Forty-seven patients (41 women, 6 men), participated in a National Institutes of Health–funded clinical trial for patients aged ≥65 years with HF. The diagnosis of HF was based on clinical criteria as previously described that included a HF clinical score from the National Health and Nutrition Examination Survey-I of ≥3, and those used by Rich etal4 and verified by a board-certified cardiologist. Patients' eligibility, trial protocol, participant characteristics, and main outcomes have been
Exercise testing responses for submaximal and peak variables are displayed in table1. There were no significant differences between the AC and ET groups for o2peak, 6-MWT distance, and other analyzed variables at baseline. Only VT (mL·kg−1·min−1) was significantly different (P=.04) between the AC and ET groups at baseline. Exercise training compliance, adherence, and adverse events were acceptable and have been presented in the main outcome report.5
After the 16-week intervention, the 6-MWT
The current study provides the first examination of the change in 6-MWT distance relative to changes in key functional capacity outcome measures after exercise training in older HFpEF patients. Data from this randomized clinical trial demonstrate that there is a no meaningful relationship between the changes in the 6-MWT distance and o2peak in either the AC or ET groups (see fig 1). These findings are in accord with the results of previous investigations indicating that the 6-MWT may not be
In summary, the findings of this study challenge the utility of the 6-MWT as a reliable serial measure of exercise intolerance in trials of older HFpEF patients and suggests that measured o2peak and VT should be used as the primary outcome measures for serial assessment of exercise tolerance in this patient population.
Schwinn Airdyne; Schwinn.
Effects of different exercise programs on the cardiorespiratory reserve in HFpEF patients: a systematic review and meta-analysis
2022, Hellenic Journal of Cardiology
HFpEF represents a heterogeneous syndrome with complex pathophysiological substrates and multiple clinical manifestations. Recently, much attention has been focused on cardiac rehabilitation programs for HFpEF patients, and several studies have examined the effects of exercise training on this specific population. This systematic review and meta-analysis included studies on adult patients with HFpEF and evaluated the impact of exercise on the cardiorespiratory fitness variables measured during CPET. The primary outcome was the difference in the change in the peak oxygen uptake (Δpeak VO2) between the groups. Literature search involved PubMed/MEDLINE, Cochrane/CENTRAL and Scopus databases. From an initial 5,143 literature records, we identified 18 studies fulfilling the inclusion criteria; 11 studies with 515 patients were finally included in the primary outcome analysis. Δpeak VO2 between baseline and study end was significantly higher in the groups of exercise training versus control (WMD 2.25ml/kg/min, 95% CI 1.81–2.70). Exercise training resulted in greater change in the 6-minute walking test (6MWT) distance (WMD 2.25m, 95% CI 1.81–2.70). Health-related quality of life (HRQoL) (WMD:−3.36, 95% CI−9.42 to 2.70, I2=14%, p=0.33) and echocardiographic indices of diastolic function showed no differences between exercise and control groups at study end. In the subgroup analysis, no difference between resistance versus aerobic exercise was noted in Δpeak VO2, but high-intensity interval training showed a greater increase in peak VO2 versus aerobic exercise (WMD 1.62ml/kg/min, 95% CI 0.96–2.29, I2=0%, p=0.82). Exercise training in HFpEF results in significant improvements in peak VO2 and 6MWT distance as compared to those for controls. High-intensity interval training may offer greater enhancement of the exercise capacity of these patients than standard aerobic exercise.
The HEART Camp Exercise Intervention Improves Exercise Adherence, Physical Function, and Patient-Reported Outcomes in Adults With Preserved Ejection Fraction Heart Failure
2022, Journal of Cardiac Failure
Despite exercise being one of few strategies to improve outcomes for individuals with heart failure with preserved ejection fraction (HFpEF), exercise clinical trials in HFpEF are plagued by poor interventional adherence. Over the last 2 decades, our research team has developed, tested, and refinedHeart failureExerciseAndResistanceTraining (HEART) Camp, a multicomponent behavioral intervention to promote adherence to exercise in HF. We evaluated the effects of this intervention designed to promote adherence to exercise in HF focusing on subgroups of participants with HFpEF and heart failure with reduced ejection fraction (HFrEF).
