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Effects of long-term endurance and resistance training on diastolic function, exercise capacity, and quality of life in asymptomatic diastolic dysfunction vs. heart failure with preserved ejection fraction.
ESC Heart Fail 2014; 1(1):59-74EH

Abstract

BACKGROUND

The long-term effects of exercise training (ET) in diastolic dysfunction (DD) and heart failure with preserved ejection fraction (HFpEF) are unknown. The present study compared the long-term effects of ET on exercise capacity, diastolic function, and quality of life (QoL) in patients with DD vs. HFpEF.

METHODS

A total of n = 43 patients with asymptomatic DD (n = 19) or HFpEF [DD and New York Heart Association (NYHA) ≥II, n = 24] and left ventricular ejection fraction ≥50% performed a combined endurance/resistance training over 6 months (2-3/week) on top of usual care. Cardiopulmonary exercise testing, echocardiography, and QoL were obtained at baseline and follow-up.

RESULTS

Patients were 62 ± 8 years old (37% female). In the HFpEF group, 67% of patients were in NYHA class II (33% in NYHA III). Exercise capacity (peak oxygen consumption, peak VO2) differed at baseline (DD 29.2 ± 8.7 mL/min/kg vs. HFpEF 17.8 ± 4.6 mL/min/kg; P = 0.004). After 6 months, peak VO2 increased significantly (P < 0.044) to 19.7 ± 5.8 mL/min/kg in the HFpEF group and also in the DD group (to 32.8 ± 8.5 mL/min/kg; P < 0.002) with no overall difference between the groups (P = 0.217). E/e' ratio (left ventricular filling index) decreased from 12.2 ± 3.5 to 10.1 ± 3.0 (P < 0.002) in patients with HFpEF and also in patients with DD (10.7 ± 3.1 vs. 9.5 ± 2.3; P = 0.03; difference between groups P = 0.210). In contrast, left atrial volume index decreased in the HFpEF group (P < 0.001) but remained stable within the DD group (difference between groups P = 0.015). After 6 months, physical QoL (Minnesota living with heart failure Questionnaire, 36-item short form health survey), general health perception, and 9-item patient health questionnaire score only improved in HFpEF (P < 0.05). In contrast, vitality improved in both groups (difference between groups P = 0.708).

CONCLUSION

A structured 6 months ET programme effectively improves exercise capacity and diastolic function in patients with DD and overt HFpEF. Therefore, controlled lifestyle modification with physical activity is effective both in DD and HFpEF.

Authors+Show Affiliations

Department of Cardiology, University of Göttingen, Robert-Koch-Str. 40, D-37075, Göttingen, Germany.Department of Prevention, Rehabilitation and Sports Medicine, Munich & German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Technische Universität München, Georg-Brauchle-Ring 56 (Campus C), D-80992, Munich, Germany.Institute for Epidemiology and Biometry, University of Würzburg, Sanderring 2, D-97070, Würzburg, Germany.Department of Prevention, Rehabilitation and Sports Medicine, Munich & German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Technische Universität München, Georg-Brauchle-Ring 56 (Campus C), D-80992, Munich, Germany.Department of Prevention, Rehabilitation and Sports Medicine, Munich & German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Technische Universität München, Georg-Brauchle-Ring 56 (Campus C), D-80992, Munich, Germany.Department of Cardiology, University of Göttingen, Robert-Koch-Str. 40, D-37075, Göttingen, Germany. German Center for Cardiovascular Research Site Göttingen, DZHK, Oudenarder Straβe 16, Building D/04 (First Floor), 13347, Berlin, Germany.Department of Cardiology, University of Göttingen, Robert-Koch-Str. 40, D-37075, Göttingen, Germany. German Center for Cardiovascular Research Site Göttingen, DZHK, Oudenarder Straβe 16, Building D/04 (First Floor), 13347, Berlin, Germany.Campus Virchow-Klinikum, Department of Cardiology, Charité-Universitätsmedizin, Augustenburger Platz 1, D-13353, Berlin, Germany.German Center for Cardiovascular Research Site Göttingen, DZHK, Oudenarder Straβe 16, Building D/04 (First Floor), 13347, Berlin, Germany. Department of Psychosomatic Medicine and Psychotherapy, German Centre for Cardiovascular Research, University of Göttingen, Wilhelmsplatz 1, 37073, Göttingen, Germany.Department of Prevention, Rehabilitation and Sports Medicine, Munich & German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Technische Universität München, Georg-Brauchle-Ring 56 (Campus C), D-80992, Munich, Germany.Department of Cardiology, Medical University of Graz, Auenbrugger Platz15, A-8036, Graz, Austria.Department of Cardiology, University of Göttingen, Robert-Koch-Str. 40, D-37075, Göttingen, Germany. German Center for Cardiovascular Research Site Göttingen, DZHK, Oudenarder Straβe 16, Building D/04 (First Floor), 13347, Berlin, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28834666

