AHA: Supervised exercise training may yield clinical benefits in HFpEF
Key takeaways:
- Exercise can improve exercise capacity and improve quality of life metrics for people with HFpEF.
- Data show a supervised exercise program can increase peak oxygen uptake 12% to 14%.
Exercise is safe and provides substantial, clinically relevant improvements in aerobic exercise capacity and quality of life for select adults with HF with preserved ejection fraction.
In a new scientific statement, the American Heart Association noted that supervised exercise training could increase peak oxygen uptake by 12% to 14% and increase total exercise time by 21% — both changes that are considered to be clinically meaningful.
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“The prevalence of heart failure with preserved ejection fraction continues to increase due to aging of the population and the growing prevalence of risk factors such as obesity and type 2 diabetes,” Vandana Sachdev, MD, director of the Echocardiography Laboratory at the NHLBI and chair of the scientific statement writing committee, said in a press release. “Improved management of this large population of patients who have HFpEF, many of whom may be undertreated, represents an urgent unmet need.”
Benefits of supervised exercise
In the statement, published in Circulation, the researchers wrote that the strength of currently available data on supervised exercise training for chronic, stable HFpEF and the paucity of effective pharmacological treatments for HFpEF provide a “substantial rationale” for increasing efforts to promote and implement exercise-based therapies for this patient population.
Researchers analyzed data from studies published since 2010 that assessed the impact of exercise-based therapies for HFpEF; types of exercise included walking, stationary cycling, high-intensity interval training, strength training and dancing in both facility settings and home-based training. Supervised exercise therapy generally occurred three times per week for each of the studies and duration varied from 1 to 8 months.
Data from studies show participants randomly assigned to supervised exercise training saw an increase from baseline in peak VO2 of 12% to 14%, depending on the EF inclusion criteria for HF. Data also showed a range of improvement in quality of life metrics as measured by the SF-36, the Minnesota Living with Heart Failure Questionnaire and the Kansas City Cardiomyopathy Questionnaire. Among studies that examined alterations in selected cardiac parameters, some reported no change and others found improvement in diastolic function measures, according to the researchers. Safety among HFpEF participants was consistently demonstrated across studies.
Although none of the analyzed studies had adequate statistical power to assess the impact of exercise on clinical events in HFpEF, the statement highlighted a recent pilot study with 50 participants, where those assigned to exercise were less likely to be hospitalized and there was a trend observed for fewer cardiac events in the exercise training group.
“The inadequacy of current data highlights the need for larger-scale, longer-term studies to examine the effects of supervised exercise training on clinical events in HFpEF,” the researchers wrote.
Medicare coverage recommended
In clinical practice, supervised exercise training is prescribed by health care professionals to improve both aerobic exercise capacity and quality of life. It is most often conducted in a clinical setting with monitoring and typically includes at least three sessions per week of aerobic-type exercises such as walking on a treadmill or stationary cycling. Other types of activities such as muscle strengthening may also be included, and 36 visits are generally prescribed/allowed by third-party payers within a 12-week period.
Specifically, patients with chronic, stable HF with reduced EF have been eligible for exercise-based cardiac rehab coverage since 2014; however, patients with HFpEF were specifically excluded from Medicare coverage because of insufficient evidence at that time, according to the statement.
The authors noted that the magnitude of benefits on exercise capacity and quality of life in HFpEF “appears comparable to or potentially greater than” that for other CV conditions like HFrEF or peripheral artery disease.
“There is now considerable evidence for the safety and efficacy of supervised exercise training for patients with chronic, stable HFpEF, including exercise capacity improvements that appear similar to or greater than those observed in patients with HFrEF,” the researchers wrote.
Reference:
- Exercise therapy is safe, may improve quality of life for many people with heart failure. https://newsroom.heart.org/news/exercise-therapy-is-safe-may-improve-quality-of-life-for-many-people-with-heart-failure. Published March 21, 2023. Accessed March 21, 2023.
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