This randomized controlled trial included 204 adults with stable, chronic HF. Of those enrolled, 59 had HFpEF and 145 had HFrEF. We tested adherence to exercise (defined as ≥120 minutes of moderate-intensity [40%–80% of heart rate reserve] exercise per week validated with a heart rate monitor) at 6, 12, and 18 months. We also tested intervention effects on symptoms (Patient-Reported Outcomes Measurement Information System-29 and dyspnea-fatigue index), HF-related health status (Kansas City Cardiomyopathy Questionnaire), and physical function (6-minute walk test). Participants with HFpEF (n = 59) were a mean of 64.6 ± 9.3 years old, 54% male, and 46% non-White with a mean ejection fraction of 55 ± 6%. Participants with HFpEF in the HEART Camp intervention group had significantly greater adherence compared with enhanced usual care at both 12 (43% vs 14%,phi = 0.32, medium effect) and 18 months (56% vs 0%,phi = 0.67, large effect). HEART Camp significantly improved walking distance on the 6-minute walk test (η2 = 0.13, large effect) and the Kansas City Cardiomyopathy Questionnaire overall (η2 = 0.09, medium effect), clinical summary (η2 = 0.16, large effect), and total symptom (η2 = 0.14, large effect) scores.In the HFrEF subgroup, only patient-reported anxiety improved significantly in the intervention group.
A multicomponent, behavioral intervention is associated with improvements in long-term adherence to exercise, physical function, and patient-reported outcomes in adults with HFpEF and anxiety in HFrEF. Our results provide a strong rationale for a large HFpEF clinical trial to validate these findings and examine interventional mechanisms and delivery modes that may further promote adherence and improve clinical outcomes in this population.
: URL: https://clinicaltrials.gov/. Unique identifier: NCT01658670(Video) Exercise and Diet as Therapy for Heart Failure with Preserved Ejection Fraction
Exercise Intolerance in Heart Failure with Preserved Ejection Fraction
2021, Heart Failure ClinicsSee AlsoInfluence of NT-proBNP on Efficacy of Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection FractionPrediction of left ventricular ejection fraction changes in heart failure patients using machine learning and electronic health records: a multi-site studyRenal denervation for resistant hypertension and heart failure with a reduced ejection fractionRight ventricular ejection fraction during exercise in patients with coronary artery disease
Impaired Exercise Tolerance in Heart Failure With Preserved Ejection Fraction: Quantification of Multiorgan System Reserve Capacity
2020, JACC: Heart Failure
Exercise intolerance is a principal feature of heart failure with preserved ejection fraction (HFpEF), whether or not there is evidence of congestion at rest. The degree of functional limitation observed in HFpEF is comparable to patients with advanced heart failure and reduced ejection fraction. Exercise intolerance in HFpEF is characterized by impairments in the physiological reserve capacity of multiple organ systems, but the relative cardiac and extracardiac deficits vary among individuals. Detailed measurements made during exercise are necessary to identify and rank-order the multiorgan system limitations in reserve capacity that culminate in exertional intolerance in a given person. We use a case-based approach to comprehensively review mechanisms of exercise intolerance and optimal approaches to evaluate exercise capacity in HFpEF. We also summarize recent and ongoing trials of novel devices, drugs, and behavioral interventions that aim to improve specific exercise measures such as peak oxygen uptake, 6-min walk distance, heart rate, and hemodynamic profiles in HFpEF. Evaluation during the clinically relevant physiological perturbation of exercise holds promise to improve the precision with which HFpEF is defined and therapeutically targeted.
Analysis of morbid obese women aerobic potential
2020, Revista Colombiana de Cardiologia
nowadays, with the increase of world obesity and the numbers of morbidly obese people, a concerning public health problem that is difficult to solve rises up.
to analyse the physiological responses after the 6-minute walk tests and maximum stress test in the arm cycle ergometer in morbidly obese pre-bariatric surgery women.
fifteen level III obesity women aged 35.6±6.6 years took part in this experiment. Firstly, they went through an anamnesis and body composition analysis; secondly, they were submitted to a 6-minute walk test and a maximum stress test in arm cycle ergometer on alternate days.
