Skip to main content
SpringerLink
Log in

Effects of exercise training on cardiac function, exercise capacity, and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

Left ventricular (LV) diastolic dysfunction is associated with the pathophysiology of heart failure with preserved ejection fraction (HFpEF) and contributes importantly to exercise intolerance that results in a reduced quality of life (QOL) in HFpEF patients. Although the effects of exercise training on LV diastolic function, exercise capacity, or QOL in HFpEF patients have been examined in randomized clinical trials (RCTs), results are inconsistent due partly to limited power with small sample sizes. We aimed to conduct a meta-analysis of RCTs examining the effects of exercise training on LV diastolic function and exercise capacity as well as QOL in HFpEF patients. The search of electronic databases identified 8 RCTs with 436 patients. The duration of exercise training ranged from 12 to 24 weeks. In the pooled analysis, exercise training improved peak exercise oxygen uptake (weighted mean difference [95% CI], 1.660 [0.973, 2.348] ml/min/kg), 6-min walk distance (33.883 [12.384 55.381] m), and Minnesota Living With Heart Failure Questionnaire total score (9.059 [3.083, 15.035] point) compared with control. In contrast, exercise training did not significantly change early diastolic mitral annular velocity (weighted mean difference [95% CI], 0.317 [− 0.952, 1.587] cm/s), the ratio of early diastolic mitral inflow to annular velocities (− 1.203 [− 4.065, 1.658]), or LV ejection fraction (0.850 [− 0.128, 1.828] %) compared with control. In conclusion, the present meta-analysis suggests that exercise training improves exercise capacity and QOL without significant change in LV systolic or diastolic function in HFpEF patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D (1999) Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol 33:1948–1955

    Article  CAS  PubMed  Google Scholar 

  2. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251–259

    Article  CAS  PubMed  Google Scholar 

  3. Tsuchihashi-Makaya M, Hamaguchi S, Kinugawa S, Yokota T, Goto D, Yokoshiki H, Kato N, Takeshita A, Tsutsui H, JCARE-CARD Investigators (2009) Characteristics and outcomes of hospitalized patients with heart failure and reduced vs preserved ejection fraction. Report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J 73:1893–1900

    Article  PubMed  Google Scholar 

  4. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ et al (2003) Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial. Lancet 362:777–781

    Article  CAS  PubMed  Google Scholar 

  5. Massie BM, Carson PE, McMurray JJ, Komajda M, McKelvie R, Zile MR et al (2008) Irbesartan in patients with heart failure and preserved ejection fraction. N Engl J Med 359:2456–2467

    Article  CAS  PubMed  Google Scholar 

  6. Cleland JG, Tendera M, Adamus J, Freemantle N, Polonski L, Taylor J (2006) The perindopril in elderly people with chronic heart failure (PEP-CHF) study. Eur Heart J 27:2338–2345

    Article  CAS  PubMed  Google Scholar 

  7. Yamamoto K, Origasa H, Hori M (2013) Effects of carvedilol on heart failure with preserved ejection fraction: the Japanese Diastolic Heart Failure Study (J-DHF). Eur J Heart Fail 15:110–118

    Article  CAS  PubMed  Google Scholar 

  8. Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, Clausell N, Desai AS, Diaz R, Fleg JL, Gordeev I, Harty B, Heitner JF, Kenwood CT, Lewis EF, O'Meara E, Probstfield JL, Shaburishvili T, Shah SJ, Solomon SD, Sweitzer NK, Yang S, McKinlay SM (2014) Spironolactone for heart failure with preserved ejection fraction. N Engl J Med 370:1383–1392

    Article  CAS  PubMed  Google Scholar 

  9. Kitzman DW, Little WC, Brubaker PH, Anderson RT, Hundley WG, Marburger CT et al (2002) Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure. JAMA 288:2144–2150

    Article  PubMed  Google Scholar 

  10. Bhella PS, Prasad A, Heinicke K, Hastings JL, rbab-Zadeh A, ms-Huet B et al (2011) Abnormal haemodynamic response to exercise in heart failure with preserved ejection fraction. Eur J Heart Fail 13:1296–1304

