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Diet, aerobic training improve exercise tolerance in patients with HFpEF
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Aerobic exercise training and calorie restriction may increase exercise capacity in obese older patients with HF with preserved ejection fraction, researchers reported in JAMA.
Dalane W. Kitzman, MD, of Wake Forest School of Medicine, and colleagues conducted a randomized, attention-controlled, 2 x 2 factorial trial between February 2009 and November 2014 at Wake Forest School of Medicine. One hundred participants (81 women; mean age, 67 years; BMI, 39.3) were randomized to one of four groups: exercise (n = 26), diet (n = 24), exercise and diet (n = 25), or control (n = 25).
The primary outcomes were exercise capacity (measured as peak oxygen consumption [VO2]) and quality of life (measured by the Minnesota Living with Heart Failure questionnaire),
Ninety-two participants completed the 20-week study.
According to the results, peak VO2 increased after exercise alone (mean increase, 1.2 mL/kg body mass/min; 95% CI, 0.7-1.7; P < .001), diet alone (1.3 mL/kg body mass/min; 95% CI, 0.8-1.8; P < .001), and both exercise and diet (2.5 mL/kg/min).
The increase in peak VO2 was positively associated with changes in percent lean body mass (r = 0.32; P = .003) and thigh muscle:intermuscular fat ratio (r = 0.27; P = .02). Body weight decreased by 7% in the diet-only group, 3% in the exercise-only group, 10% in the exercise and diet group, and 1% in the control group. Diet was positively correlated with decreases in left ventricular mass (–4g; 95% CI, –7 to 0; P = .03) and LV relative wall thickness (–0.03; 95% CI, –0.05 to –0.01; P = .005) and increases in mitral E/A velocity ratio (0.10; 95% CI, 0.02 to 0.17; P = .01). NYHA HF class improved with both exercise (–0.4 class; 95% CI, –0.6 to –0.2; P < .001) and diet (–0.4 class; 95% CI, –0.5 to –0.2; P = .001).
The researchers observed to change in quality of life scores after diet alone (–6 units; 95% CI, –12 to 1; P = .08) or exercise alone (–1 unit; 95% CI, –8 to 5; P = .7).
“The major novel findings of this randomized clinical trial are that among older obese participants with chronic, stable [HF, preserved ejection fraction], intentional weight loss via caloric restriction diet was feasible, appeared safe and significantly improved the co-primary outcome of exercise capacity,” Kitzman and colleagues wrote. The researchers cautioned, however, that the “heart failure obesity paradox” warrants further research before diet can be recommended in this population.
Nanette K. Wenger
In a related editorial, Nanette K. Wenger, MD, of the Emory University School of Medicine and Cardiology Today Editorial Board member, acknowledged a need for “further investigation in a community population, with longer follow-up, either with or without specific provision of meals to effect caloric restriction.” However, she noted that testing this intervention in a community setting may be challenging. “Whether nonprofessionally administered diet and nonmedically supervised exercise could safely attain similar benefit is uncertain, but worthy of exploration,” she wrote. – by Tracey Romero
Disclosure: Kitzman reports receiving personal fees from AbbVie, Corvia Medical, Forest Laboratories, GlaxoSmithKline, Icon, Merck, Regeneron and Relypsa. Wenger reports no relevant financial disclosures.
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