patients were able to perform the maximum stress test and showed better aerobic potentials in the arm cycle ergometer than in the 6-minute walk test. No significant differences were found between SPO2 and diastolic blood pressure between the moments of rest and after the tests, neither in the systolic blood pressure after the 6-minute walk test and the values of rest and post 5minutes in the maximum stress test. The main differences found were between the maximum systolic blood pressure in the cycle ergometer test and the other moments and the heart rate after the tests and the heart rate at rest.
the maximum stress test in arm cycle ergometer is a safe method that allows greater requirement and control applied to the heart system than in the 6-minute walk test. In addition, it allows the development of a more individualized aerobic training and prescription of aerobic physical exercise program.(Video) How to Detect and Treat Heart Failure with Preserved Ejection Fraction (IMAD HUSSAIN, MD)
Actualmente, con el aumento de la obesidad en el mundo y del número de obesos mórbidos se evidencia un problema de salud pública de difícil resolución.
analizar las respuestas fisiológicas, tras las pruebas de caminata de 6 minutos y de esfuerzo máximo en cicloergómetro de brazos, en obesas mórbidas precirugía bariátrica.
se evaluaron 15 mujeres con obesidad grado III con edad media de 35,6±6,6 años, las cuales participaron inicialmente de una anamnesis con el análisis de la composición corporal y posteriormente participaron en días alternos de la prueba de 6 minutos de caminata y del mismo, prueba de esfuerzo máximo en cicloergómetro de brazos.
las pacientes lograron realizar la prueba de esfuerzo máximo y demostraron mejores potenciales aeróbicos en el cicloergómetro de brazos que en la prueba de caminata. No se encontraron diferencias significativas entre la SPO2 y la presión arterial diastólica entre los momentos de reposo y después de las pruebas y también en la presión arterial sistólica posterior a la prueba de caminata y los valores de reposo y después de 5 minutos en la prueba de esfuerzo máximo. Las principales diferencias se observaron entre la presión arterial sistólica máxima en la prueba en cicloergómetro y los otros momentos y en la frecuencia cardiaca después de las pruebas y las frecuencias cardiacas en reposo.
la prueba de esfuerzo máximo en cicloergómetro de brazos es un método seguro que posibilita mayor exigencia y control aplicado al sistema cardíaco que en la prueba de caminata. Adicionalmente, permite un programa de entrenamiento y una prescripción del ejercicio físico aeróbico más individualizados.
Differential plasma protein expression after ingestion of essential amino acid-based dietary supplement verses whey protein in low physical functioning older adults
Six-minute walk test in moderate to severe heart failure with preserved ejection fraction: Useful for functional capacity assessment?
International Journal of Cardiology, Volume 203, 2016, pp. 800-802See AlsoL’Insuffisance Cardiaque à Fraction d’Éjection Réduite à Tombouctou : Aspects Cliniques et ParacliniquesBruno Trimarco | ScienceDirect南京信息工程大学主页平台管理系统 顾彬--中文主页--首页Miocardiopatía hipertrófica e hipertrofia ventricular izquierda en la cardiopatía hipertensiva con fracción de eyección levemente reducida o conservada: información a partir de la mecánica alterada y el mapeo T1 nativo
Aerobic exercise training and general health status in ambulatory heart failure patients with a reduced ejection fraction—Findings from the Heart Failure and A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION)trial
American Heart Journal, Volume 186, 2017, pp. 130-138
Although aerobic exercise improves quality of life as assessed by a disease-specific instrument in ambulatory HF patients with a reduced ejection fraction (EF), the impact of an exercise intervention on general health status has not been previously reported.
A secondary analysis was performed of the HF-ACTION trial (ClinicalTrials.gov Number: NCT00047437), which enrolled 2331 medically stable outpatients with HF and an EF ≤35% and randomized them to aerobic exercise training, consisting of 36 supervised sessions followed by home-based training versus usual care for a median follow-up of 30 months. The EuroQOL 5-dimension questionnaire (EQ-5D) was administered to study participants at baseline, 3 months, and 12 months. EQ-5D includes functional dimensions (ie, mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), which were mapped to corresponding utility scores (ie, 0=death and 1=perfect health), and a visual analogue scale (VAS) ranging from 0 (ie, “worst imaginable health state”) to 100 (ie, “best imaginable health state”).
