Clinical Considerations and Exercise Responses of Patients with Heart Failure and Preserved Ejection Fraction: What Have We Learned in 20 Years?

2020 ◽  
Vol 9 (1) ◽  
pp. 17-28
Author(s):  
Peter H. Brubaker ◽  
Wesley J. Tucker ◽  
Mark J. Haykowsky
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
The United States ◽  
Exercise Intolerance ◽  
Peak Exercise ◽  
Preserved Ejection Fraction ◽  
Rehabilitation Programs

ABSTRACT Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of all heart failure (HF) cases and is the fastest growing form of HF in the United States. The cornerstone symptom of clinically stable HFpEF is severe exercise intolerance (defined as reduced peak exercise oxygen uptake, VO2peak) secondary to central and peripheral abnormalities that result in reduced oxygen delivery to and/or use by exercising skeletal muscle. To date, pharmacotherapy has not been shown to improve VO2peak, quality of life, and survival in patients with HFpEF. In contrast, exercise training is currently the only efficacious treatment strategy to improve VO2peak, aerobic endurance, and quality of life in patients with HFpEF. In this updated review, we discuss the specific central and peripheral mechanisms that are responsible for the impaired exercise responses as well as the role of exercise training to improve VO2peak in clinically stable patients with HFpEF. We also discuss the central and peripheral adaptations that contribute to the exercise training-mediated improvement in VO2peak in HFpEF. Finally, we provide clinical exercise physiologists with evidence-based exercise prescription guidelines to assist with the safe implementation of exercise-based cardiac rehabilitation programs in clinically stable patients with HFpEF.

scholarly journals Exercise Training Improved Longitudinal Intrinsic Left Ventricle Function in Heart Failure with Preserved Ejection Fraction

2019 ◽  
Vol 28 (01) ◽  
pp. 044-049
Author(s):  
Sidhi Purwowiyoto ◽  
Budhi Purwowiyoto ◽  
Amiliana Soesanto ◽  
Anwar Santoso
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
World Health ◽  
Volume Index ◽  
Lv Function ◽  
Preserved Ejection Fraction

Exercise improves morbidity, fatality rate, and quality of life in heart failure with low ejection fraction, but fewer data available in heart failure with preserved ejection fraction (HFPEF).The purpose of this study is to test the hypothesis that exercise training might improve the longitudinal intrinsic left ventricular (LV) function in HFPEF patients.This quasi-experimental study had recruited 30 patients with HFPEF. Exercise training program had been performed for a month with a total of 20 times exercise sessions and evaluated every 2 weeks. Echocardiography was performed before sessions, second week and fourth week of exercise training. Six-minute walk tests (6MWTs) and quality-of-life variables using Minnesota living with HF scoring and the 5-item World Health Organization Well-Being Index scoring were measured before and after exercise as well.Left ventricular filling pressure, represented by the ratio of early diastolic mitral flow velocity/early diastolic annular velocity and left atrial volume index, improved during exercise. The longitudinal intrinsic LV function, represented by four-chamber longitudinal strain, augmented during exercise (p < 0.001). Aerobic capacity, measured by 6MWT, increased significantly (p = 0.001). Quality of life improved significantly during exercise (p < 0.001).Exercise training was suggested to improve the longitudinal intrinsic LV function and quality of life in HFPEF. Clinical Trial Registration: ACTRN12614001042639.

Effects of exercise training on different quality of life dimensions in heart failure with preserved ejection fraction: the Ex-DHF-P trial

2014 ◽  
Vol 22 (5) ◽  
pp. 582-593 ◽  
Author(s):  
Kathleen Nolte ◽  
Christoph Herrmann-Lingen ◽  
Rolf Wachter ◽  
Götz Gelbrich ◽  
Hans-Dirk Düngen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Preserved Ejection Fraction

Clinical outcomes and cardiovascular responses to exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis

2015 ◽  
Vol 119 (6) ◽  
pp. 726-733 ◽  
Author(s):  
Gudrun Dieberg ◽  
Hashbullah Ismail ◽  
Francesco Giallauria ◽  
Neil A. Smart
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Short Form ◽  
Cardiovascular Responses ◽  
Preserved Ejection Fraction ◽  
Heart Failure Patients

Exercise training induces physical adaptations for heart failure patients with systolic dysfunction, but less is known about those patients with preserved ejection fraction. To establish whether exercise training produces changes in peak V̇o2 and related measures, quality of life, general health, and diastolic function in heart failure patients with preserved ejection fraction. We conducted a MEDLINE search (1985 to October 10, 2014), for exercise-based rehabilitation trials in heart failure, using search terms “exercise training, heart failure with preserved ejection fraction, heart failure with normal ejection fraction, peak V̇o2, and diastolic heart dysfunction”. Seven intervention studies were included providing a total of 144 exercising subjects and 114 control subjects, a total of 258 participants. Peak V̇o2 increased by a mean difference (MD) 2.13 ml·kg−1·min−1 [95% confidence interval (CI) 1.54 to 2.71, P < 0.00001] in exercise training vs. sedentary control, equating to a 17% improvement from baseline. The corresponding data are provided for the following exercise test variables: V̇e/V̇co2 slope, MD 0.85 ml·kg−1·min−1 (95% CI 0.05 to 1.65, P = 0.04); maximum heart rate, MD 5.60 beats per minute (95% CI 3.95 to 7.25, P < 0.00001); Six-Minute Walk Test, MD 32.1 m (95% CI 17.2 to 47.1, P < 0.0001); and indices of diastolic function: E/A ratio, MD 0.07 (95% CI 0.02 to 0.12, P = 0.005); E/E′ ratio MD −2.31 (95% CI −3.44 to −1.19, P < 0.0001); deceleration time (DT), MD −13.2 ms (95% CI −19.8 to −6.5, P = 0.0001); and quality of life: Minnesota Living with Heart Failure Questionnaire, MD −6.50 (95% CI −9.47 to −3.53, P < 0.0001); and short form-36 health survey (physical dimension), MD 15.6 (95% CI 7.4 to 23.8, P = 0.0002). In 3,744 h patient-hours of training, not one death was directly attributable to exercise. Exercise training appears to effect several health-related improvements in people with heart failure and preserved ejection fraction.

