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Effect of Endurance Exercise Training on Endothelial Function and Arterial Stiffness in Older Patients With Heart Failure and Preserved Ejection Fraction
Open accessAbstract
Objectives The study sought to evaluate the effects of endurance exercise training (ET) on endothelial-dependent flow-mediated arterial dilation (FMD) and carotid artery stiffness, and their potential contributions to the training-related increase in peak exercise oxygen consumption (Vo2) in older patients with heart failure with preserved ejection fraction (HFPEF).Background Elderly HFPEF patients have severely reduced peak Vo2, which improves with ET, however, the mechanisms of this improvement are unclear. FMD and arterial distensibility are critical components of the exercise response and are reduced with aging. However, it is unknown whether these improve with ET in elderly HFPEF or contribute to the training-related improvement in peak Vo2.Methods A total of 63 HFPEF patients (age 70 ± 7 years) were randomized to 16 weeks of ET (walking, arm and leg ergometry, n = 32) or attention control (CT) (n = 31). Peak Vo2, brachial artery FMD in response to cuff ischemia, carotid artery distensibility by high-resolution ultrasound, left ventricular function, and quality of life were measured at baseline and follow-up.Results ET increased peak Vo2 (ET: 15.8 ± 3.3 ml/kg/min vs. CT: 13.8 ± 3.1 ml/kg/min, p = 0.0001) and quality of life. However, brachial artery FMD (ET: 3.8 ± 3.0% vs. CT: 4.3 ± 3.5%, p = 0.88), and carotid arterial distensibility (ET: 0.97 ± 0.56 vs. CT: 1.07 ± 0.34 × 10(-3) mm·mm Hg(-2); p = 0.65) were unchanged. Resting left ventricular systolic and diastolic function were unchanged by ET.Conclusions In elderly HFPEF patients, 16 weeks of ET improved peak Vo2 without altering endothelial function or arterial stiffness. This suggests that other mechanisms, such as enhanced skeletal muscle perfusion and/or oxygen utilization, may be responsible for the ET-mediated increase in peak Vo2 in older HFPEF patients. (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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“Several studies reported that (modest) weight loss caused by lifestyle interventions in obesity-related HFpEF patients improved exercise capacity but had no effect on cardiac structure or function.”
From The cardioprotective effects of semaglutide exceed those of dietary weight loss in mice with HFpEF (2023) · cites this paper as [56]
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McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab368 · Cited by 13,344
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Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., Falk, V., González-Juanatey, J. R., Harjola, V.-P., Jankowska, E. A., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw128 · Cited by 11,429
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2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
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Metadata
- Authors
- Kitzman, D. W., Brubaker, P. H., Herrington, D. M., Morgan, T. M., Stewart, K. P., Hundley, W. G., Abdelhamed, A., & Haykowsky, M. J.
- Affiliations
- Wake Forest University Health Sciences (US)
- Wake Forest University (US)
- Wright State University (US)
- University of Alberta (CA)
- Corresponding author
- Kitzman, Dalane W.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-08
- Volume
- 62
- Issue
- 7
- Pages
- 584-592
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC3740089
- OpenAlex
- W113644040
- Cited by
- 369
- References
- 69
- Citations by year
- 2026: 19 · 2025: 23 · 2024: 21 · 2023: 33 · 2022: 39 · 2021: 32 · 2020: 18 · 2019: 30 · 2018: 25 · 2017: 35 · 2016: 24 · 2015: 32 · 2014: 31 · 2013: 7
- FWCI
- 74.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (R37AG18915, R01AG12257, and P30AG021332)
- Novartis
- Topics
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- heart failure with preserved ejection fraction, endurance training, endothelial function, flow-mediated dilation, arterial stiffness, carotid distensibility, older adults, quality of life, left ventricular function, skeletal muscle perfusion, ergometry, attentional control
- MeSH terms
- Age Factors, Aged, Aged, 80 and over, Angiography, Carotid Arteries, Endothelium, Vascular, Exercise Therapy, Female, Follow-Up Studies, Heart Failure, Humans, Male, Oxygen Consumption, Prospective Studies, Quality of Life, Reference Values, Severity of Illness Index, Stroke Volume, Ultrasonography, Single-Blind Method, Ventricular Function, Left, Treatment Outcome, Exercise Tolerance, Risk Assessment, Vascular Stiffness
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