    Article  PubMed  PubMed Central  Google Scholar 

  11. Zile MR, Baicu CF, Gaasch WH (2004) Diastolic heart failure—abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med 350:1953–1959

    Article  CAS  PubMed  Google Scholar 

  12. Lam CS, Roger VL, Rodeheffer RJ, Bursi F, Borlaug BA, Ommen SR et al (2007) Cardiac structure and ventricular-vascular function in persons with heart failure and preserved ejection fraction from Olmsted County, Minnesota. Circulation 115:1982–1990

    Article  PubMed  PubMed Central  Google Scholar 

  13. Zile MR, Gottdiener JS, Hetzel SJ, McMurray JJ, Komajda M, McKelvie R et al (2011) Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction. Circulation 124:2491–2501

    Article  PubMed  Google Scholar 

  14. Kitzman DW, Higginbotham MB, Cobb FR, Sheikh KH, Sullivan MJ (1991) Exercise intolerance in patients with heart failure and preserved left ventricular systolic function: failure of the Frank-Starling mechanism. J Am Coll Cardiol 17:1065–1072

    Article  CAS  PubMed  Google Scholar 

  15. Zile MR, Kjellstrom B, Bennett T, Cho Y, Baicu CF, Aaron MF, Abraham WT, Bourge RC, Kueffer FJ (2013) Effects of exercise on left ventricular systolic and diastolic properties in patients with heart failure and a preserved ejection fraction versus heart failure and a reduced ejection fraction. Circ Heart Fail 6:508–516

    Article  CAS  PubMed  Google Scholar 

  16. Maeder MT, Thompson BR, Brunner-La Rocca HP, Kaye DM (2010) Hemodynamic basis of exercise limitation in patients with heart failure and normal ejection fraction. J Am Coll Cardiol 56:855–863

    Article  PubMed  Google Scholar 

  17. Abudiab MM, Redfield MM, Melenovsky V, Olson TP, Kass DA, Johnson BD, Borlaug BA (2013) Cardiac output response to exercise in relation to metabolic demand in heart failure with preserved ejection fraction. Eur J Heart Fail 15:776–785

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gary RA, Sueta CA, Dougherty M, Rosenberg B, Cheek D, Preisser J, Neelon V, McMurray R (2004) Home-based exercise improves functional performance and quality of life in women with diastolic heart failure. Heart Lung 33:210–218

    Article  PubMed  Google Scholar 

  19. Kitzman DW, Brubaker PH, Morgan TM, Stewart KP, Little WC (2010) Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. Circ Heart Fail 3:659–667

    Article  PubMed  PubMed Central  Google Scholar 

  20. Edelmann F, Gelbrich G, Dungen HD, Frohling S, Wachter R, Stahrenberg R 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 58:1780–1791

    Article  PubMed  Google Scholar 

  21. Smart NA, Haluska B, Jeffriess L, Leung D (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 18:295–301

    Article  PubMed  Google Scholar 

  22. Alves AJ, Ribeiro F, Goldhammer E, Rivlin Y, Rosenschein U, Viana JL et al (2012) Exercise training improves diastolic function in heart failure patients. Med Sci Sports Exerc 44:776–785

    Article  PubMed  Google Scholar 

  23. Kitzman DW, Brubaker PH, Herrington DM, Morgan TM, Stewart KP, Hundley WG, Abdelhamed A, Haykowsky MJ (2013) Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. J Am Coll Cardiol 62:584–592

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kitzman DW, Brubaker P, Morgan T, Haykowsky M, Hundley G, Kraus WE, Eggebeen J, Nicklas BJ (2016) Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical trial. JAMA 315:36–46

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Fu TC, Yang NI, Wang CH, Cherng WJ, Chou SL, Pan TL, Wang JS (2016) Aerobic interval training elicits different hemodynamic adaptations between heart failure patients with preserved and reduced ejection fraction. Am J Phys Med Rehabil 95:15–27

    Article  PubMed  Google Scholar 

  26. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(264–9):W64

    Google Scholar 

  27. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  28. Follmann D, Elliott P, Suh I, Cutler J (1992) Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol 45:769–773

