Exercise Training Improves Exercise Capacity and Diastolic Function in Patients With Heart Failure With Preserved Ejection Fraction: Results of the Ex-DHF Pilot Study

Study Questions:

Does structured exercise training (ET) improve maximal exercise capacity, left ventricular (LV) diastolic function, and quality of life (QoL) in patients with heart failure with preserved ejection fraction (HFpEF)?


The study cohort was comprised of 64 patients (65 ± 7 years, 44% male) with HFpEF, and these patients were prospectively randomized (2:1) to supervised endurance/resistance training in addition to usual care (ET, n = 44) or to usual care alone (UC, n = 20). The change in peak VO2 after 3 months was the primary endpoint. Secondary endpoints included effects on cardiac structure, diastolic function, and QoL.


The investigators found that peak VO2 increased (16.1 ± 4.9 ml/min/kg to 18.7 ± 5.4 ml/min/kg; p < 0.001) with ET and remained unchanged (16.7 ± 4.7 ml/min/kg to 16.0 ± 6.0 ml/min/kg; p = NS) with UC. The mean benefit of ET was 3.3 ml/min/kg (95% confidence interval [CI], 1.8-4.8; p ± 0.001). E/e’ (mean difference of changes: -3.2; 95% CI, -4.3 to -2.1; p < 0.001) and left atrial volume index (milliliters per square meter) decreased with ET and remained unchanged with UC (-4.0, -5.9 to -2.2, p < 0.001). The physical functioning score (a 36-Item Short-Form Health Survey) improved with ET and remained unchanged with UC (15; 95% CI, 7-24; p < 0.001). The decrease of E/e’ due to exercise was associated with 38% gain in peak VO2 and 50% of the improvement in physical functioning score.


The investigators concluded that ET improves exercise capacity and physical dimensions of QoL in HFpEF, and that this benefit is associated with improved LV diastolic function and atrial reverse remodeling.


This study supports the premise that lifestyle change, particularly exercise, is a good method to improve LV function in patients with diastolic heart failure, as shown earlier (Heart Fail Clin 2008;4:99-115). One of the key determinants of LV dysfunction in diastolic heart failure is the interaction of the ventricle with the vascular system—the ‘ventricular-vascular’ interaction (Heart Fail Clin 2008;4:23-36). The improvements in LV diastolic function are probably due to better vascular health including ‘destiffening’ of the aorta and other vessels (Heart Fail Clin 2008;4:ix-xii). Further studies are needed to validate these findings, and this is particularly important as the burden of diastolic heart failure continues to increase with the aging population.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Chronic Heart Failure, Heart Transplant, Exercise

Keywords: Life Style, Heart Failure, Diastolic, Ventricular Function, Left, Kidney Failure, Chronic, Exercise, Heart Transplantation, Health Surveys, Heart Diseases, Renal Dialysis, Quality of Life, Heart Failure, Atrial Remodeling, Confidence Intervals

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