title: Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial.
abstract: BACKGROUND
  Heart failure (HF) with preserved left ventricular ejection fraction (HFPEF) is the most common form of HF in the older population. Exercise intolerance is the primary chronic symptom in patients with HFPEF and is a strong determinant of their reduced quality of life (QOL). Exercise training (ET) improves exercise intolerance and QOL in patients with HF with reduced ejection fraction (EF). However, the effect of ET in HFPEF has not been examined in a randomized controlled trial.
  
  
  RESULTS
  This 16-week investigation was a randomized, attention-controlled, single-blind study of medically supervised ET (3 days per week) on exercise intolerance and QOL in 53 elderly patients (mean age, 70±6 years; range, 60 to 82 years; women, 46) with isolated HFPEF (EF ≥50% and no significant coronary, valvular, or pulmonary disease). Attention controls received biweekly follow-up telephone calls. Forty-six patients completed the study (24 ET, 22 controls). Attendance at exercise sessions in the ET group was excellent (88%; range, 64% to 100%). There were no trial-related adverse events. The primary outcome of peak exercise oxygen uptake increased significantly in the ET group compared to the control group (13.8±2.5 to 16.1±2.6 mL/kg per minute [change, 2.3±2.2 mL/kg per minute] versus 12.8±2.6 to 12.5±3.4 mL/kg per minute [change, -0.3±2.1 mL/kg per minute]; P=0.0002). There were significant improvements in peak power output, exercise time, 6-minute walk distance, and ventilatory anaerobic threshold (all P<0.002). There was improvement in the physical QOL score (P=0.03) but not in the total score (P=0.11).
  
  
  CONCLUSIONS
  ET improves peak and submaximal exercise capacity in older patients with HFPEF.
authors.affiliation: Cardiology Section, Department of Internal Medicine, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA. dkitzman@wfubmc.edu
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
authors.forename: Peter H
authors.initials: PH
authors.lastname: Brubaker
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Morgan
authors.forename: Kathryn P
authors.initials: KP
authors.lastname: Stewart
authors.forename: William C
authors.initials: WC
authors.lastname: Little
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015308:Anaerobic Threshold; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010806:Physical Education and Training; D011788:Quality of Life; D016037:Single-Blind Method; D013318:Stroke Volume