Top Things to Know: Supervised Exercise Training for Chronic HF with Preserved Ejection Fraction
Published: March 21, 2023
Prepared by Mu Huang, PhD, DPT, Science and Medicine Advisor
- Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure; its prevalence is increasing worldwide, and outcomes are worsening.
- Improved management of the large, inadequately treated population of patients with HFpEF represents an urgent unmet need.
- This statement aims to critically examine the currently available literature regarding the effects of exercise-based therapies for chronic stable HFpEF, potential mechanisms for improvement of exercise capacity and symptoms, and how these data compare with exercise therapy for other cardiovascular conditions.
- Recent guidelines give the highest level of recommendation (Class 1, Level of Evidence A) for supervised exercise training for people with heart failure. However, this recommendation does not distinguish between heart failure with reduced ejection fraction (HFrEF) versus HFpEF.
- This review of the literature found that in multiple randomized clinical trials of supervised exercise training (SET) in selected patients with chronic, stable HFpEF, exercise is safe and provides substantial, clinically relevant improvements in aerobic exercise capacity and quality of life.
- Specifically, exercise training in this clinical population was shown to increase peak VO2 by 6-14%, increase total exercise time by 9-21% (a 10% increase is considered clinically meaningful), may improve quality-of-life scores, and reduce hospitalizations and cardiac events.
- The positive changes gained with SET in individuals with HFpEF are at least comparable or potentially more significant than with exercise therapy in individuals with HFrEF.
- This is notable as exercise-based therapies (e.g., cardiac rehabilitation) are now typically covered by third-party payers, such as Medicare for HFrEF but not for HFpEF.
- This statement emphasizes the importance of exercise-based therapies for chronic, stable HFpEF and for pursuing referral, adherence, and coverage efforts during implementation.
- Future research needs include focusing on maximizing the benefits and accessibility of SET for chronic HFpEF, extending its availability to medically supervised, home-based, and hybrid settings, and addressing common barriers to long-term adherence.
Citation
Sachdev V, Sharma K, Keteyian SJ, Alcain CF, Desvigne-Nickens P, Fleg JL, Florea VG, Franklin BA, Guglin M, Halle M, Leifer ES, Panjrath G, Tinsley EA, Wong RP, Kitzman DW; on behalf of the American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; and American College of Cardiology. Supervised exercise training for chronicheart failure with preserved ejection fraction: a scientific statement from the American Heart Associationand American College of Cardiology [published online ahead of print March 21, 2023]. Circulation. doi: 10.1161/CIR.0000000000001122