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Effect of Endurance Training on the Determinants of Peak Exercise Oxygen Consumption in Elderly Patients With Stable Compensated Heart Failure and Preserved Ejection Fraction
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Objectives The purpose of this study was to evaluate the mechanisms for improved exercise capacity after endurance exercise training (ET) in elderly patients with heart failure and preserved ejection fraction (HFPEF).Background Exercise intolerance, measured objectively by reduced peak oxygen consumption (VO(2)), is the primary chronic symptom in HFPEF and is improved by ET. However, the mechanisms are unknown.Methods Forty stable, compensated HFPEF outpatients (mean age 69 ± 6 years) were examined at baseline and after 4 months of ET (n = 22) or attention control (n = 18). The VO(2) and its determinants were assessed during rest and peak upright cycle exercise.Results After ET, peak VO(2) in those patients was higher than in control patients (16.3 ± 2.6 ml/kg/min vs. 13.1 ± 3.4 ml/kg/min; p = 0.002). That was associated with higher peak heart rate (139 ± 16 beats/min vs. 131 ± 20 beats/min; p = 0.03), but no difference in peak end-diastolic volume (77 ± 18 ml vs. 77 ± 17 ml; p = 0.51), stroke volume (48 ± 9 ml vs. 46 ± 9 ml; p = 0.83), or cardiac output (6.6 ± 1.3 l/min vs. 5.9 ± 1.5 l/min; p = 0.32). However, estimated peak arterial-venous oxygen difference was significantly higher in ET patients (19.8 ± 4.0 ml/dl vs. 17.3 ± 3.7 ml/dl; p = 0.03). The effect of ET on cardiac output was responsible for only 16% of the improvement in peak VO(2).Conclusions In elderly stable compensated HFPEF patients, peak arterial-venous oxygen difference was higher after ET and was the primary contributor to improved peak VO(2). This finding suggests that peripheral mechanisms (improved microvascular and/or skeletal muscle function) contribute to the improved exercise capacity after ET in HFPEF. (Prospective Aerobic Reconditioning Intervention Study [PARIS]; NCT01113840).
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“In older patients with HF with preserved ejection fraction, the increased peak V˙o2 after moderate-intensity continuous endurance exercise training was secondary to peripheral adaptations that resulted in increased peak exercise AV˙o2 difference without a change in cardiovascular function (ie, no change in peak exercise cardiac output, central artery stiffness, or peripheral arterial endothelial”
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Metadata
- Authors
- Haykowsky, M. J., Brubaker, P. H., Stewart, K. P., Morgan, T. M., Eggebeen, J., & Kitzman, D. W.
- Affiliations
- University of Alberta (CA)
- Wake Forest University (US)
- Wake Forest University Health Sciences (US)
- Corresponding author
- Kitzman, Dalane W.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-07
- Volume
- 60
- Issue
- 2
- Pages
- 120-128
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC3429944
- OpenAlex
- W2049452504
- Cited by
- 358
- References
- 62
- Citations by year
- 2026: 17 · 2025: 30 · 2024: 20 · 2023: 31 · 2022: 22 · 2021: 34 · 2020: 25 · 2019: 25 · 2018: 24 · 2017: 34 · 2016: 19 · 2015: 24 · 2014: 29 · 2013: 16 · 2012: 7
- FWCI
- 59.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R37 AG18915, RO1AG12257)
- Claude D. Pepper Older Americans Independence Center of Wake Forest University NIH (P30AG21332)
- General Clinical Research Center of Wake Forest University School of Medicine (MO1RR07122)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- endurance training, peak oxygen uptake, exercise capacity, arteriovenous oxygen difference, cardiac output, elderly patients, exercise intolerance, microvascular function, skeletal muscle function
- MeSH terms
- Aged, Female, Heart Failure, Hemodynamics, Humans, Male, Middle Aged, Oxygen Consumption, Stroke Volume, Ventricular Function, Left, Exercise Tolerance, Muscle, Skeletal
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