Browse > Article

The Effects of Exercise-based Cardiac Rehabilitation Phase II on Pro- and Anti-inflammatory Markers in Patients with Acute Coronary Syndrome  

Kim, Al-Chan (Divison of Sports Science, Baekseok University)
Oh, Jae-Keun (Department of Health and Exercise Science, Korea National Sport University)
Shin, Kyung-Ah (Department of Clinical Laboratory Science, Shinsung University)
Kim, Young-Joo (Department of Rehabilitation Medicine, Sanggye-Paik Hospital)
Publication Information
Biomedical Science Letters / v.19, no.1, 2013 , pp. 61-69 More about this Journal
Abstract
The aim of this study was to evaluate the effect of exercise-based cardiac rehabilitation on pro- and anti-inflammatory markers in patients with acute coronary syndrome (ACS). ACS patients who underwent percutaneous coronary intervention (PCI) and took medicine during phase II of rehabilitation were recruited for study. Subjects were divided into two groups; exercise group (EX, n=21) and a non-exercise group (non-EX, n=13). Supervised exercise program in hospital consisted of treadmill and bicycle exercise was performed three times per week for 6 weeks. Patients of EX received individual counseling, including knowledge of heart disease, risk factor modification, and physical training. Cardiopulmonary fitness, body composition, and biochemical blood factors were analyzed before and after experiment. There was no significant difference in serum levels of hs-CRP and TGF-${\beta}1$ between groups, and between time intervals. But there was a significant decrease in serum levels of IL-18 (P<.001). And there was a significant increase in ratio of IL-18 to IL-10 (P<.01) and serum levels of IL-10 (P<.001). After cardiac rehabilitation, there was significant increase in exercise duration (P<.001), maximal oxygen uptake ($VO_{2peak}$; P<.001) and decrease in submaximal rate-pressure product (sRPP; P<.05) in EX. In conclusion, exercise-based cardiac rehabilitation during phase II in patients with ACS after PCI decreased serum IL-18 (pro-inflammatory) content and ratio of IL-18 to IL-10 in serum (highly related with disease recurrence), and increased serum IL-10 (anti-inflammatory) content. In addition, it led to improved cardiopulmonary fitness.
Keywords
Cardiac rehabilitation program; Percutaneous coronary intervention (PCI); Pro-, Anti-inflammation; CRP; Interleukin-10; Interleukin-18; Transforming growth factor-${\beta}1$;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Wenger N, Froelicher E, Smith L, Philip A, Ades P, Berra K. Clinical Practice Guidelines No. 17: Cardiac Rehabilitation as Secondary Prevention. Rockville, Md: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, National Heart, Lung and Blood Institute; AHCPR Publication. 1995. 96-0672.
2 Weiss J, Cuff C, Berman J. TGF-b downmodulates cytokine induced monocyte chemoattractant protein (MCP)-1 expression in human endothelial cells. A putative role for TGF-b in the modulation of TNF receptor expression. Endothelium. 1999. 6: 291-302.   DOI
3 Whaley MH, Brubaker PH, Otto RM, Armstrong L, Balady GJ, Berry NJ. ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins. seventh edition. 2006.
4 Williams SG, Jackson M, Ng LL, Barker D, Patwala A, Tan LB. Exercise duration and peak systolic blood pressure are predictive of mortality in ambulatory patients with mildmoderate chronic heart failure. Cardiology. 2005. 104: 221-226.   DOI   ScienceOn
5 Mallat Z, Henry P, Fressonnet R, Alouani S, Scoazec A, Beaufils P, Chvatchko Y, Tedgui A. Increased plasma concentrations of interleukin-18 in acute coronary syndromes. Heart. 2002. 88: 467-469.   DOI
6 Packard RR, Libby P. Inflammation in atherosclerosis: from vascular biology to biomarker discovery and risk prediction. Clin Chem. 2008. 54: 24-38.
7 Petersen A, Pedersen B. The role of IL-6 in mediating the anti-imflammatory effects of exercise. J Physiology and Pharmacology 2006. 57: 43-51.
