Exercise Training in Heart Failure With Preserved Systolic Function: A Randomized Controlled Trial of the Effects on Cardiac Function and Functional Capacity

Abstract

Exercise training improves functional capacity in patients with exercise limitation attributed to systolic dysfunction (SD), but exercise training effects in patients with diastolic dysfunction is unclear. The authors determined the functional capacity, quality of life, and echocardiography responses of heart failure with preserved ejection fraction (HFpEF) patients to 16 weeks exercise training. Thirty patients with HFpEF were randomized to an exercise training or non-exercising control group. The patients had a baseline mean age of 64±8 years, left ventricular ejection fraction 57%±10%, and peak oxygen consumption (peak VO₂) of 13.3±3.8 mL O₂/kg/min. Minnesota Living With Heart Failure and Hare-Davis scores and echocardiographic measures (ejection fraction, systolic and diastolic tissue velocity and filling pressure [E/E']) were performed at baseline and after 16 weeks of exercise training. The exercise training and non-exercising control groups showed similar baseline VO₂ (12.2±3.6 mL/kg/min vs 14.1±4.1 mL/kg/min), ejection fraction (58%±13% vs 57%±8%), and systolic and diastolic function. After exercise training the increment in peak VO₂ in the exercise training group was (24.6%, P=.02), and the non-exercising control group (5.1%, P=.19). VE/VCO₂ slope was reduced by 12.7% in the exercise training group (P=.02) but was unchanged in the non-exercising control group (P=.03). No significant changes in diastolic or systolic function were noted in either group. Quality-of-life and depression scores were unchanged with exercise training. Changes in peak VO₂ and VE/VCO₂ slope were unrelated to measures of diastolic and systolic function. In patients with exercise limitation attributed to HFpEF, the improvement in peak VO₂ with exercise training was not clearly related to changes in cardiac function.