Study participants had a median (25th, 75th) age of 59 (51, 68) years and 71% were male. A history of ischemic heart disease was reported in 51% of participants and the EF was 25% (20%, 30%). Baseline VAS and mapped utility scores were 65±19 and 0.81±0.14. Exercise training led to an improvement in VAS score compared with usual care from baseline to 3 months (exercise training: 6±17 vs usual care: 3±20; P <.01) although there were no further significant changes at 12 months. Aerobic exercise training did not favorably change mapped utility scores over either timeframe. After multivariable adjustment, lower mapped utility (hazard ratio [HR] 1.19 per 0.1 decrease, 95% CI 1.09–1.29; P < .0001) and VAS scores (HR 1.05 per 10 point decrease, 95% CI 1.02–1.08; P < .01) at baseline were associated with increased risk of death or hospitalization.
Ambulatory HF patients with a reduced EF had impaired health status at baseline which was associated with increased morbidity and mortality, in part mitigated by a structured aerobic exercise regimen.(Video) Why bed-Rest was replaced by "ON YOUR BIKE" for heart failure patients
Association between the 6-minute walk test and exercise confidence in patients with heart failure: A prospective observational study
Heart & Lung, Volume 47, Issue 1, 2018, pp. 54-60
Exercise confidence predicts exercise adherence in heart failure (HF) patients. The association between simple tests of functional capacity on exercise confidence are not known.
To evaluate the association between a single 6-min walk test (6MWT) and exercise confidence in HF patients.
Observational study enrolling HF outpatients who completed the Cardiac Depression Scale and an Exercise Confidence Survey at baseline and following the 6MWT. Paired t-test was used to compare repeated-measures data, while Repeated Measures Analysis of Covariance was used for multivariate analysis.
106 HF patients were enrolled in the study (males, 82%; mean age, 64±12 years). Baseline Exercise Confidence was inversely associated with age (p<0.01), NYHA class (p<0.001), and depression (p<0.001). The 6MWT was associated with an improvement in Exercise Confidence (F(1,92)=5.0, p=0.03) after adjustment for age, gender, HF duration, NYHA class and depression.
The 6MWT is associated with improved exercise confidence in HF patients.
Research articleSee AlsoImpacto del empeoramiento de la insuficiencia cardíaca en el pronóstico a largo plazo en pacientes con insuficiencia cardíaca con fracción de eyección reducidaProteína C reactiva y estatinas en la insuficiencia cardiaca con fracción de eyección reducida y conservadaCaracterísticas electrofisiológicas y clínicas de la ablación con catéter para la taquicardia auricular izquierda aislada durante un período de 10 años
Prognostic value of cardiopulmonary exercise testing in heart failure with preserved ejection fraction. The Henry Ford HospITal CardioPulmonary EXercise Testing (FIT-CPX) project
American Heart Journal, Volume 174, 2016, pp. 167-172
Although cardiopulmonary exercise (CPX) testing in patients with heart failure and reduced ejection fraction is well established, there are limited data on the value of CPX variables in patients with HF and preserved ejection fraction (HFpEF). We sought to determine the prognostic value of select CPX measures in patients with HFpEF.
This was a retrospective analysis of patients with HFpEF (ejection fraction ≥ 50%) who performed a CPX test between 1997 and 2010. Selected CPX variables included peak oxygen uptake (VO2), percent predicted maximum oxygen uptake (ppMVO2), minute ventilation to carbon dioxide production slope (VE/VCO2 slope) and exercise oscillatory ventilation (EOV). Separate Cox regression analyses were performed to assess the relationship between each CPX variable and a composite outcome of all-cause mortality or cardiac transplant.
We identified 173 HFpEF patients (45% women, 58% non-white, age 54 ± 14 years) with complete CPX data. During a median follow-up of 5.2 years, there were 42 deaths and 5 cardiac transplants. The 1-, 3-, and 5-year cumulative event-free survival was 96%, 90%, and 82%, respectively. Based on the Wald statistic from the Cox regression analyses adjusted for age, sex, and β-blockade therapy, ppMVO2 was the strongest predictor of the end point (Wald χ2 = 15.0, hazard ratio per 10%, P < .001), followed by peak VO2 (Wald χ2 = 11.8, P = .001). VE/VCO2 slope (Wald χ2= 0.4, P = .54) and EOV (Wald χ2 = 0.15, P = .70) had no significant association to the composite outcome.
