12 weeks of high-intensity interval training or moderate continuous training did not significantly improve KCCQ overall summary scores compared to standard care in patients with HFrEF or HFpEF.
Meta-Analysis (n=391)
Does 12 weeks of supervised exercise training (HIIT or MCT) improve patient-reported outcomes compared to standard care in patients with HFrEF and HFpEF?
A 12-week supervised exercise training program (HIIT or MCT) did not significantly improve patient-reported quality of life scores compared to standard care in patients with HFrEF or HFpEF.
p-value: p=0.48
Abstract Background Exercise training in heart failure (HF) is recommended to enhance exercise capacity, improve quality of life (QoL) and reduce hospitalisations. High-intensity interval training (HIIT) and moderate continuous training (MCT) provide similar exercise capacity improvement, but impact on patient-reported outcomes remains insufficiently explored. We compared patient-reported outcomes following HIIT and MCT in patients with HF with reduced (HFrEF) and preserved (HFpEF) ejection fraction. Purpose This study investigated the effects of 12 weeks of supervised exercise training on Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. We hypothesised that both HIIT and MCT would improve KCCQ scores compared to usual care and explored differences according to ejection fraction and sex. Methods We performed a pooled analysis of two randomised controlled trials. SMARTEX-HF enrolled HFrEF-patients with left ventricular ejection fraction (LVEF) ≤35% on optimal HF therapy; OptimEx-CLIN included HFpEF-patients with LVEF ≥50% and elevated natriuretic peptides or diastolic dysfunction. Both trials compared HIIT, MCT and standard care. Patient-reported outcomes were assessed using KCCQ overall summary score (OSS) and individual domains. Changes from baseline to 3 months were analysed using linear mixed models for within- and between-group differences. Results In total, 391 patients were analysed (215 HFrEF, mean age 61 years, 19% female, mean LVEF 28%; and 176 HFpEF, mean age 70 years, 66% female, mean LVEF 62%). Among all patients, the KCCQ OSS had small nonsignificant increases in all 3 groups (MCT +4.7 ±12.3, HIIT +3.2 ±12.5, control +3.3 ±14.4, p-interaction=0.48). Improvements in physical limitations, self-efficacy and symptom frequency were observed across all groups. Only HIIT produced clinically meaningful gains in social limitation and symptom stability, whereas only MCT had a relevant improvement in quality of life and symptom burden. Patients with HFpEF had significantly higher KCCQ OSS but changes were not different between HF types (MCT +6.4 ±11.8, HIIT +3.4 ±14.0, control +6.7 ±15.3) than those with HFrEF (MCT +3.3 ±12.6, HIIT +3.1 ±11.5, control +0.9 ±13.2), p for EF group=0.03, p-interaction=0.38. Additionally, women had higher KCCQ OSS scores than men, but changes did not differ between sexes (women: MCT +6.1 ±11.6, HIIT +6.0 ±13.2, control +5.6 ±15.5; men: MCT+3.9 ±12.6, HIIT+1.3 ±11.6, control +1.9 ±13.5; p for sex=0.002, p-interaction=0.10). Conclusion Changes in patient-reported outcomes following exercise training were small in both HFrEF and HFpEF, and did not differ significantly from non-exercise controls. Higher KCCQ scores were observed in HFpEF and in women.
Delvaeye et al. (Mon,) conducted a meta-analysis in Heart failure with reduced and preserved ejection fraction (n=391). High-intensity interval training (HIIT) and moderate continuous training (MCT) vs. Standard care was evaluated on Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score (OSS) change from baseline to 3 months (p=0.48). 12 weeks of high-intensity interval training or moderate continuous training did not significantly improve KCCQ overall summary scores compared to standard care in patients with HFrEF or HFpEF.