An Investigation of the Effects of Aerobic Exercise on Serum Brain Natriuretic Peptide and C-Reactive Protein in women with Cardiovascular Diseases

Document Type: Original Article


1 Sport Physiologist, Department of Physical Education and Sport Science, Science and Research Branch, Islamic Azad University, Shiraz, Iran.

2 Sport Physiologist& Nutritionist, Department of Physical Education and Sport Sciences, Shiraz branch, Islamic Azad University, Shiraz, Iran

3 Cardiologist, Department of cardiovascular disease, Shiraz University of Medical Sciences, Shiraz, Iran


Introduction: The aim of this study was to evaluate the effects of aerobic exercise on brain natriuretic peptide (BNP) and C-reactive protein (CRP) levels in women with cardiovascular diseases.
Materials and Methods: In this semi experimental study, thirty female patients with at least one coronary artery stenosis (more than70%) were chosen and divided into two groups of aerobic training (n=15) and control (n=15). Blood samples were obtained at the beginning and end of the study to measure brain natriuretic peptide (BNP) and C-reactive protein (CRP) levels. The aerobic group cycled on a stationary ergometer for three sessions per week (period of eight weeks). The control group did not receive any exercise. Each exercise session included a10-minute warm-up, a 15-minute or more aerobic training program and a 5-minute cool-down. In the warm-up and cool-down stages, running, walking and stretching activities were used. During the first week of training, subjects exercised for 15 minutes at 55-60% of their target heart rates. Each week, exercise duration extended by five minutes, while the intensity was unchanged.
Results: Results indicated that 8 weeks of aerobic training had a significant effect on decreasing the BNP and CRP levels in females with Cardiovascular Diseases (P=0.005 and P=0.017 , respectively). Moreover, a significant Difference was seen between the control and experimental groups in mean BNP and CRP values (P=0.0001 and P=0.001 respectively), while no significant difference were seen between the pre and post tests in the Control group for BNP (P=0.21) and CRP (P= 0.28). There were significant reduction in BNP (p
Conclusion: Aerobic exercise can attenuate BNP and CRP levels in females with cardiovascular diseases; hence it can be used as a part of treatment.


1. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation2002; 105(3): 310–315.

2. Ridker PM, Paynter NP, Rifai N, Gaziano JM, Cook NR: C-reactive protein and parental history improve global cardiovascular risk prediction: the Reynolds Risk Score for men. Circulation 2008;  118: 2243–2251.

3. Hall C. Essential biochemistry and physiology of (NT-pro) BNP. Eur J Heart Fail. 2004;  6: 257–260.

4. De Ferranti S, Rifai N. C-reactive protein and cardiovascular disease: a review of risk prediction and interventions.  Clin Chim Acta 2002; 317:1-15.

5. Church TS, Barlow CE, Earnest CP, Kampert JB, Priest EL, Blair SN. Associations between cardiorespiratory fitness and C-reactive protein in men.  Arterioscler Thromb Vasc Biol 2002; 22:1869-1876 .

6. Stewart LK, Flynn MG, Campbell WW, Craig BA, Robinson JP, Timmerman KL, et al.The Influence of exercise training on inflammatory cytokines and C reactive protein. Med Sci Sports Exerc 2007; 39: 1714-1719.

7. Martins RA, Neves AP, Coelho- Silva MJ, Verissimo MT, Teixeira AM. The effect of aerobic versus strength- based training on high- sensitivity C- reactive protein in older adults. Eur J Appl Physiol 2010; 110:161-9. doi: 10.1007/s00421-010-1488-5.

8. Ogawa K, Sanada K, Machida S, Okutsu M, Suzuki K. Resistance Exercise Training-Induced Muscle Hypertrophy Was Associated with Reduction of Inflammatory Markers in Elderly Women. Mediators Inflamm volume 2010, Article ID, 171023.  doi :10.1155/2010/171023.


9. Lakka TA, Lakka H-M, Rankinen T, Leon AS, Rao DC, Skinner JS, et al. Effect of Exercise Training On Plasma Levels of C- reactive protein in Healthy Adults: the Heritage Family Study.  Eur Heart J 2005; 26:2018-25.

10. Hagobian TA, Jacobs KA, Subudhi AW, Fattor JA, Rock PB, Muza SR, et al. Cytokine responses at high altitude: effects of exercise and antioxidants at 4300 m. Med Sci Sports Exerc2006; 38:276-85.

11. Nicklas BJ, Ambrosius W,  Messir SP, Miller GD, penninx BW, loeser RF et al. Diet- induced weignt loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial. Am J Clin Nutr 2004; 79:544-551.