8 Pinderski Oslund LJ, Hedrick CC, Olvera T, Hagenbaugh A, Territo M, Berliner JA, Fyfe AI. Interleukin-10 blocks atherosclerotic events in vitro and in vivo. Arteriosclerosis Thrombosis and Vascular Biology 1999. 19: 2847-2853.   DOI   ScienceOn
9 Rankovic G, Milicic B, Savic T, Dindic B, Mancev Z, Pesic G. Effects of physical exercise on inflammatory parameters and risk for repeated acute coronary syndrome in patients with ischemic heart disease. Vojnosanit Pregl. 2009. 66: 44-48.   DOI
10 Ribeiro F, Alves AJ, Teixeira M, Miranda F, Azevedo C, Duarte JA, Oliveira J. Exercise training increases interleukin-10 after an acute myocardial infarction: a randomised clinical trial. Int J Sports Med. 2012. 33: 192-198.   DOI   ScienceOn
11 Ridker PM. High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation. 2001. 103: 1813-1818.   DOI   ScienceOn
12 Shephard RJ, Balady GJ. Exercise as cardiovascular therapy. Circulation. 1999. 99: 963-972.   DOI   ScienceOn
13 Smith DA, Irving SD, Sheldon J, Cole D, Kaski JC. Serum levels of the antiinflammatory cytokine interleukin-10 are decreased in patients with unstable angina. Circulation. 2001. 104: 756-761.   DOI   ScienceOn
14 Smith W, Noack L, Khew-Goodall Y, Isenmann S, Vadas M, Gamble J. Transforming growth factor-b1 inhibits the production of IL-8 and the transmigration of neutrophils through activated endothelium. J Immunol. 1996. 157: 360-368.
15 Stefan B, Laurence T, Christoph B, Dirk P, Francois C. Interleukin-18 Is a Strong Predictor of Cardiovascular Death in Stable and Unstable Angina. Circulation. 2002. 106: 24-30.   DOI   ScienceOn
16 Stewart K, Turner K, Bacher A, DeRegis J, Sung J, Tayback M, Ouyang P. Are fitness, activity, and fatness associated with health related quality of life and mood in older persons? J Cardiopulm Rehabil. 2003. 23: 115-121.   DOI   ScienceOn
17 Tedgui A, Mallat Z. Anti-inflammatory mechanisms in the vascular wall. Circulation Research. 2001. 88: 877-887.   DOI   ScienceOn
18 Tziakas DN, Chalikias GK, Kaski JC, Kekes A, Hatzinikolaou EI, Stakos DA, Tentes IK, Kortsaris AX, Hatseras DI. Inflammatory and anti-inflammatory variable clusters and risk prediction in acute coronary syndrome patients: a factor analysis approach. Atherosclerosis. 2007. 193: 196-203.   DOI
19 Cipollone F, Fazia M, Mincione G, Iezzi A, Pini B, Cuccurullo C, Ucchino S, Spigonardo F, Di Nisio M, Cuccurullo F, Mezzetti A, Porreca E. Increased Expression of Transforming Growth Factor-{beta}1 as a Stabilizing Factor in Human Atherosclerotic Plaques. Stroke. 2004. 35: 2253-2257.   DOI   ScienceOn
20 Gerdes N, Sukhova GK, Libby P, Reynolds RS, Young JL, Schonbeck U. Expression of interleukin (IL)-18 and functional IL-18 receptor on human vascular endothelial cells, smooth muscle cells, and macrophages: implications for atherogenesis. J Exp Med. 2002. 195: 245-257.   DOI
21 Goldhammer E, Tanchilevitch AM, aor I, Beniamini Y, Rosenschein U, Sagiv M. Exercise training modulates cytokines activity in coronary heart disease patients. Int J Cardiology. 2005. 100: 93-99.   DOI   ScienceOn
22 Grainger DJ, Kemp PR, Metcalfe JC, Liu AC, Lawn RM, Williams NR, Grace AA, Schofield PM, Chauhan A. The serum concentration of active transforming growth factor-beta is severely depressed in advanced atherosclerosis. Nat Med. 1995. 1: 74-79.   DOI   ScienceOn
23 Hasdai D, Scheinowitz H, Leinovitz E, Sclarovsky S, Eldar E, Barak V. Increased serum concentration of interleukin-$l{\beta}$ in patients with coronary artery disease. Heart. 1996. 76: 24-28.   DOI   ScienceOn
24 Heeschen C, Dimmeler S, Hamm CW, Fichtlscherer S, Boersma E, Simoons ML, Zeiher AM. CAPTURE Study Investigators. Serum level of the antiinflammatory cytokine interleukin-10 is an important prognostic determinant in patients with acute coronary syndromes. Circulation. 2003. 107: 2109-2114.   DOI   ScienceOn
25 Hering S, Jost C, Schulz H, Hellmich B, Schatz H, Pfeiffer H. Circulating transforming growth factor beta1 (TGFbeta1) is elevated by extensive exercise. Eur J Appl Physiol. 2002. 86: 406-410.   DOI
26 Karvonen MJ, Kentala E, Mustala O. The effect of training on heart rate: a longitudinal study. Ann Med Exp Biol Fenn. 1957. 35: 307-315.
