Study of insulin resistance, TNF-α, total antioxidant capacity and lipid profile in patients with chronic heart failure under exercise.

Gluco-metabolic syndrome, oxidative stress and inflammation are common in chronic heart failure (CHF). Exercise training programmes are known to improve oxidative status, insulin sensitivity and endothelial function. In this study, the effects of walking on improving lipid and glucose metabolism in CHF patients, under statin treatment, were investigated. Fasting glucose, serum insulin, tumor necrosis factor-α (TNF-α), total antioxidant capacity (TAC), uric acid (UA), total cholesterol, triglycerides, high-density lipoproteins (HDL), direct low-density lipoproteins (LDL-dir), apolipoprotein-B, apolipoprotein-A1, and lipoprotein-a (Lp(a)) were monitored. Insulin resistance was depicted by fasting insulin resistance index (FIRI) (FIRI≥2.94±1.41). HDL significantly increased with walking and was positively correlated with the non-significant triglyceride decrease and significant Lp(a) decrease. Significant correlations were found in all CHF patients at baseline between FIRI and New York Heart Association (NYHA) functional class, ejection fraction, HDL, triglycerides and TNF-α. All non-diabetic CHF patients were characterized by insulin resistance. Serum insulin and fasting glucose significantly decreased with walking, while decrease in FIRI was positively associated with patients' adherence to the walking program. Elevated uric acid and TNF-α levels also significantly decreased. In conclusion, the present study demonstrated that moderate, unsupervised, everyday physical activity was able to ameliorate the lipid and glycemic profile of CHF patients, with simultaneous attenuation of inflammation and oxidative stress.