Clinical Research
Heart Failure
Exercise Training Improves Exercise Capacity and Diastolic Function in Patients With Heart Failure With Preserved Ejection Fraction: Results of the Ex-DHF (Exercise training in Diastolic Heart Failure) Pilot Study

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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 Vo2 after 3 months. Secondary endpoints included effects on cardiac structure, diastolic function, and QoL.

Results

Peak Vo2 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 Vo2 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)

Key Words

diastolic dysfunction
exercise training
heart failure with preserved ejection fraction
therapy

Abbreviations and Acronyms

CI
confidence interval
ET
exercise training
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
IQR
interquartile range
LAVI
left atrial volume index
LVMI
left ventricular mass index
MLWHFQ
Minnesota Living With Heart Failure Questionnaire
NT-proBNP
N-terminal pro–B-type natriuretic peptide
NYHA
New York Heart Association
QoL
quality of life
RCT
randomized controlled trial
SF-36
36-Item Short-Form Health Survey
UC
usual care
Vo2
oxygen consumption

Cited by (0)

This study was supported by the German Competence Network of Heart Failure, funded by the Federal Ministry of Education and Research, grant no. 01GI0205. The study group received NT-proBNP reagents from Roche Diagnostics free of charge. Dr. Hasenfuss is a consultant for Servier. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Edelmann, Gelbrich, and Düngen contributed equally to this work.