27 Libby P. Atherosclerosis: the new view. Sci Am. 2002. 286: 46-55.
28 Kasapis C, Thompson PD. The effects of physical activity on serum C-reactive protein and inflammatory markers: a systematic review. J Am Coll Cardiol. 2005. 45: 1563-1569.   DOI   ScienceOn
29 Kohut ML, McCann DA, Russell DW, Konopka DN, Cunnick JE, Franke WD, Castillo MC, Reighard AE, Vanderah E. Aerobic exercise, but not flexibility / resistance exercise, reduces serum IL-18, CRP, and IL-6 independent of beta-blockers, BMI, and psychosocial factors in older adults. Brain Behav Immun. 2006. 20: 201-209.   DOI   ScienceOn
30 Leick L, Lindegaard B, Stensvold D, Plomgaard P, Saltin B, Pilegaard H. Adipose tissue interleukin-18 mRNA and plasma interleukin-18: effect of obesity and exercise. Obesity (Silver Spring). 2007. 15: 356-363.   DOI
31 Mallat Z, Besnard S, Duriez M, Deleuze V, Emmanuel F, Bureau MF, Soubrier F, Esposito B, Duez H, Fievet C, Staels B, Duverger N, Scherman D, Tedgui A. Protective role of interleukin-10 in atherosclerosis. Circulation Reserch. 1999. 85: 17-24.   DOI   ScienceOn
32 Mallat Z, Corbaz A, Scoazec A, Besnard S, Leseche G, Chvatchko Y, Tedgui AL. Expression of interleukin-18 in human atherosclerotic plaques and relation to plaque instability. Circulation. 2001. 104: 1598-1603.   DOI   ScienceOn
33 AACVPR (American Association of Cardiovascular and Pulmonary Rehabilitation). Guidelines for cardiac rehabilitation programs. 1995. 2nd ed. Champaign. IL: Human Kinetics. USA.
34 Ades PA, Balady GJ, Berra K. Transforming exercise-based cardiac rehabilitation programs into secondary prevention centers: a national imperative. J Cardiopulm Rehabil. 2001. 21: 263-272.   DOI   ScienceOn
35 Alam SE, Nasser SS, Fernainy KE, Habib AA, Badr KF. Cytokine imbalance in acute coronary syndrome. Curr Opin Pharmacol. 2004. 4: 166-170.   DOI   ScienceOn
36 Biasucci LM, Vitelli A, Liuzzo G, Altamura S, Caligiuri G, Monaco C, Rebuzzi AG, Ciliberto G, Maseri A. Elevated levels of interleukin-6 in unstable angina. Circulation. 1996. 94: 874-877.   DOI   ScienceOn
37 Andreotti F, Porto I, Crea F, Maseri A. Inflammatory gene polymorphisms and ischemic heart disease: review of population association studies. Heart. 2002. 87: 107-112.   DOI
38 Balady GJ, Ades PA, Comoss P, Limacher M, Pina IL, Southard D, Williams MA, Bazzarre T. Core components of cardiac rehabilitation/secondary prevention programs: A statement for healthcare professionals from the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation Writing Group. Circulation. 2000. 102: 1069-1073.   DOI   ScienceOn
39 Belardinelli R, Scocco V, Mazzanti M, Purcaro A. Effects of aerobic training in patients with moderate chronic heart failure. G Ital Cardiol. 1992. 22: 919-930.
40 Blankenberg S, Tiret L, Bickel C, Peetz D, Cambien F, Meyer J, Rupprecht HJ. Interleukin-18 is a strong predictor of cardiovascular death in stable and unstable angina. Circulation. 2002. 106: 24-30.   DOI   ScienceOn
41 Bruce RA, Kusumi F, Hosmer D. Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease. Am Heart J. 1973. 85: 546-562.   DOI   ScienceOn
42 Chalikias GK, Tziakas DN, Kaski JC, Hatzinikolaou EI, Stakos DA, Tentes IK, Kortsaris A, Hatseras DI. Interleukin-18: interleukin-10 ratio and in-hospital adverse events in patients with acute coronary syndrome. Atherosclerosis 2005. 182: 135-143.   DOI
43 Chalikias GK, Tziakas DN, Kaski JC, Hatzinikolaou EI, Stakos DA, Tentes IK, Kortsaris AX, Hatseras DI. Interleukin-18 / interleukin-10 ratio is an independent predictor of recurrent coronary events during a 1-year follow-up in patients with acute coronary syndrome. Int J Cardiology. 2007. 117: 333-339.   DOI   ScienceOn
44 Singh NN, Ramji DP. The role of transforming growth factor-b in atherosclerosis. Cytokine & Growth Factor Reviews 2006. 17: 487-499.   DOI   ScienceOn
45 Chen C, Manning A. TGF-b1, IL-10 and IL-4 differentially modulate the cytokine-induced expression of IL-6 and IL-8 in human endothelial cells. Cytokine 1996. 8: 58-65.   DOI   ScienceOn
46 de Vries JE. Immunosuppressive and anti-inflammatory properties of interleukin-10. Ann Med. 1995. 27: 537-541.   DOI   ScienceOn