    Article  CAS  PubMed  Google Scholar 

  29. Pandey A, Parashar A, Kumbhani DJ, Agarwal S, Garg J, Kitzman D, Levine BD, Drazner M, Berry JD (2015) Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials. Circ Heart Fail 8:33–40

    Article  PubMed  Google Scholar 

  30. Fukuta H, Goto T, Wakami K, Ohte N (2016) Effects of drug and exercise intervention on functional capacity and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Eur J Prev Cardiol 23:78–85

    Article  PubMed  Google Scholar 

  31. Pearson MJ, Mungovan SF, Smart NA (2017) Effect of exercise on diastolic function in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 22:229–242

    Article  CAS  PubMed  Google Scholar 

  32. Karavidas A, Driva M, Parissis JT, Farmakis D, Mantzaraki V, Varounis C, Paraskevaidis I, Ikonomidis I, Pirgakis V, Anastasiou-Nana M, Filippatos G (2013) Functional electrical stimulation of peripheral muscles improves endothelial function and clinical and emotional status in heart failure patients with preserved left ventricular ejection fraction. Am Heart J 166:760–767

    Article  CAS  PubMed  Google Scholar 

  33. Palau P, Dominguez E, Nunez E, Schmid JP, Vergara P, Ramon JM et al (2013) Effects of inspiratory muscle training in patients with heart failure with preserved ejection fraction. Eur J Prev Cardiol

  34. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107–133

    Article  PubMed  Google Scholar 

  35. Haykowsky MJ, Tomczak CR, Scott JM, Paterson DI, Kitzman DW (2015) Determinants of exercise intolerance in patients with heart failure and reduced or preserved ejection fraction. J Appl Physiol (1985) 119:739–744

    Article  CAS  Google Scholar 

  36. Haykowsky MJ, Brubaker PH, Stewart KP, Morgan TM, Eggebeen J, Kitzman DW (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 60:120–128

    Article  PubMed  PubMed Central  Google Scholar 

  37. Tu RH, Zeng ZY, Zhong GQ, Wu WF, Lu YJ, Bo ZD, He Y, Huang WQ, Yao LM (2014) Effects of exercise training on depression in patients with heart failure: a systematic review and meta-analysis of randomized controlled trials. Eur J Heart Fail 16:749–757

    Article  PubMed  Google Scholar 

  38. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62:e147–e239

    Article  PubMed  Google Scholar 

  39. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200

    Article  PubMed  Google Scholar 

  40. Vaduganathan M, Michel A, Hall K, Mulligan C, Nodari S, Shah SJ, Senni M, Triggiani M, Butler J, Gheorghiade M (2016) Spectrum of epidemiological and clinical findings in patients with heart failure with preserved ejection fraction stratified by study design: a systematic review. Eur J Heart Fail 18:54–65

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Core Laboratory, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8601, Japan

    Hidekatsu Fukuta

  2. Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Toshihiko Goto, Kazuaki Wakami & Nobuyuki Ohte

  3. Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Takeshi Kamiya

Authors
  1. Hidekatsu Fukuta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshihiko Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kazuaki Wakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takeshi Kamiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nobuyuki Ohte
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hidekatsu Fukuta.

Ethics declarations

Conflict of interest

Dr. Ohte has received lecture fees from Takeda Pharmaceutical Co. Ltd., Daiichi Sankyo Co., Ltd., Bayer GA, AstraZeneca plc, and Boehringer Ingelheim and grant support from Takeda Pharmaceutical Co. Ltd., Bayer GA, Daiichi Sankyo Co., Ltd., MSD, Novartis International AG, Boehringer Ingelheim, Astellas Pharma Inc., and Otsuka Pharmaceutical Co., Ltd. No other disclosures were reported.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOC 127 kb)

ESM 2

(DOC 68 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fukuta, H., Goto, T., Wakami, K. et al. Effects of exercise training on cardiac function, exercise capacity, and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Heart Fail Rev 24, 535–547 (2019). https://doi.org/10.1007/s10741-019-09774-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-019-09774-5

Keywords

Search

Navigation