title: Effects of inspiratory muscle training in patients with heart failure with preserved ejection fraction.
abstract: BACKGROUND
  Heart failure with preserved ejection fraction (HFpEF) is remarkably common in elderly people with highly prevalent comorbid conditions. Despite its increasing in prevalence, there is no evidence-based effective therapy for HFpEF. We sought to evaluate whether inspiratory muscle training (IMT) improves exercise capacity, as well as left ventricular diastolic function, biomarker profile and quality of life (QoL) in patients with advanced HFpEF and nonreduced maximal inspiratory pressure (MIP).
  
  
  METHODS
  A total of 26 patients with HFpEF (median (interquartile range) age, peak exercise oxygen uptake (peak VO2) and left ventricular ejection fraction of 73 years (66-76), 10 ml/min/kg (7.6-10.5) and 72% (65-77), respectively) were randomized to receive a 12-week programme of IMT plus standard care vs. standard care alone. The primary endpoint of the study was evaluated by positive changes in cardiopulmonary exercise parameters and distance walked in 6 minutes (6MWT). Secondary endpoints were changes in QoL, echocardiogram parameters of diastolic function, and prognostic biomarkers.
  
  
  RESULTS
  The IMT group improved significantly their MIP (p < 0.001), peak VO2 (p < 0.001), exercise oxygen uptake at anaerobic threshold (p = 0.001), ventilatory efficiency (p = 0.007), metabolic equivalents (p < 0,001), 6MWT (p < 0.001), and QoL (p = 0.037) as compared to the control group. No changes on diastolic function parameters or biomarkers levels were observed between both groups.
  
  
  CONCLUSIONS
  In HFpEF patients with low aerobic capacity and non-reduced MIP, IMT was associated with marked improvement in exercise capacity and QoL.
authors.affiliation: University of Valencia. Valencia, Spain patri.palau@gmail.com.
authors.forename: Patricia
authors.initials: P
authors.lastname: Palau
authors.affiliation: Hospital General de Castellón, Castellón, Spain.
authors.forename: Eloy
authors.initials: E
authors.lastname: Domínguez
authors.affiliation: University of Valencia. Valencia, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.affiliation: University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Schmid
authors.affiliation: University of Valencia. Valencia, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Vergara
authors.affiliation: University of Valencia. Valencia, Spain.
authors.forename: Jose María
authors.initials: JM
authors.lastname: Ramón
authors.affiliation: University of Valencia. Valencia, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Mascarell
authors.affiliation: University of Valencia. Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.affiliation: University of Valencia. Valencia, Spain.
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Chorro
authors.affiliation: University of Valencia. Valencia, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001945:Breathing Exercises / Q000379:methods*; D003971:Diastole; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012132:Respiratory Muscles / Q000503:physiopathology*; D013030:Spain; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers
keywords: Exercise capacity; heart failure with preserved ejection fraction; inspiratory muscle training