Eur J Prev Cardiol. 2025 Apr 28:zwaf269. doi: 10.1093/eurjpc/zwaf269. Online ahead of print.
ABSTRACT
AIMS: Chronotropic incompetence (ChI) in heart failure with preserved ejection fraction (HFpEF) is associated with a reduced exercise capacity. The role of exercise training in improving chronotropic response (ChR) and functional capacity in these patients remains uncertain. This study assessed the effects of four different exercise programs on peak oxygen consumption (peakVO₂), Kansas City Cardiomyopathy Questionnaire (KCCQ) score and ChR in patients with the ChI HFpEF phenotype.
METHODS: In this randomized clinical trial, 80 symptomatic (NYHA class II-III/IV) patients with the ChI HFpEF phenotype were randomized (1:1:1:1) to one of four interventions: (a) a 12-week supervised aerobic training (AT) program, (b) AT with low-intensity strength training (AT/LRT), (c) AT with moderate- to high-intensity strength training (AT/HRT), or (d) non-supervised exercise recommendations (ER). The primary endpoint was the change in peakVO2 at 12 weeks. Secondary endpoints included changes in ChR and KCCQ. A linear regression model was used.
RESULTS: The mean age of 80 participants was 75.1±7.2 years, and 59.6% were women. Baseline values for peakVO2, chronotropic index, and KCCQ were 11.8±2.6 mL/kg/min, 0.4±0.2, and 63.5±17.9, respectively, with no significant differences across arms. All supervised training programs led to significant improvements in peakVO2 compared to ER: AT/HRT: Δ+4.0, (95% CI: 2.9 to 5.1, p< 0.001), AT/LRT: Δ+3.6, (95% CI: 2.5-4.6, p<0.001), and AT: Δ+2.9, (95% CI: 1.9-4.0, p<0.001). AT/HRT was superior over AT alone: Δ+1.1, (95% CI, 0.1 to 2.2, p=0.046). Likewise, supervised exercise improved ChR and KCCQ without statistical differences between groups.
CONCLUSIONS: Different supervised exercise training improved peakVO2, ChR and KCCQ in patients with ChI HFpEF phenotype.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT05649787).
PMID:40294211 | DOI:10.1093/eurjpc/zwaf269
