Association Between 6-Minute Walk Test Distance and Objective Variables of Functional Capacity After Exercise Training in Elderly Heart Failure Patients With Preserved Ejection Fraction: A Randomized Exercise Trial (2023)

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

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.

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.

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.

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.

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 (V_E/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). V_E/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.

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.

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.