Clinical Research
Heart Failure
Effect of Endurance Exercise Training on Endothelial Function and Arterial Stiffness in Older Patients With Heart Failure and Preserved Ejection Fraction: A Randomized, Controlled, Single-Blind Trial

https://doi.org/10.1016/j.jacc.2013.04.033Get rights and content
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Objectives

The study sought to evaluate the effects of endurance exercise training (ET) on endothelial-dependent flow-mediated arterial dilation (FMD) and carotid artery stiffness, and their potential contributions to the training-related increase in peak exercise oxygen consumption (Vo2) in older patients with heart failure with preserved ejection fraction (HFPEF).

Background

Elderly HFPEF patients have severely reduced peak Vo2, which improves with ET, however, the mechanisms of this improvement are unclear. FMD and arterial distensibility are critical components of the exercise response and are reduced with aging. However, it is unknown whether these improve with ET in elderly HFPEF or contribute to the training-related improvement in peak Vo2.

Methods

A total of 63 HFPEF patients (age 70 ± 7 years) were randomized to 16 weeks of ET (walking, arm and leg ergometry, n = 32) or attention control (CT) (n = 31). Peak Vo2, brachial artery FMD in response to cuff ischemia, carotid artery distensibility by high-resolution ultrasound, left ventricular function, and quality of life were measured at baseline and follow-up.

Results

ET increased peak Vo2 (ET: 15.8 ± 3.3 ml/kg/min vs. CT: 13.8 ± 3.1 ml/kg/min, p = 0.0001) and quality of life. However, brachial artery FMD (ET: 3.8 ± 3.0% vs. CT: 4.3 ± 3.5%, p = 0.88), and carotid arterial distensibility (ET: 0.97 ± 0.56 vs. CT: 1.07 ± 0.34 × 10−3 mm·mm Hg−2; p = 0.65) were unchanged. Resting left ventricular systolic and diastolic function were unchanged by ET.

Conclusions

In elderly HFPEF patients, 16 weeks of ET improved peak Vo2 without altering endothelial function or arterial stiffness. This suggests that other mechanisms, such as enhanced skeletal muscle perfusion and/or oxygen utilization, may be responsible for the ET-mediated increase in peak Vo2 in older HFPEF patients. (Prospective Aerobic Reconditioning Intervention Study [PARIS]; NCT01113840)

Key Words

aging
exercise
heart failure
preserved ejection fraction

Abbreviations and Acronyms

A-Vo2Diff
arteriovenous oxygen difference
BNP
B-type natriuretic peptide
CT
attention control
ET
exercise training
FMD
flow-mediated arterial dilation
HF
heart failure
HFPEF
heart failure with preserved ejection fraction
HFREF
heart failure with reduced ejection fraction
LV
left ventricular
QOL
quality of life
RER
respiratory exchange ratio
Vo2
oxygen consumption
Vo2peak
peak exercise oxygen uptake

Cited by (0)

This study was supported by the following National Institutes of Health research grants: R37AG18915, R01AG12257, and P30AG021332. Dr. Kitzman is a consultant for Relypsa Inc., Boston Scientific Corp., Abbott, Servier, AbbVie, and GlaxoSmithKline; has received grant support from Novartis; and owns stock in Gilead Sciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.