These data support the prognostic utility of peak VO2 and ppMVO2 in patients with HFpEF. Additional studies are needed to define optimal cut points to identify low- and high-risk patients.(Video) Patient Education and Professional Issues in Heart Failure, Recap and Post test
How to perform and report a cardiopulmonary exercise test in patients with chronic heart failure
International Journal of Cardiology, Volume 288, 2019, pp. 107-113
In the present practice review, we will explain how to perform and interpret a cardiopulmonary exercise test (CPET) in heart failure patients. Specifically, we will explain why cycle ergometer should be preferred to treadmill, the type of protocol needed, and the ideal exercise duration. Thereafter, we will discuss how to interpret CPET findings and determine the parameters that should be included. We will focus specifically on: peak VO2 (absolute value and a percentage of its predicted value), exercise duration, respiratory exchange ratio, peak work rate, heart rate, O2 pulse, end-tidal carbon dioxide pressure (PetCO2), PetO2, and -if blood gas samples are obtained-dead space to tidal volume ratio. Moreover, we will discuss the physiological and clinical value of anaerobic threshold, respiratory compensation point, ventilation vs. VCO2 and VO2 vs. work relationships. Finally, attention will be dedicated to exercise-induced periodic breathing. We will also discuss when and why CPET should be integrated with other measurements in the so-called complex CPET. Specifically: a) when and how to use a complex non-invasive CPET, which integrates CPET measurements with non-invasive cardiac output determination, working muscle near-infrared spectroscopy, transthoracic echocardiography, thoracic ultrasound, and lung diffusion analysis; b) when and how to use a complex minimally invasive CPET, in which CPET is combined with esophageal balloon recordings or with serial arterial blood sampling for blood gas analysis; c) when and how to use a complex invasive CPET, which usually implies the presence of a Swan Ganz catheter in the pulmonary artery and an arterial line.
Meta-analysis of Exercise Training on Left Ventricular Ejection Fraction in Heart Failure with Reduced Ejection Fraction: A 10-year Update
Progress in Cardiovascular Diseases, Volume 62, Issue 2, 2019, pp. 163-171
The role of exercise training modality to attenuate left ventricular (LV) remodeling in heart failure patients with reduced ejection fraction (HFrEF) remains uncertain. The authors performed a systematic review and meta-analysis of published reports on exercise training (moderate-intensity continuous aerobic, high-intensity interval aerobic, and resistance exercise) and LV remodeling in clinically stable HFrEF patients.
We searched MEDLINE, Cochrane Central Registry of Controlled Trials, CINAHL, and PubMed (2007 to 2017) for randomized controlled trials of exercise training on resting LV ejection fraction (EF) and end-diastolic and end-systolic volumes in HFrEF patients.
18 trials reported LV ejection fraction (LVEF) data, while 8 and 7 trials reported LV end-diastolic and LV end-systolic volumes, respectively. Overall, moderate-intensity continuous training (MICT) significantly increased LVEF (weighted mean difference, WMD = 3.79%; 95% confidence interval, CI, 2.08 to 5.50%) with no change in LV volumes versus control. In trials ≥6 months duration, MICT significantly improved LVEF (WMD = 6.26%; 95% CI 4.39 to 8.13%) while shorter duration (<6 months) trials modestly increased LVEF (WMD = 2.33%; 95% CI 0.84 to 3.82%). High-intensity interval training (HIIT) significantly increased LVEF compared to control (WMD = 3.70%; 95% CI 1.63 to 5.77%) but was not different than MICT (WMD = 3.17%; 95% CI −0.87 to 7.22%). Resistance training performed alone or combined with aerobic training (MICT or HIIT) did not significantly change LVEF.(Video) Electrical Stimulation for Patients with Cardiopulmonary Dysfunction
In clinically stable HFrEF patients, MICT is an effective therapy to attenuate LV remodeling with the greatest benefits occurring with long-term (≥6 months) training. HIIT performed for 2 to 3 months is superior to control, but not MICT, for improvement of LVEF.