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

• Published in: Journal of the American College of Cardiology Vol. 58; no. 17; pp. 1780 - 1791
• Main Authors: EDELMANN, Frank, GELBRICH, Götz, HERRMANN-LINGEN, Christoph, LÖFFLER, Markus, HASENFUSS, Gerd, HALLE, Martin, PIESKE, Burkert, DÜNGEN, Hans-Dirk, FRÖHLING, Stefan, WACHTER, Rolf, STAHRENBERG, Raoul, BINDER, Lutz, TOPPER, Agnieszka, LASHKI, Diana Jahandar, SCHWARZ, Silja
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 18.10.2011; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular system; Diastole; Drug therapy; Exercise; Exercise Tolerance; Female; Heart; Heart attacks; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Failure, Diastolic - therapy; Heart Function Tests; Humans; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Pilot Projects; Prospective Studies; Quality of Life; Resistance Training; Germany; Physical exercise; Human; Heart failure; Cardiac performance; Diastole; Cardiovascular disease; Patient; Result; Capacity; Heart disease; Exercise tolerance test; Circulatory system; Hemodynamics; Cardiology; Ejection fraction
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2011.06.054

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). Nearly one-half of patients with heart failure experience HFpEF, but effective therapeutic strategies are sparse. 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. 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. 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).