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.
RCT (n=64)
2:1
Does supervised endurance/resistance training improve peak Vo(2) in patients with heart failure with preserved ejection fraction?
Supervised exercise training significantly improves exercise capacity, diastolic function, and quality of life in patients with HFpEF.
Effect estimate: Mean benefit 3.3 ml/min/kg (95% CI 1.8 to 4.8)
p-value: p=<0.001
OBJECTIVES: We sought to determine whether structured exercise training (ET) improves maximal exercise capacity, left ventricular diastolic function, and quality of life (QoL) in patients with heart failure with preserved ejection fraction (HFpEF). BACKGROUND: Nearly one-half of patients with heart failure experience HFpEF, but effective therapeutic strategies are sparse. METHODS: A total of 64 patients (age 65 ± 7 years, 56% female) with HFpEF were prospectively randomized (2:1) to supervised endurance/resistance training in addition to usual care (ET, n = 44) or to usual care alone (UC) (n = 20). The primary endpoint was the change in peak Vo(2) after 3 months. Secondary endpoints included effects on cardiac structure, diastolic function, and QoL. RESULTS: Peak Vo(2) increased (16.1 ± 4.9 ml/min/kg to 18.7 ± 5.4 ml/min/kg; p < 0.001) with ET and remained unchanged (16.7 ± 4.7 ml/min/kg to 16.0 ± 6.0 ml/min/kg; p = NS) with UC. The mean benefit of ET was 3.3 ml/min/kg (95% confidence interval CI: 1.8 to 4.8, p < 0.001). E/e' (mean difference of changes: -3.2, 95% CI: -4.3 to -2.1, p < 0.001) and left atrial volume index (milliliters per square meter) decreased with ET and remained unchanged with UC (-4.0, 95% CI: -5.9 to -2.2, p < 0.001). The physical functioning score (36-Item Short-Form Health Survey) improved with ET and remained unchanged with UC (15, 95% CI: 7 to 24, p < 0.001). The ET-induced decrease of E/e' was associated with 38% gain in peak Vo(2) and 50% of the improvement in physical functioning score. CONCLUSIONS: Exercise training improves exercise capacity and physical dimensions of QoL in HFpEF. This benefit is associated with atrial reverse remodeling and improved left ventricular diastolic function. (Exercise Training in Diastolic Heart Failure-Pilot Study: A Prospective, Randomised, Controlled Study to Determine the Effects of Physical Training on Exercise Capacity and Quality of Life Ex-DHF-P; ISRCTN42524037).
“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.”
Edelmann et al. (Sat,) conducted a 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.