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Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study.
J Am Coll Cardiol 2011; 58(17):1780-91JACC

Abstract

OBJECTIVES

We sought to determine whether structured exercise training (ET) improves maximal exercise capacity, left ventricular diastolic function, and quality of life (QoL) in patients with heart failure with preserved ejection fraction (HFpEF).

BACKGROUND

Nearly one-half of patients with heart failure experience HFpEF, but effective therapeutic strategies are sparse.

METHODS

A total of 64 patients (age 65 ± 7 years, 56% female) with HFpEF 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 primary endpoint was the change in peak Vo(2) after 3 months. Secondary endpoints included effects on cardiac structure, diastolic function, and QoL.

RESULTS

Peak Vo(2) 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 to 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, 95% CI: -5.9 to -2.2, p < 0.001). The physical functioning score (36-Item Short-Form Health Survey) improved with ET and remained unchanged with UC (15, 95% CI: 7 to 24, p < 0.001). The ET-induced decrease of E/e' was associated with 38% gain in peak Vo(2) and 50% of the improvement in physical functioning score.

CONCLUSIONS

Exercise training improves exercise capacity and physical dimensions of QoL in HFpEF. This benefit is associated with atrial reverse remodeling and improved left ventricular diastolic function. (Exercise Training in Diastolic Heart Failure-Pilot Study: A Prospective, Randomised, Controlled Study to Determine the Effects of Physical Training on Exercise Capacity and Quality of Life [Ex-DHF-P]; ISRCTN42524037).

Authors+Show Affiliations

Department of Cardiology, University of Göttingen, Göttingen, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21996391

Citation

Edelmann, Frank, et al. "Exercise Training Improves Exercise Capacity and Diastolic Function in Patients With Heart Failure With Preserved Ejection Fraction: Results of the Ex-DHF (Exercise Training in Diastolic Heart Failure) Pilot Study." Journal of the American College of Cardiology, vol. 58, no. 17, 2011, pp. 1780-91.
Edelmann F, Gelbrich G, Düngen HD, et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol. 2011;58(17):1780-91.
Edelmann, F., Gelbrich, G., Düngen, H. D., Fröhling, S., Wachter, R., Stahrenberg, R., ... Pieske, B. (2011). Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. Journal of the American College of Cardiology, 58(17), pp. 1780-91. doi:10.1016/j.jacc.2011.06.054.
Edelmann F, et al. Exercise Training Improves Exercise Capacity and Diastolic Function in Patients With Heart Failure With Preserved Ejection Fraction: Results of the Ex-DHF (Exercise Training in Diastolic Heart Failure) Pilot Study. J Am Coll Cardiol. 2011 Oct 18;58(17):1780-91. PubMed PMID: 21996391.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. AU - Edelmann,Frank, AU - Gelbrich,Götz, AU - Düngen,Hans-Dirk, AU - Fröhling,Stefan, AU - Wachter,Rolf, AU - Stahrenberg,Raoul, AU - Binder,Lutz, AU - Töpper,Agnieszka, AU - Lashki,Diana Jahandar, AU - Schwarz,Silja, AU - Herrmann-Lingen,Christoph, AU - Löffler,Markus, AU - Hasenfuss,Gerd, AU - Halle,Martin, AU - Pieske,Burkert, PY - 2011/03/10/received PY - 2011/06/21/revised PY - 2011/06/27/accepted PY - 2011/10/15/entrez PY - 2011/10/15/pubmed PY - 2011/12/13/medline SP - 1780 EP - 91 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 58 IS - 17 N2 - OBJECTIVES: We sought to determine whether structured exercise training (ET) improves maximal exercise capacity, left ventricular diastolic function, and quality of life (QoL) in patients with heart failure with preserved ejection fraction (HFpEF). BACKGROUND: Nearly one-half of patients with heart failure experience HFpEF, but effective therapeutic strategies are sparse. METHODS: A total of 64 patients (age 65 ± 7 years, 56% female) with HFpEF 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 primary endpoint was the change in peak Vo(2) after 3 months. Secondary endpoints included effects on cardiac structure, diastolic function, and QoL. RESULTS: Peak Vo(2) 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 to 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, 95% CI: -5.9 to -2.2, p < 0.001). The physical functioning score (36-Item Short-Form Health Survey) improved with ET and remained unchanged with UC (15, 95% CI: 7 to 24, p < 0.001). The ET-induced decrease of E/e' was associated with 38% gain in peak Vo(2) and 50% of the improvement in physical functioning score. CONCLUSIONS: Exercise training improves exercise capacity and physical dimensions of QoL in HFpEF. This benefit is associated with atrial reverse remodeling and improved left ventricular diastolic function. (Exercise Training in Diastolic Heart Failure-Pilot Study: A Prospective, Randomised, Controlled Study to Determine the Effects of Physical Training on Exercise Capacity and Quality of Life [Ex-DHF-P]; ISRCTN42524037). SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/21996391/Exercise_training_improves_exercise_capacity_and_diastolic_function_in_patients_with_heart_failure_with_preserved_ejection_fraction:_results_of_the_Ex_DHF__Exercise_training_in_Diastolic_Heart_Failure__pilot_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02852-X DB - PRIME DP - Unbound Medicine ER -