Exercise Training in Patients With Heart Failure and Preserved Ejection Fraction: Meta-Analysis of Randomized Control Trials

Study Questions:

In patients with heart failure with preserved ejection fraction (HFPEF), what are the effects of exercise training on cardiorespiratory fitness (CRF), quality of life, and diastolic function?

Methods:

This was a meta-analysis of randomized controlled trials of adult patients with HFPEF. Eligible studies included ≥1 of the following predefined study outcomes: change in CRF (measured as change in peak oxygen uptake in ml/kg/min), quality of life (assessed by changes in the Minnesota Living With HF Questionnaire), markers of diastolic function (changes in E/A ratio and early deceleration time), and left ventricular ejection fraction (LVEF).

Results:

The authors included six randomized controlled trials (n = 276 participants) with a mean follow-up duration of 12-24 weeks (weighted mean duration, 19 weeks). Patients with HFPEF who underwent exercise training had significantly improved CRF (ml/kg/min; weighted mean difference, 2.72; 95% confidence interval [CI], 1.79-3.65) and quality of life (weighted mean difference, -3.97; 95% CI, -7.21 to -0.72), when compared with control. Exercise training did not exert any significant change on systolic or diastolic function.

Conclusions:

In patients with HFPEF, exercise training improves CRF and quality of life, but it is not associated with significant changes in systolic and diastolic dysfunction.

Perspective:

This is an important study that establishes the value of exercise training in patients with HFPEF. As the authors acknowledge, their meta-analysis included only six clinical trials. Nonetheless, these findings are particularly important in light of how ubiquitous exercise intolerance is among patients with HFPEF. Patients with HFPEF may stand to have improved CRF and quality of life with exercise training, and the prescription for exercise should not be overlooked and may have therapeutic advantage. The mechanism(s) through which HFPEF exerts beneficial effects on CRF and quality of life have not been fully elucidated (and are probably multifactorial), but may not be mediated through changes in systolic or diastolic function. Future studies should assess the impact of exercise training on clinical endpoints.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Exercise

Keywords: Follow-Up Studies, Minnesota, Quality of Life, Exercise, Heart Failure, Stroke Volume, Confidence Intervals, Questionnaires, Oxygen, Deceleration, AHA Annual Scientific Sessions


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