12. Mattusch F, Duffax B, Heine O, Mertense I, Rost R. Reduction of the plasma concentration of the C reactive protein  following  nine month  of endurance training. Int J Sports Med. 2000; 21:21-4.

13. Olson TP, Dengel DR, Leon AS, Schmitz KH. Changes in inflammatory biomarkers following one- year of moderate resistance training in overweight women. Int J Obes 2007; 31:996-1003.

14. Gray SR, Baker G, Wright A, Fitzsimons CF, Mutrie N, Nimmo MA. The effect of a 12 week walking intervention on markers of insulin resistance and systemic inflammation. Prev Med 2009; 48:39-44. doi: 10.1016/j.ypmed.2008.10.013.

15. Hammet CJ, Prapavessis H, Baldi JC, Varo N, Schoenbeck U, Ameratunga R, et al. Effects of exercise Training on 5 in Flammatory Markers Associated with Cardiovascular Risk. Am Heart J 2006; 51 :367.e7-367.e16.

16. Nassis GP, Papantakou K, Skenderi K, Kavouras SA, Yannakoulia M, Chrousos GP, et al. Aerobic exercise training improves insulin sensivity without changes in body weight, body fat, adiponectin, and inflammatory markers in overweight and obese girls. Metabolism (clinical and experimental) 2005;  54:1472-1479.

17. Muntner P, Winston J, Uribarii J, Mann D, Fox CS. Overweight, Obesity, and elevated serum cystatin C levels in adults in the United States. Am J Med 2008;121:341-8. doi: 10.1016/j.amjmed.2008.01.003

18. Maria SF, Gristina T, Brusca I, Milia S, Raimondi R, Sajeva M, et al. Exercise capacity, gas exchange and N- terminal pro- brain natriuretic peptide levels in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 2006; 13:812-7.

19. Passino C, Severino S, Poletti R, Piepoli MF, Mammini C, Clerico A, et al. Aerobic training decreases B-type Natriuretic Peptide expression and adrenergic activation in patients with heart failure. J Am Coll Cardiol 2006; 47:1835-9.

20. Frassl W, Kowoll R, Katz  N, Speth M, Stangl  A, Brechtel L,  et al. Cardiac markers (BNP, NT- pro- BNP, Troponin I, Troponin T), in female amateur runners before and up until three days after a marathon. Clin Lab 2008; 54:81-7.

21. Frohlich J, Al- Sarraf A. Cardiovascular risk and atherosclerosis prevention. Cardiovasc Pathol 2013; 22:16-8. doi: 10.1016/j.carpath.2012.03.001.

22. Viviane M. Conraads, Paul Beckers, Johan Vaes, Manuella Martin, Viviane Van Hoof, et al.   Combined endurance/resistance training reduces NT-proBNP levels in patients with chronic heart failure. Eur Heart J 2004; 25:1797-805.

23. Bordbar S,  Babaee Bigi MA, Aslani A,  Rahimi E, Ahmadi N. Effect of endurance and strength exercise on release of brain natriuretic peptide. .  J Cardiovasc Dis Res 2012; 3:22-5. doi: 10.4103/0975-3583.91599.

24. Neilan TG, Januzzi JL, Lee- Lewandrowski E, Ton- Nu TT, Yoerger DM, et al. Myocardial Injury and Ventricular Dysfunction Related to Training Levels among None lite Participants in the Boston Marathon. Circulation  2006; 114:2325-33.

25.Vidotto C, Tschan H, Atamaniuk J, Pokan P, Bachi N, Muller MM. Responses of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTnI) to competitive endurance exercise in recreational athletes. Int J Sport Med 2005; 26:645-50.

26. Leers MP, Schepers R, Baumgarten R. Effect of a long a long-distance run on cardiac markers in healthy athletes. Clin Chem Lab Med 2006; 44:999-1003

27. Selvin E, Paynter NP, Erlinger TP. The Effect of Weight Loss on C - reactive protein. Arch Intern Med 2007; 167: 31-9.

28. Hamer M, Molloy GJ. Association of C-reactive protein and muscle strength in the English Longitudinal Study of Ageing. Age (Dordrecht) 2009; 31:171-7. doi: 10.1007/s11357-009-9097-0.

29. Kaptoge S, Di Angelantonio E, Lowe G, Pepys MB, Thompson SG, Collins R, Danesh J. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. The Lancet 2010; 375:132-40.

 30. Rawson ES, Freedson PS, Osganian ST, Matthews CE, Reed G, Ockene IS. Body mass index, but not physical activity, is associated with C-reactive protein. Med Sci Sports Exerc 2003; 35: 1160-1166.