Reversing Cardiac Effects of Sedentary Aging

Study Questions:

What is the effect of 2 years of supervised high-intensity exercise training on left ventricular (LV) stiffness?

Methods:

The investigators randomly assigned 61 (48% male) healthy, sedentary, middle-aged participants (53 ± 5 years) to either 2 years of exercise training (n = 34) or attention control (control; n = 27). Right heart catheterization and three-dimensional echocardiography were performed with preload manipulations to define LV end-diastolic pressure-volume relationships and Frank-Starling curves. LV stiffness was calculated by curve fit of the diastolic pressure-volume curve. Maximal oxygen uptake (VO2max) was measured to quantify changes in fitness.

Results:

Fifty-three participants completed the study. Adherence to prescribed exercise sessions was 88 ± 11%. VO2max increased by 18% (exercise training: pre 29.0 ± 4.8 to post 34.4 ± 6.4; control: pre 29.5 ± 5.3 to post 28.7 ± 5.4, group × time p < 0.001) and LV stiffness was reduced (right/downward shift in the end-diastolic pressure-volume relationships; pre-exercise training stiffness constant 0.072 ± 0.037 to post-exercise training 0.051 ± 0.0268, p = 0.0018), whereas there was no change in controls (group × time p < 0.001; prestiffness constant 0.0635 ± 0.026 to post 0.062 ± 0.031, p = 0.83). Exercise increased LV end-diastolic volume (group × time p < 0.001), whereas pulmonary capillary wedge pressure was unchanged, providing greater stroke volume for any given filling pressure (loading × group × time p = 0.007).

Conclusions:

The authors concluded that in previously sedentary healthy middle-aged adults, 2 years of exercise training improved maximal oxygen uptake and decreased cardiac stiffness.

Perspective:

This prospective study reports that 2 years of exercise training performed for at least 30 minutes, 4-5 days per week, and including at least one high-intensity interval session per week, results in a significant reduction in LV chamber and myocardial stiffness. Furthermore, this study also demonstrated that exercise training can be adhered to by middle-aged adults over a prolonged period, suggesting that this may be an effective strategy to mitigate the deleterious effects of sedentary aging on the heart and possibly prevent the development of heart failure with preserved ejection fraction. Additional prospective studies are indicated to evaluate the role of exercise training in specific populations at risk of developing heart failure with a preserved ejection fraction.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Chronic Heart Failure, Echocardiography/Ultrasound, Exercise

Keywords: Blood Pressure, Cardiac Catheterization, Cardiac Imaging Techniques, Echocardiography, Three-Dimensional, Exercise, Heart Failure, Diastolic, Heart Failure, Middle Aged, Myocardium, Primary Prevention, Pulmonary Wedge Pressure, Risk Factors, Stroke Volume


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