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The Benefits of Exercise Training on Aerobic Capacity in Patients with Heart Failure and Preserved Ejection Fraction

Chapter
First Online:
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1000)

Abstract

Heart failure with preserved ejection fraction (HFpEF) is defined as an inability of the ventricles to optimally accept blood from atria with blunted end- diastolic volume response by limiting the stroke volume and cardiac output. The HEpEF prevalence is higher in elderly and women and may be associated to hypertension, diabetes mellitus and atrial fibrillation. Severe exercise intolerance, manifested by dyspnea and fatigue during physical effort is the important chronic symptom in HFpEF patients, in which is the major determinant of their reduced quality of life. In this sense, several studies demonstrated reduced aerobic capacity in terms of lower peak oxygen consumption (peak VO2) in patients with HFpEF. In addition, the lower aerobic capacity observed in HFpEF may be due to impaired both convective and diffusive O2 transport (i.e. reduced cardiac output and arteriovenous oxygen difference, respectively).

Exercise training program can help restore physiological function in order to increase aerobic capacity and improve the quality of life in HFpEF patients. Therefore, the primary purpose of this chapter was to clarify the physiological mechanisms associated with reduced aerobic capacity in HFpEF patients. Secondly, special focus was devoted to show how aerobic exercise training can improve aerobic capacity and quality of life in HFpEF patients.

Keywords

Exercise Aerobic capacity Heart Failure with Preserved Ejection Fraction 
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References

  1. 1.
    Dieberg G, Ismail H, Giallauria F et al (2015) Clinical outcomes and cardiovascular responses to exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis. J Appl Physiol 119(6):726–733CrossRefPubMedGoogle Scholar
  2. 2.
    Bhathia RS, JV T, Austin PC et al (2006) Epidemiology and clinical course of heart failure with preserved ejection fraction. N Engl J Med 355(3):260–269CrossRefGoogle Scholar
  3. 3.
    Lam CS, Donal E, Kraigher- Krainer E et al (2011) Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail 13(1):18–28CrossRefPubMedGoogle Scholar
  4. 4.
    Lee DS, Gona P, Vasan RS et al (2009) Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction. Circulation 119(24):3070–3077CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Haykowsky MJ, Kitzman DW (2014) Exercise physiology in heart failure and preserved ejection fraction. Heart Fail Clin 10(3):445–452CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Prado DM, Rocco EA, Silva AG et al (2016) Effect of exercise training on ventilatory efficiency in patients with heart disease. Braz J of Med Biol Res 49(7)Google Scholar
  7. 7.
    Prado DM, Benatti FB, de Sá- Pinto AL et al (2013) Exercise training in childhood- onset systemic lupus erythematosus: a controlled randomized trial. Arthritis Res Ther 15(2):R46CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Rocco EA, Prado DM, Silva AG et al (2012) Effect of continuous and interval exercise training on the PeTCO2 response during graded exercise test in patients with coronary artery disease. Clinicis 67(6):623–628Google Scholar
  9. 9.
    Dhakal BP, Malhotra R, Murphy RM et al (2015) Mechanisms of exercise intolerance in heart failure with preserved ejection fraction. Circ Heart Fail 8(2):286–294CrossRefPubMedGoogle Scholar
  10. 10.
    Abudiab MM, Redfield MM, Melenovsky V et al (2015) Cardiac output response to exercise in relation to metabolic demand in heart failure with preserved ejection fraction. Euro J Heart Fail 15(7):776–785CrossRefGoogle Scholar
  11. 11.
    Bhella PS, Prasad A, Heinicke K et al (2011) Abnormal haemodynamic response to exercise in heart failure with preserved ejection fraction. Eur J Heart Fail 13(12):1296–1304CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Borlaug BA, Nishimura RA, Sorajja P et al (2010) Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ Heart Fail 3(5):588–595CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Borlaug BA, Melenovsky V, Russell SD et al (2006) Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and preserved ejection fraction. Circulation 114(20):2138–2147CrossRefPubMedGoogle Scholar
  14. 14.
    Smart NA, Haluska B, Jeffriess L et al (2012) Exercise training in heart failure with preserved systolic function: a randomized controlled trial of the effects on cardiac function and functional capacity. Congest Heart Fail 18(6):295–301CrossRefPubMedGoogle Scholar
  15. 15.
    Kitzman DW, Brubaker PH, Morgan TM et al (2010) Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single- blind trial. Circ Heart Fail 3(6):659–667CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Edelman F, Gelbrich G, Dungen HD et al (2011) 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. J Am Coll Cardiol 58(17):1780–1791CrossRefGoogle Scholar
  17. 17.
    Haykowsky MJ, Brubaker PH, John SM et al (2011) Determinants of exercise intolerance in elderly heart failure patients with preserved ejection fraction. J Am Coll Cardiol 58(3):265–274CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kitzman DW, Higginbotham MB, Cobb FR et al (1991) Exercise intolerance in patients with heart failure and preserved left ventricular systolic function: failure of the Frank-starling mechanism. J Am Coll Cardiol 17(5):1065–1072CrossRefPubMedGoogle Scholar
  19. 19.
    Hirai DM, Musch TI, Poole DC (2015) Exercise training in chronic heart failure: improving skeletal muscle O2 transport and utilization. Am J Physiol Heart Circ Physiol 309(9):H1419–H1439CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Prado DM, Silva AG, Rocco DFM (2015) Impaired aerobic capacity in systemic lupus erythematosus patients: what are the physiological mechanisms? Rheumatology (S6):008Google Scholar
  21. 21.
    Borlaug BA, Olson TP, Lam CS et al (2010) Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction. J Am Coll Cardiol 56(11):845–854CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Tan YT, Wenzelburger F, Lee E et al (2009) The pathophysiology of heart failure with normal ejection fraction: exercise echocardiography reveals complex abnormalities of both systolic and diastolic ventricular function involving torsion, untwist, and longitudinal motion. J Am Coll Cardiol 54(1):36–46CrossRefPubMedGoogle Scholar
  23. 23.
    Pandey A, Parashar A, Kumbhani DJ et al (2015) Exercise training in patients with heart failure and preserved ejection fraction meta-analysis of randomized control trials. Circ Heart Fail 8(1):33–40CrossRefPubMedGoogle Scholar
  24. 24.
    Chan E, Giallauria F, Vigorito C et al (2016) Exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta- analysis. Monaldi Arch Ches Dis 86(1–2):759Google Scholar
  25. 25.
    Haykowsky MJ, Brubaker PH, Stewart KP et al (2012) Effect of endurance training on the determinants of peak exercise oxygen consumption in elderly patients with stable compensated heart failure and preserved ejection fraction. J Am Coll Cardiol 60(2):120–128CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Kitzman DW, Brubaker PH, Herrington DM et al (2013) Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction. J Am Coll Cardiol 62(7):584–592CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Note K, Herrmann-Lingen C, Wachter R et al (2015) Effects of exercise training on different quality of life dimensions in heart failure with preserved ejection fraction: the ex- DHF-P trial. Eur J of Prev Cardiol 22(5):582–593CrossRefGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2017

Authors and Affiliations

  1. 1.TotalCor Hospital, Amil GroupSão PauloBrazil

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