Impact of multicomponent exercise training in older individuals with and without heart failure with reduced ejection fraction – the role of functional capacity and novel biomarkers

Background and aims Exercise training is recommended for patients with heart failure (HF), however its efficacy in older individuals (≥80 years) with HF is less clear. Methods From the cluster-randomised controlled Bestform-trial (NCT04207307) in older residents of senior care facilities the effects of 6-month multicomponent machine-based exercise training were assessed for those with and without HF. Functional capacity using the Short Physical Performance Battery (SPPB), Chair-Stand-Test (CST), handgrip strength, and 6-Minute-Walk-Test (6MWT) as well as inflammatory, catabolic and anabolic biomarkers were analysed pre- and post-training using linear mixed models. Results A total of 57 participants (mean 84.4±6.7 years) were included in the analysis, of whom 24 had HF. Baseline data revealed significantly lower 6MWT-distance (mean difference [MD] -71.3, 95%-confidence interval [95% CI] -119.5 to -23.2 m) and handgrip strength (MD -4.3, 95%CI -8.4 to -0.3 kg). Moreover, significantly higher GDF-15 concentrations were observed in participants with HF compared to No HF (MD 544.2, 95%CI: 39.1 to 1049.4 pg/mL). Post-training, SPPB (β=0.60, 95%CI 0.22 to 0.98), CST (β=0.37, 95%CI 0.15 to 0.58), and 6MWT-distance (β=15.22, 95%CI 3.47 to 26.97) significantly improved in the whole analysis population. Among biomarkers, TNF-α decreased significantly (β=-0.22, 95%CI -0.43 to -0.01), and P3NP declined (β=-0.23, 95%CI -0.38 to -0.08) with a Time×Group interaction (β=0.41, 95%CI 0.11 to 0.70) indicating a reduction only in the No HF-group. Conclusions Six months of multicomponent exercise training enhanced functional capacity and reduced circulating TNF-α in older individuals, irrespective of HF status, while P3NP declined only in those without HF.