scholarly journals The Effect of Exercise Training, IMT and FES on Diastolic Function, Exercise Capacity and Quality of Life in Patients With Heart Failure With Preserved Ejection Fraction: a Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Chenchen Zhuang ◽  
Xufei Luo ◽  
Qiongying Wang ◽  
Shipeng Li ◽  
Xiaofang Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Endurance Training ◽  
Meta Analysis ◽  
Preserved Ejection Fraction ◽  
Combined Exercise

Abstract Background: We aimed to better understand the effects of two exercise training interventions [endurance training and a combination of endurance and resistance training (combined exercise)] and two physiotherapies [functional electrical stimulation (FES) and inspiratory muscle training (IMT)] on diastolic function, exercise performance and quality of life (QoL) in heart failure with preserved ejection fraction (HFpEF) patients.Methods: Cochrane Library, EMBASE and MEDLINE via PubMed for randomized controlled trials were searched from their inception to May 2020. The methodological quality was assessed using the Physiotherapy Evidence Database sacle. All analyses were used by STATA.Results: A total of 14 articles on 13 trials were included in this meta-analysis with 673 HFpEF patients. The pooling revealed that peak oxygen uptake was improved by endurance training [MD (95% CI): 1.89 ml.kg-1.min-1 (1.32, 2.46), P < 0.001], FES [MD (95% CI): 2.28 ml.kg-1.min-1 (0.92, 3.65), P = 0.001] and IMT [MD (95% CI): 2.72 ml.kg-1.min-1 (1.44, 3.99), P < 0.001]. Similar results were observed for 6-minute walk test and QoL. Besides, endurance training increased arterial venous oxygen difference [MD (95% CI): 1.41 (0.09, 2.74), P = 0.036]. Combined exercise was beneficial to the ratio of peak early to late diastolic mitral inflow velocities [MD (95% CI): -2.90 (-4.97, -0.83), P = 0.006] and the early diastolic mitral annual velocity [MD (95% CI): 1.40 (0.68, 2.12), P = 0.006]. IMT improved ventilation/carbon dioxide ratio slope [MD (95% CI): -3.36 ml.kg-1.min-1 (-6.17, -0.54), P = 0.019].Conclusions: FES and IMT may be therapeutic options to improve functional capacity and QoL in HFpEF patients, and the outcomes are similar to endurance training. Combined exercise tends to improve diastolic function in HFpEF patients.

scholarly journals Exercise Training for Heart Failure With Preserved Ejection Fraction (ExTraMATCH III): Protocol for an Individual Patient Data Meta-Analysis

2021 ◽  
Vol 10 (1) ◽  
pp. 3-11
Author(s):  
Neil A. Smart ◽  
Melissa J. Pearson ◽  
Rod S. Taylor ◽  
John Cleland
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Cardiac Rehabilitation ◽  
Meta Analysis ◽  
Preserved Ejection Fraction ◽  
Related Quality ◽  
Health Related

ABSTRACT Background: We will undertake an individual patient data (IPD) meta-analysis to assess the impact of exercise-based cardiac rehabilitation in patients with heart failure with preserved ejection fraction (HFpEF) on mortality and hospitalization and quality of life of exercise-based cardiac rehabilitation according to patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischemic etiology, ejection fraction, and exercise capacity. Despite emerging evidence supporting exercise training in HFpEF, uncertainties remain in the interpretation and understanding of this evidence base. Clinicians and health care providers seek definitive estimates of impact on mortality, hospitalization and health-related quality of life (HRQoL). This work is, therefore, important as HFpEF treatment options are evolving; however, efficacy of some medications is equivocal, so optimizing exercise rehabilitation is vital. Methods: We conducted a systematic search to identify randomized trials of exercise training for at least 3 weeks compared with no exercise control with 6-month follow up or longer, providing IPD time to event on mortality or hospitalization (all-cause or heart failure-specific). IPD will be combined into a single dataset. We will use Cox proportional hazards models to investigate the effect of exercise-based cardiac rehabilitation and the interactions between exercise-based cardiac rehabilitation and participant characteristics. We will use a mix of one-stage and two-stage models. Original IPD will be requested from the authors of all eligible trials; we will check original data and compile a master dataset. IPD meta-analyses will be conducted using a one-step approach where the IPD from all studies are modeled simultaneously while accounting for the clustering of participants with studies. Results: We expect our analyses to show improved mortality, hospitalization, cardiorespiratory fitness, and health-related quality of life. Conclusion: This work will clarify exercise-based rehabilitation delivery methods to optimize benefits for people with HFpEF.

scholarly journals Quality of life in heart failure with preserved ejection fraction: importance of obesity, functional capacity, and physical inactivity

2020 ◽  
Vol 22 (6) ◽  
pp. 1009-1018 ◽  
Author(s):  
Yogesh N.V. Reddy ◽  
Aruna Rikhi ◽  
Masaru Obokata ◽  
Sanjiv J. Shah ◽  
Gregory D. Lewis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Functional Capacity ◽  
Physical Inactivity ◽  
Preserved Ejection Fraction
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