title: Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study.
abstract: OBJECTIVE
  We sought to determine whether structured exercise training (ET) improves maximal exercise capacity, left ventricular diastolic function, and quality of life (QoL) in patients with heart failure with preserved ejection fraction (HFpEF).
  
  
  BACKGROUND
  Nearly one-half of patients with heart failure experience HFpEF, but effective therapeutic strategies are sparse.
  
  
  METHODS
  A total of 64 patients (age 65 ± 7 years, 56% female) with HFpEF were prospectively randomized (2:1) to supervised endurance/resistance training in addition to usual care (ET, n = 44) or to usual care alone (UC) (n = 20). The primary endpoint was the change in peak Vo(2) after 3 months. Secondary endpoints included effects on cardiac structure, diastolic function, and QoL.
  
  
  RESULTS
  Peak Vo(2) increased (16.1 ± 4.9 ml/min/kg to 18.7 ± 5.4 ml/min/kg; p < 0.001) with ET and remained unchanged (16.7 ± 4.7 ml/min/kg to 16.0 ± 6.0 ml/min/kg; p = NS) with UC. The mean benefit of ET was 3.3 ml/min/kg (95% confidence interval [CI]: 1.8 to 4.8, p < 0.001). E/e' (mean difference of changes: -3.2, 95% CI: -4.3 to -2.1, p < 0.001) and left atrial volume index (milliliters per square meter) decreased with ET and remained unchanged with UC (-4.0, 95% CI: -5.9 to -2.2, p < 0.001). The physical functioning score (36-Item Short-Form Health Survey) improved with ET and remained unchanged with UC (15, 95% CI: 7 to 24, p < 0.001). The ET-induced decrease of E/e' was associated with 38% gain in peak Vo(2) and 50% of the improvement in physical functioning score.
  
  
  CONCLUSIONS
  Exercise training improves exercise capacity and physical dimensions of QoL in HFpEF. This benefit is associated with atrial reverse remodeling and improved left ventricular diastolic function. (Exercise Training in Diastolic Heart Failure-Pilot Study: A Prospective, Randomised, Controlled Study to Determine the Effects of Physical Training on Exercise Capacity and Quality of Life [Ex-DHF-P]; ISRCTN42524037).
authors: Department of Cardiology, University of Göttingen, Göttingen, Germany.
authors: Frank
authors: F
authors: Edelmann
authors: Götz
authors: G
authors: Gelbrich
authors: Hans-Dirk
authors: HD
authors: Düngen
authors: Stefan
authors: S
authors: Fröhling
authors: Rolf
authors: R
authors: Wachter
authors: Raoul
authors: R
authors: Stahrenberg
authors: Lutz
authors: L
authors: Binder
authors: Agnieszka
authors: A
authors: Töpper
authors: Diana Jahandar
authors: DJ
authors: Lashki
authors: Silja
authors: S
authors: Schwarz
authors: Christoph
authors: C
authors: Herrmann-Lingen
authors: Markus
authors: M
authors: Löffler
authors: Gerd
authors: G
authors: Hasenfuss
authors: Martin
authors: M
authors: Halle
authors: Burkert
authors: B
authors: Pieske
mesh_terms: D000368:Aged; D003971:Diastole; D017079:Exercise Tolerance; D005260:Female; D054144:Heart Failure, Diastolic / Q000628:therapy*; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D055070:Resistance Training