Funding

None.

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