BACKGROUND: BNP and the N-terminal portion (NT-pro-BNP) have emerged as powerful tools in the diagnosis and prognosis of heart failure on acute presentation. The aim of this work was to systematically review the effect of exercise training on BNP and NT-pro-BNP levels in patients with left ventricular dysfunction. METHODS: A systematic search was conducted of Medline (Ovid) (1950 to July 2008), Embase.com (1974 to current), Cochrane Central Register of Controlled Trials, CINAHL (1981 to current) and Web of Science (2000 to current) to identify randomized controlled trials of aerobic and/or resistance exercise training in heart failure patients that measured BNP and/or pro-BNP. Primary outcome measures were changes in BNP and NT-pro-BNP. Secondary outcomes were changes in functional capacity and energy expenditure, measures of study quality were also recorded. RESULTS: Nine randomized controlled studies measuring BNP or NT-pro-BNP met our eligibility criteria. Exercise training had a favourable effect on BNP (mean difference -79 pg/ml 95% CI -141 to -17 pg/ml, p = 0.01) and NT-pro-BNP (mean difference -621 pg/ml, 95% CI -844 to -398 pg/ml, p <= 0.00001). Moreover the trials that showed a significant change in NT-pro-BNP all had a weekly exercise energy expenditure of more than 400 Kcal. CONCLUSION: Data from nine published studies, suggest exercise training has a favorable effect on BNP and NT-pro-BNP in heart failure patients.

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