May 15, 2026Journal of the American College of Cardiology
Exercise Training Improves Exercise Capacity and Diastolic Function in Patients With Heart Failure With Preserved Ejection Fraction
Key result
Supervised exercise training improves peak VO2 by ~3.3 ml/min/kg vs usual care in HFpEF.
- Mean benefit 3.3 ml/min/kg
- 95% CI 1.8 to 4.8
- P<0.001
- n=64
Why the study?
Nearly one-half of patients with heart failure experience HFpEF, but effective therapeutic strategies remain sparse.
Does supervised endurance/resistance training improve peak Vo(2) in patients with heart failure with preserved ejection fraction?
Population
64 patients with HFpEF
Comparison
Supervised endurance/resistance training plus usual care vs usual care alone
Design
Prospective 2:1 randomized controlled trial
Follow-up
3 months
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
AGAndreas GevaertAssistant Professor, ESC Preventive Cardiology Section Secretary
“Almost 15 years ago, the Exercise in Diastolic Heart Failure (Ex-DHF) pilot study demonstrated in a group of 64 patients with heart failure and preserved ejection fraction (HFpEF) that 3 months of supervised endurance/resistance training improved peak oxygen uptake (VO2). The effect was quite impressive: peak VO2 increased with 2.6 mL/kg/min in patients randomized to training, while it reduced with -0.7 mL/kg/min in controls.”
“Exercising helps improve the heart's pumping ability, decreases blood vessel stiffness and improves the function and energy capacity of skeletal muscle. Exercise capacity is an independent, clinically meaningful patient outcome, and research has indicated that guided exercise therapy is actually more effective at improving quality of life for people who have HFpEF than most medications.”
Implication
Supports supervised exercise for functional gains in HFpEF; leaves open effects on clinical events in larger trials.
Key Points
- This study aims to evaluate the effects of structured exercise training on exercise capacity, diastolic function, and quality of life in patients with heart failure with preserved ejection fraction.
- Prospectively randomized 64 patients with heart failure with preserved ejection fraction to exercise training (ET, n = 44) or usual care (UC, n = 20).
- ET included supervised endurance/resistance training alongside usual care for 3 months.
- Primary endpoint involved measuring the change in peak Vo(2) after the intervention.
- Peak Vo(2) significantly increased from 16.1 ± 4.9 ml/min/kg to 18.7 ± 5.4 ml/min/kg in ET (p < 0.001).
- E/e' decreased by a mean of -3.2 with ET (95% CI: -4.3 to -2.1, p < 0.001), indicating improved diastolic function.
- Physical functioning score improved by 15 points in ET participants (95% CI: 7 to 24, p < 0.001).
Study Design
Type
RCT (n=64)
Randomization
2:1
Structured PICO
Does supervised endurance/resistance training improve peak Vo(2) in patients with heart failure with preserved ejection fraction?
P
Population
64 patients with heart failure with preserved ejection fraction (HFpEF), mean age 65 ± 7 years, 56% female.
I
Intervention
Supervised endurance/resistance training in addition to usual care for 3 months.
C
Comparator
Usual care alone.
O
Outcome
Change in peak Vo(2) after 3 months.surrogate
Main Result
Effect estimate: Mean benefit 3.3 ml/min/kg (95% CI 1.8 to 4.8)
p-value: p=<0.001
Supervised exercise training significantly improves exercise capacity, diastolic function, and quality of life in patients with HFpEF.
Cite This Study
Edelmann et al. (2011) conducted an RCT in heart failure with preserved ejection fraction (HFpEF) (n=64). supervised endurance/resistance training vs. usual care alone was evaluated on change in peak Vo(2) after 3 months (Mean benefit 3.3 ml/min/kg, 95% CI 1.8 to 4.8, p=<0.001). Supervised exercise training in patients with HFpEF significantly improved peak VO2 by a mean of 3.3 ml/min/kg (95% CI 1.8 to 4.8; p<0.001) compared to usual care at 3 months.