Exercise Training Improves Exercise Capacity and Diastolic Function in Patients With Heart Failure With Preserved Ejection Fraction

Edelmann, Frank; Gelbrich, Götz; Düngen, Hans‐Dirk; Fröhling, Stefan; Wachter, Rolf; Stahrenberg, Raoul; Binder, Lutz; Töpper, Agnieszka; Lashki, Diana Jahandar; Schwarz, Silja; Herrmann‐Lingen, Christoph; Löffler, Markus; Hasenfuß, Gerd; Halle, Martin; Pieske, Burkert

doi:10.1016/j.jacc.2011.06.054

Cited by 587 publications

(524 citation statements)

References 45 publications

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“…Also, our results did not show any association between E/e′ and PA. This agrees with previous finding where throughout several exercise training trials in HFpEF, the impact of exercise training on diastolic function still remains unclear 18, 19, 39. Kitzman et al .…”

Section: Discussionsupporting

confidence: 93%

“…Furthermore, the positive effect of exercise training on the prognosis of HFrEF was shown in the large HF‐ACTION trial 10. In elderly HFpEF patients, regular exercise training was shown to improve self‐rated physical dimensions of QoL, but not other aspects of QoL 17, 18, 19, 29. These data were consistent with our findings on the total amount of PA and SF‐36 physical function score.…”

Section: Discussionsupporting

confidence: 89%

“…In addition, data on PA in patients with clinically manifest HFpEF are scarce. Although several training interventions have shown promising results in improving exercise capacity and QoL in HFpEF,17, 18, 19 there are no data available on the health‐relevant extent of PA for this patient cohort. Previous trials comparing different training modalities in patients with HF and risk of HF did not identify a clear intensity mode for exercise 20, 21…”

Section: Introductionmentioning

confidence: 99%

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Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction

et al. 2017

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AimsHeart failure with preserved ejection fraction (HFpEF) remains a common condition with no pharmacological treatment. Physical activity (PA) improves symptoms and quality of life (QoL), but no clear recommendations exist on PA in HFpEF patients. We investigated the association of PA (amount/intensity) on clinical phenotype in HFpEF.Methods and resultsThe Aldosterone in Diastolic Heart Failure trial investigated spironolactone vs. placebo in stable HFpEF patients. At baseline, all patients underwent detailed phenotypization including echocardiography, cardiopulmonary exercise testing, 6 minute walking test (6MWT), and QoL assessment (36‐item Short‐Form questionnaire). PA was assessed by a self‐report questionnaire, classified in metabolic equivalents of task (MET) and analysed with regard to exercise capacity, diastolic function, and QoL. Four hundred twenty‐two patients (52% women, age 67 ± 8 years, New York Heart Association II and III) were classified by weekly MET hours into a low (<70), middle (70–140), or high (>140) level of PA. Total PA correlated positively with 6MWT distance (r = 0.17; P = 0.002) and physical function of QoL (r = 0.10; P = 0.05), but not with peak oxygen uptake (peakVO2). In contrast, both 6MWT distance and peakVO2 were significantly higher in patients who performed high‐intensity PA for >8 h/week (P < 0.001, P = 0.02, respectively). Time of high‐intensity PA was related to higher 6MWT distance (r = 0.21, P < 0.001), peakVO2, and better physical function of QoL (both r = 0.13, P = 0.01), whereas low‐intensity PA did not show significant associations. Interestingly, PA was not related to any measure of diastolic function.ConclusionsA higher amount of PA is related to higher submaximal exercise capacity and physical function of QoL. Regarding maximal exercise capacity, only high‐intensity PA showed significant association in HFpEF patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction

et al. 2017

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“…Regular physical activity and structured exercise training (ET) are a cornerstone of non‐pharmacological management in HF patients 4, 5. ET was found to be effective in improving cardiorespiratory fitness6, 7 and dimensions of quality of life in patients with HFpEF 8. Strikingly, ET as a mean of cardiovascular rehabilitation has also been associated to improved left ventricular diastolic function in patients with reduced6 and preserved7 ejection fraction.…”

Section: Introductionmentioning

confidence: 99%

“…The purpose of the present post hoc analysis of the Ex‐DHF‐P trial7 was to investigate the impact of structured and supervised ET on ghrelin, related adipokines, markers of inflammation, and neuro‐hormonal activation in the setting of a prospective, controlled, randomized multi‐centre trial in patients with HFpEF. ET improved exercise capacity and physical dimensions of quality of life in HFpEF.…”

Section: Introductionmentioning

confidence: 99%

Ghrelin and hormonal markers under exercise training in patients with heart failure with preserved ejection fraction: results from the Ex‐DHF pilot study

et al. 2016

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BackgroundOver 50% of patients with symptomatic heart failure (HF) experience HF with preserved ejection fraction (HFpEF). Exercise training (ET) is effective in improving cardiorespiratory fitness and dimensions of quality of life in patients with HFpEF. A systemic pro‐inflammatory state induced by comorbidities as the cause of myocardial structural and functional alterations has been proposed in HFpEF. ET modifies myocardial structure and has been related to inflammatory state. We investigated Ghrelin, related adipokines, markers of inflammation, and neuro‐hormonal activation in patients undergoing a structured ET vs. usual care are with HFpEF. Methods and resultsEx‐DHF‐P was a prospective, controlled, randomized multi‐centre trial on structured and supervised ET in patients with HFpEF. We performed a post hoc analysis in 62 patients from Ex‐DHF‐P. Ghrelin, adiponectin, leptin, IL‐1ß, IL‐6, IL‐10, tumour necrosis factor‐alpha, MR‐proANP, MR‐proADM, CT‐proET1, and CT‐proAVP were assessed to seize the impact of ET on these markers in patients with HFpEF. Thirty‐six (58%) patients were female, mean age was 64 years, and median ghrelin was 928 pg/mL (interquartile range 755–1156). When stratified for high versus low ghrelin, groups significantly differed at baseline in presence obesity, waist circumference, and adiponectin levels (P < 0.05, respectively). Overall, ghrelin levels rose significantly to 1013 pg/mL (interquartile range 813–1182) (P < 0.001). Analysis of covariance modelling for change in ghrelin identified ET (P = 0.013) and higher baseline adiponectin levels (P = 0.035) as influencing factors.ConclusionsExercise training tended to increase ghrelin levels in Ex‐DHF‐P. This increase was especially pronounced in patients with higher baseline adiponectin levels. Future trials are needed to investigate the effect of ET on endogenous ghrelin levels in regard to interactions with cardiac structure and clinically meaningful surrogate parameters.

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Defining Diastolic Heart Failure and Identifying Effective Therapies

Cleland¹,

Pellicori²

2013

JAMA

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Exercise Training Improves Exercise Capacity and Diastolic Function in Patients With Heart Failure With Preserved Ejection Fraction

Cited by 587 publications

References 45 publications

Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction

Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction

Ghrelin and hormonal markers under exercise training in patients with heart failure with preserved ejection fraction: results from the Ex‐DHF pilot study

Defining Diastolic Heart Failure and Identifying Effective Therapies

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