Response to Endurance Exercise Training in Older Adults with Heart Failure with Preserved or Reduced Ejection Fraction.
OBJECTIVE
To systematically examine the relative magnitude and predictors of responses to exercise training in older adult with heart failure (HF) with reduced ejection fraction (HFrEF), and preserved EF (HFpEF).


METHODS
Secondary analysis of a randomized controlled trial.


METHODS
Outpatient cardiac rehabilitation program.


METHODS
Individuals with HF (24 HFrEF, 24 HFpEF) who underwent supervised exercise training.


METHODS
The study included individual-level data from the exercise training arms of a randomized controlled trial that evaluated the effect of 16 weeks of supervised moderate-intensity endurance exercise training in older adults with chronic, stable HFpEF and HFrEF. Changes in peak oxygen uptake (VO2peak) in response to supervised training in individuals with HFpEF were compared with that of individuals with HFrEF. The significant clinical predictors of changes in VO2peakwith exercise training were assessed using univariate and multivariate regression models.


RESULTS
Training-related improvement in VO2peakwas higher in participants with HFpEF than in those with HFrEF (change: 18.7 ± 17.6% vs -0.3 ± 15.4%, P < .001). In univariate analysis, echocardiographic abnormalities in left ventricular structure and function and lower body mass index were associated with blunted response of VO2peakwith exercise training. In multivariate regression analysis using stepwise selection, submaximal exercise systolic blood pressure, and resting early deceleration time were independent predictors of change in VO2peak.


CONCLUSIONS
The change in VO2peakin response to endurance exercise training in older adults with HF differs significantly according to HF subtype, with greater VO2peakimprovement in HFpEF than HFrEF. These results suggest that the current Centers for Medicare and Medicaid Services policy excluding individuals with HFpEF from reimbursement from cardiac rehabilitation may need to be revisited.
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
Ambarish
A
Pandey
Section of Cardiovascular Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.|Sections of Geriatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Dalane W
DW
Kitzman
Translational Science Center, Wake Forest University, Winston-Salem, North Carolina.|Health and Exercise Science Department, Wake Forest University, Winston-Salem, North Carolina.
Peter
P
Brubaker
College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas.
Mark J
MJ
Haykowsky
Department of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Timothy
T
Morgan
Section of Cardiovascular Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.|Sections of Geriatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
J Thomas
JT
Becton
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.|Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
Jarett D
JD
Berry
D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009749:Nutrition Surveys; D011788:Quality of Life; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D014481:United States; D016277:Ventricular Function, Left / Q000502:physiology*
cardiorespiratory fitness; exercise training; heart failure