Exercise training affects hemodynamics and exercise capacity in cases of heart failure with preserved ejection fraction: a non-randomized controlled trial in individuals aged 65–80 years

Frontiers in Cardiovascular Medicine · 6 authors, 3 centres

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This non-randomized controlled trial in older Japanese patients with heart failure with preserved ejection fraction found that 5 months of exercise training improved exercise capacity and some hemodynamic and echocardiographic measures, but benefits were limited, particularly in patients with diabetes mellitus.

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This study was a single-center, open-label, non-randomized controlled trial enrolling 99 Japanese outpatients aged 65–80 years with HFpEF. Fifteen participants (30.1%) in the intervention group achieved a clinically meaningful improvement of 10% in peakVO2; this subgroup had a lower prevalence of diabetes mellitus, lower VE vs. Limitations include the non-randomized, open-label design, single-center setting, and exclusive focus on a Japanese population. The results suggest exercise training can improve exercise intolerance in this demographic, but its benefits may be limited in patients with comorbidities like diabetes mellitus.

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RCT

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cardiology

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ORIGINAL PAPER

PMC10646767

Exercise training affects hemodynamics and exercise capacity in cases of heart failure with preserved ejection fraction: a non-randomized controlled trial in individuals aged 65–80 years

Frontiers in Cardiovascular Medicine

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ABSTRACT

Abstract Introduction Exercise training is an established intervention method for improving exercise capacity and survival rates in patients with heart failure with preserved ejection fraction (HFpEF). However, most reports have focused on European and American patients, with limited data regarding the effects of exercise training on cardiac function, hemodynamics, and exercise capacity in East Asian patients. This study investigated the effects of exercise training on cardiac function, hemodynamics, and exercise capacity in Japanese patients aged 65–80 years with HFpEF. Methods This single-center, open-label, non-randomized, controlled trial prospectively enrolled 99 outpatients. Eligibility criteria for HFpEF patients were an HFA score ≥5 in addition to clinical symptoms of heart failure and left ventricular diastolic dysfunction. Exercise training in the intervention group consisted of aerobic exercise and strength training thrice weekly for 5 months. Patients in the control group continued the usual treatment for 5 months. Resting cardiac function was evaluated using echocardiography. Peak oxygen uptake (peakVO 2 ), ventilatory equivalent (VE) vs. carbon dioxide output (VCO 2 ) slope, peak cardiac output index, and arteriovenous oxygen difference were calculated using cardiopulmonary exercise testing combined with impedance cardiography. Results After 5 months of exercise training, remarkable interactions were observed, with peakVO 2 as the primary outcome. Additionally, significant interactions were observed between hemodynamic indices and some echocardiographic parameters. The mean percentage change in peakVO 2 from baseline was 8.3% in the intervention group. Fifteen study participants (30.1%) in the intervention group achieved a clinically meaningful change of 3.0 ml/min/kg (10% improvement) in peakVO 2 from baseline. The group with 3.0 ml/min/kg or 10% improvement in peakVO 2 from baseline had a considerably lower prevalence of diabetes mellitus and VE vs. VCO 2 slope and considerably higher left atrial-global longitudinal strain values than the group without any notable improvements. Conclusions Although exercise training can help improve exercise intolerance in Japanese patients aged 65–80 years with HFpEF, its benefits are limited. Our results suggest that HFpEF, complicated by diabetes mellitus and decreased ventilatory efficiency during exercise, may require reconsideration of intervention strategies. This trial was registered with the University Hospital Medical Information Network, a trial registry in Japan (registration number: UMIN000045474). Keywords: heart failure with preserved ejection fraction, exercise training, peak oxygen uptake, peak stroke volume, peak heart rate, peak arteriovenous oxygen difference, ventilatory equivalent vs. carbon dioxide output slope, echocardiography

CITATION EXPORT

Yousuke Sugita, Katsuhiko Ito, Yui Yoshioka et al.. Exercise training affects hemodynamics and exercise capacity in cases of heart failure with preserved ejection fraction: a non-randomized controlled trial in individuals aged 65–80 years. Frontiers in Cardiovascular Medicine. (2023). https://doi.org/10.3389/fcvm.2023.1246739

AUTHORS

6 · 3 CENTRES

Yousuke Sugita, Katsuhiko Ito, Yui Yoshioka, Ayano Kudo, Sota Arakawa, Satoshi Sakai

1Faculty of Health Sciences, Tsukuba University of Technology, Tsukuba, Japan
2Department of Rehabilitation, National Hospital Organization Matsumoto National Hospital, Matsumoto, Japan
3Department of Rehabilitation, Musashino General Hospital, Kawagoe, Japan