Endurance exercise training significantly increased peak oxygen consumption compared to attention control (16.3 vs. 13.1 ml/kg/min; p=0.002) in elderly patients with stable compensated HFPEF.
RCT (n=40)
Does endurance exercise training improve peak oxygen consumption in elderly patients with stable compensated heart failure and preserved ejection fraction?
Endurance training improves exercise capacity in elderly patients with HFpEF primarily through peripheral mechanisms (increased peak arterial-venous oxygen difference) rather than central cardiac output improvements.
Absolute Event Rate: 16.3% vs 13.1%
p-value: p=0.002
Objective Evaluate the mechanism(s) for improved exercise capacity after endurance exercise training (ET) in elderly patients with heart failure and preserved ejection fraction (HFPEF). Background: Exercise intolerance, measured objectively by reduced peak oxygen consumption (VO2), is the primary chronic symptom in HFPEF and is improved by ET. However, the mechanism(s) are unknown. Methods Forty stable, compensated HFPEF outpatients (mean age 69 ± 6 yrs) were examined at baseline and after 4 months of ET (n=22) or attention control (n=18). VO2 and its determinants were assessed during rest and peak upright cycle exercise. Results Following ET, peak VO2 was higher than controls (16.3 ± 2.6 vs. 13.1 ± 3.4 ml/kg/min; p=0.002). This was associated with higher peak heart rate (139 ± 16 vs. 131 ± 20 beats/min; p=0.03), but no difference in peak end-diastolic volume (77 ± 18 vs. 77 ± 17 ml; p=0.51), stroke volume (48 ± 9 vs. 46 ± 9 ml; p=0.83), or cardiac output (6.6 ± 1.3 vs. 5.9 ± 1.5 L/min; p=0.32). However, estimated peak arterial-venous oxygen difference (A-VO2 Diff) was significantly higher in ET (19.8 ± 4.0 vs. 17.3 ± 3.7 ml/dl; p=0.03). The effect of ET on cardiac output was responsible for < 15% of the improvement in peak VO2. Conclusions In elderly stable compensated HFPEF patients, peak A-VO2 Diff was higher following ET and was the primary contributor to improved peak VO2. This suggests that peripheral mechanisms (improved microvascular and/or skeletal muscle function) contribute to the improved exercise capacity after ET in HFPEF.
Haykowsky et al. (Sun,) conducted a rct in Heart failure and preserved ejection fraction (HFPEF) (n=40). Endurance exercise training vs. Attention control was evaluated on Peak oxygen consumption (VO2) (p=0.002). Endurance exercise training significantly increased peak oxygen consumption compared to attention control (16.3 vs. 13.1 ml/kg/min; p=0.002) in elderly patients with stable compensated HFPEF.