Effects of long-term endurance and resistance training on diastolic function, exercise capacity, and quality of life in asymptomatic diastolic dysfunction vs. heart failure with preserved ejection fraction

Background The long-term effects of exercise training (ET) in diastolic dysfunction (DD) and heart failure with preserved ejection fraction (HFpEF) are unknown. The present study compared the long-term effects of ET on exercise capacity, diastolic function, and quality of life (QoL) in patients with DD vs. HFpEF. Methods A total of n=43 patients with asymptomatic DD (n=19) or HFpEF [DD and New York Heart Association (NYHA) ≥II, n=24] and left ventricular ejection fraction ≥50% performed a combined endurance/resistance training over 6months (2–3/week) on top of usual care. Cardiopulmonary exercise testing, echocardiography, and QoL were obtained at baseline and follow-up. Results Patients were 62±8 years old (37% female). In the HFpEF group, 67% of patients were in NYHA class II (33% in NYHA III). Exercise capacity (peak oxygen consumption, peak VO2) differed at baseline (DD 29.2±8.7mL/min/kg vs. HFpEF 17.8±4.6 mL/min/kg; P=0.004). After 6months, peak VO2 increased significantly (P<0.044) to 19.7±5.8 mL/min/kg in the HFpEF group and also in the DD group (to 32.8±8.5mL/min/kg; P<0.002) with no overall difference between the groups (P=0.217). E/e′ ratio (left ventricular filling index) decreased from 12.2±3.5 to 10.1±3.0 (P<0.002) in patients with HFpEFand also in patients with DD (10.7±3.1 vs. 9.5±2.3; P=0.03; difference between groups P=0.210). In contrast, left atrial volume index decreased in the HFpEF group (P<0.001) but remained stable within the DD group (difference between groups P=0.015). After 6 months, physical QoL (Minnesota living with heart failure Questionnaire, 36-item short form health survey), general health perception, and 9-item patient health questionnaire score only improved in HFpEF (P<0.05). In contrast, vitality improved in both groups (difference between groups P=0.708). Conclusion A structured 6 months ET programme effectively improves exercise capacity and diastolic function in patients with DD and overt HFpEF. Therefore, controlled lifestylemodification with physical activity is effective both in DD and HFpEF.