Citation

Nolte, Kathleen, et al. "Effects of Long-term Endurance and Resistance Training On Diastolic Function, Exercise Capacity, and Quality of Life in Asymptomatic Diastolic Dysfunction Vs. Heart Failure With Preserved Ejection Fraction." ESC Heart Failure, vol. 1, no. 1, 2014, pp. 59-74.
Nolte K, Schwarz S, Gelbrich G, et al. Effects of long-term endurance and resistance training on diastolic function, exercise capacity, and quality of life in asymptomatic diastolic dysfunction vs. heart failure with preserved ejection fraction. ESC Heart Fail. 2014;1(1):59-74.
Nolte, K., Schwarz, S., Gelbrich, G., Mensching, S., Siegmund, F., Wachter, R., ... Edelmann, F. (2014). Effects of long-term endurance and resistance training on diastolic function, exercise capacity, and quality of life in asymptomatic diastolic dysfunction vs. heart failure with preserved ejection fraction. ESC Heart Failure, 1(1), pp. 59-74. doi:10.1002/ehf2.12007.
Nolte K, et al. Effects of Long-term Endurance and Resistance Training On Diastolic Function, Exercise Capacity, and Quality of Life in Asymptomatic Diastolic Dysfunction Vs. Heart Failure With Preserved Ejection Fraction. ESC Heart Fail. 2014;1(1):59-74. PubMed PMID: 28834666.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of long-term endurance and resistance training on diastolic function, exercise capacity, and quality of life in asymptomatic diastolic dysfunction vs. heart failure with preserved ejection fraction. AU - Nolte,Kathleen, AU - Schwarz,Silja, AU - Gelbrich,Götz, AU - Mensching,Steffen, AU - Siegmund,Friederike, AU - Wachter,Rolf, AU - Hasenfuss,Gerd, AU - Düngen,Hans-Dirk, AU - Herrmann-Lingen,Christoph, AU - Halle,Martin, AU - Pieske,Burkert, AU - Edelmann,Frank, PY - 2014/07/14/received PY - 2014/08/05/revised PY - 2014/08/05/accepted PY - 2017/8/24/entrez PY - 2014/9/1/pubmed PY - 2014/9/1/medline KW - Diastolic dysfunction KW - Exercise training KW - Heart failure with preserved ejection fraction SP - 59 EP - 74 JF - ESC heart failure JO - ESC Heart Fail VL - 1 IS - 1 N2 - BACKGROUND: The long-term effects of exercise training (ET) in diastolic dysfunction (DD) and heart failure with preserved ejection fraction (HFpEF) are unknown. The present study compared the long-term effects of ET on exercise capacity, diastolic function, and quality of life (QoL) in patients with DD vs. HFpEF. METHODS: A total of n = 43 patients with asymptomatic DD (n = 19) or HFpEF [DD and New York Heart Association (NYHA) ≥II, n = 24] and left ventricular ejection fraction ≥50% performed a combined endurance/resistance training over 6 months (2-3/week) on top of usual care. Cardiopulmonary exercise testing, echocardiography, and QoL were obtained at baseline and follow-up. RESULTS: Patients were 62 ± 8 years old (37% female). In the HFpEF group, 67% of patients were in NYHA class II (33% in NYHA III). Exercise capacity (peak oxygen consumption, peak VO2) differed at baseline (DD 29.2 ± 8.7 mL/min/kg vs. HFpEF 17.8 ± 4.6 mL/min/kg; P = 0.004). After 6 months, peak VO2 increased significantly (P < 0.044) to 19.7 ± 5.8 mL/min/kg in the HFpEF group and also in the DD group (to 32.8 ± 8.5 mL/min/kg; P < 0.002) with no overall difference between the groups (P = 0.217). E/e' ratio (left ventricular filling index) decreased from 12.2 ± 3.5 to 10.1 ± 3.0 (P < 0.002) in patients with HFpEF and also in patients with DD (10.7 ± 3.1 vs. 9.5 ± 2.3; P = 0.03; difference between groups P = 0.210). In contrast, left atrial volume index decreased in the HFpEF group (P < 0.001) but remained stable within the DD group (difference between groups P = 0.015). After 6 months, physical QoL (Minnesota living with heart failure Questionnaire, 36-item short form health survey), general health perception, and 9-item patient health questionnaire score only improved in HFpEF (P < 0.05). In contrast, vitality improved in both groups (difference between groups P = 0.708). CONCLUSION: A structured 6 months ET programme effectively improves exercise capacity and diastolic function in patients with DD and overt HFpEF. Therefore, controlled lifestyle modification with physical activity is effective both in DD and HFpEF. SN - 2055-5822 UR - https://www.unboundmedicine.com/medline/citation/28834666/Effects_of_long_term_endurance_and_resistance_training_on_diastolic_function_exercise_capacity_and_quality_of_life_in_asymptomatic_diastolic_dysfunction_vs__heart_failure_with_preserved_ejection_fraction_ L2 - https://doi.org/10.1002/ehf2.12007 DB - PRIME DP - Unbound Medicine ER -