Key result
Supervised aerobic and moderate-to-high intensity strength training improves peakVO2 by ~4.0 vs non-supervised recommendations.
Why the study?
The role of exercise training in improving chronotropic response and functional capacity in patients with heart failure with preserved ejection fraction and chronotropic incompetence remains uncertain.
Does supervised exercise training improve peak oxygen consumption in symptomatic patients with chronotropic incompetence and HFpEF?
RCT (n=80)
1:1:1:1
Does supervised exercise training improve peak oxygen consumption in symptomatic patients with chronotropic incompetence and HFpEF?
Effect estimate: Δ +4.0 (AT/HRT), Δ +3.6 (AT/LRT), Δ +2.9 (AT) (95% CI 2.9-5.1 (AT/HRT), 2.5-4.6 (AT/LRT), 1.9-4.0 (AT))
p-value: p=<0.001
Supervised exercise training, particularly aerobic combined with moderate-to-high intensity strength training, significantly improves exercise capacity, chronotropic response, and quality of life in patients with HFpEF and chronotropic incompetence.
Supervised combined training merits priority in symptomatic ChI HFpEF; extends RCT evidence for this phenotype.
AIMS: Chronotropic incompetence (ChI) in heart failure with preserved ejection fraction (HFpEF) is associated with a reduced exercise capacity. The role of exercise training in improving chronotropic response (ChR) and functional capacity in these patients remains uncertain. This study assessed the effects of four different exercise programmes on peak oxygen consumption (peakVO₂), Kansas City Cardiomyopathy Questionnaire (KCCQ) score, and ChR in patients with the ChI HFpEF phenotype. METHODS AND RESULTS: In this randomized clinical trial, 80 symptomatic (NYHA classes II-III/IV) patients with the ChI HFpEF phenotype were randomized (1:1:1:1) to one of four interventions: (i) a 12-week supervised aerobic training (AT) programme, (ii) AT with low-intensity strength training (AT/LRT), (iii) AT with moderate- to high-intensity strength training (AT/HRT), or (iv) non-supervised exercise recommendations (ER). The primary endpoint was the change in peakVO2 at 12 weeks. Secondary endpoints included changes in ChR and KCCQ. A linear regression model was used. The mean age of 80 participants was 75.1 ± 7.2 years, and 59.6% were women. Baseline values for peakVO2, chronotropic index, and KCCQ were 11.8 ± 2.6 mL/kg/min, 0.4 ± 0.2, and 63.5 ± 17.9, respectively, with no significant differences across arms. All supervised training programmes led to significant improvements in peakVO2 compared to ER: AT/HRT: Δ + 4.0 [95% confidence interval (CI): 2.9-5.1, P < 0.001], AT/LRT: Δ + 3.6 (95% CI: 2.5-4.6, P < 0.001), and AT: Δ + 2.9 (95% CI: 1.9-4.0, P < 0.001). AT/HRT was superior over AT alone: Δ + 1.1 (95% CI, 0.1-2.2, P = 0.046). Likewise, supervised exercise improved ChR and KCCQ without statistical differences between groups. CONCLUSION: Different supervised exercise training improved peakVO2, ChR, and KCCQ in patients with ChI HFpEF phenotype. REGISTRATION: ClinicalTrials.gov (NCT05649787).
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Palau et al. (2025) conducted an RCT in Chronotropic incompetence and heart failure with preserved ejection fraction (ChI HFpEF) (n=80). Supervised aerobic training (AT), AT with low-intensity strength training (AT/LRT), or AT with moderate- to high-intensity strength training (AT/HRT) vs. Non-supervised exercise recommendations (ER) was evaluated on Change in peakVO2 at 12 weeks (Δ +4.0 (AT/HRT), Δ +3.6 (AT/LRT), Δ +2.9 (AT), 95% CI 2.9-5.1 (AT/HRT), 2.5-4.6 (AT/LRT), 1.9-4.0 (AT), p=<0.001). Supervised exercise training, particularly aerobic with moderate-to-high intensity strength training, significantly improved peakVO2 compared to non-supervised recommendations (Δ +4.0; P<0.001).
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