Impaired Aerobic Capacity and Physical Functional Performance in Older Heart Failure Patients With Preserved Ejection Fraction: Role of Lean Body Mass
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BACKGROUND: Exercise intolerance is the primary chronic symptom in patients with heart failure and preserved ejection fraction (HFPEF), the most common form of heart failure in older persons, and can result from abnormalities in cardiac, vascular, and skeletal muscle, which can be further worsened by physical deconditioning. However, it is unknown whether skeletal muscle abnormalities contribute to exercise intolerance in HFPEF patients. METHODS: This study evaluated lean body mass, peak exercise oxygen consumption (VO2), and the short physical performance battery in 60 older (69 ± 7 years) HFPEF patients and 40 age-matched healthy controls. RESULTS: In HFPEF versus healthy controls, peak percent total lean mass (60.1 ± 0.8% vs. 66.6 ± 1.0%, p < .0001) and leg lean mass (57.9 ± 0.9% vs. 63.7 ± 1.1%, p = .0001) were significantly reduced. Peak VO2 was severely reduced including when indexed to leg lean mass (79.3 ± 18.5 vs. 104.3 ± 20.4 ml/kg/min, p < .0001). Peak VO2 was correlated with percent total (r = .51) and leg lean mass (.52, both p < .0001). The slope of the relationship of peak VO2 with percent leg lean mass was markedly reduced in HFPEF (11 ± 5 ml/min) versus healthy controls (36 ± 5 ml/min; p < .001). Short physical performance battery was reduced (9.9 ± 1.4 vs. 11.3 ± 0.8) and correlated with peak VO2 and total and leg lean mass (all p < .001). CONCLUSION: Older HFPEF patients have significantly reduced percent total and leg lean mass and physical functional performance compared with healthy controls. The markedly decreased peak VO2 indexed to lean body mass in HFPEF versus healthy controls suggests that abnormalities in skeletal muscle perfusion and/or metabolism contribute to the severe exercise intolerance in older HFPEF patients.
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A consequence of the HF-mediated decline in peak VO2 is decreased physical functional performance and greater risk for poor outcomes.
“A consequence of the HF-mediated decline in peak V˙o2 is decreased physical functional performance and greater risk for poor outcomes.186,187,189–193”
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- Authors
- Haykowsky, M. J., Brubaker, P. H., Morgan, T. M., Kritchevsky, S., Eggebeen, J., & Kitzman, D. W.
- Affiliations
- University of Alberta (CA)
- Wake Forest University Health Sciences (US)
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-03-22
- Volume
- 68
- Issue
- 8
- Pages
- 968-975
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- PMC
- PMC3712362
- OpenAlex
- W2118960401
- Cited by
- 189
- References
- 34
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 10 · 2023: 19 · 2022: 26 · 2021: 12 · 2020: 14 · 2019: 11 · 2018: 8 · 2017: 19 · 2016: 14 · 2015: 12 · 2014: 17 · 2013: 5
- FWCI
- 37.82
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wake Forest University (P30 AG21332)
- National Institutes of Health
- National Institute on Aging (#R37AG18915, R01AG018915, R37AG018915, P30AG-21332, P30AG021332)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › 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
- heart failure with preserved ejection fraction, exercise intolerance, lean body mass, peak oxygen uptake, physical functional performance, older adults, skeletal muscle, leg lean mass, Short Physical Performance Battery, exercise capacity
- MeSH terms
- Aged, Body Composition, Body Weight, Female, Heart Failure, Humans, Leg, Male, Middle Aged, Oxygen Consumption, Sex Factors, Stroke Volume, Exercise, Case-Control Studies, Exercise Tolerance, Muscle, Skeletal
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