Table 1: Randomised Controlled Exercise Intervention Trials in HFpEF.
| Study | Group (n) | Age (yrs) | Female (%) | EF (%) | Mode | Freq (d/wk) | Intensity | Duration (min) | Program length (wks) | Main findings | Predictors of peak VO2 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Angadi et al. 2015[30] | HIIT (9) | 69 | 11 | 65 | TM | 3 | 4 x 2–4 min at 80–95 % HRpeak × 2–3 min active recovery at 50 % HRpeak | 16 min HIIT | 4 | ↑VO2peak; ↓ DD grade, E; ↔ VO2 at VnT, LAVI, A, E/A, DT; e’ (septal), E/e’, IVRT, EF, BAFMD | - |
| MICT (6) | 72 | 33 | 66 | TM | 3 | 60–70 % HRpeak | 15–30 min | 4 | ↔ VO2peak, VO2 at VnT, DD grade, LAVI, E, A, E/A, DT, e’ (septal), E/e’, IVRT, EF, BAFMD | ||
| Edelmann et al. 2011[25] | ET (44) | 64 | 55 | 67 | CYC + RT | 2–3 2 |
50–70 % VO2peak 60–65 % 1RM |
20-40 15 reps |
12 wk: 5–12 | ↑ VO2peak, 6MWD, VnT, e’, QoL, NYHA class; ↓ LAVI, E/e’, procollagen type I; ↔ LVEF, LVMI, NT- proBNP | ↑ VO2peak inversely correlated with E/e’ (r = –0.37, =0.002) |
| Con (20) | 65 | 60 | 66 | ||||||||
| Fu et al. 2016[26] | ET (30) | 61 | 33 | 58 | CYC | 3 | 5 by 3 min 30 at 80 % VO2peak × 3-min active recovery at 40 % VO2peak | 30 | 12 | ↑ VO2peak, peak a–VO2 Diff, cerebral/muscle oxygenation ↓ E/e’, Ve/VCO2; ↔ LVEF, LVIDd, LVIDs, peak SVI, CI, HR | VO2peak correlated with peak change in perfusion in frontal lobe (p=0.002) and VL (p=0.04) adjusted r2 =0.4 |
| Con (30) | 63 | 40 | 57 | ||||||||
| Kitzman et al. 2010[27] | ET (24) | 70 | 83 | 61 | Walk / CYC | 3 | 40–70 % HRR | 60 | 16 | ↑ VO2peak, 6MWD, VnT, physical QoL; ↔ rest LV EDV, ESV, EF, LVM, LVM/vol, E, A, DT, IVRT, Norepinephrine, BNP | - |
| Con (22) | 69 | 91 | 60 | ||||||||
| Haykowsky et al. 2012a [37] | ET (22) | 70 | 82 | - | Walk/CYC | ↑ peak HR, a–vO2Diff; ↔ peak LV EDV, ESV, SV, CO, SVR | 84 % of ↑ In VO2peak due to ↑ a–VO2Diff | ||||
| Con (18) | 68 | 94 | - | ||||||||
| Kitzman et al. 2013[32] | ET (24) | 70 | 72 | 58 | Walk/CYC/AE | 3 | 40–70 % HRR | 60 | 16 | ↑ VO2peak, peak HR, 6MWD, VnT physical QOL; ↔ carotid arteria stiffness, BAFMD, rest LV EDV, ESV, SV, EF, E, A, DT, IVRT | |
| Con (30) | 70 | 80 | 56 | ||||||||
| Kitzman et al. 2016[31] | ET (24) | 67* | 81 %* | 61* | Walk | 3 | Individualised based on HRR | 60 | 20 | Main effects ET: ↑VO2peak, 6MWD, ↓ peak DBP, body weight, fat mass, NYHA class; ↔ rest LVM, EDV, EF, LAD, E/A, E, E/e’, arterial stiffness. | ↑ VO2peak correlated with change in percent lean mass (r = 0.32, p=0.003) and change in thigh SM:IMF ratio (r = 0.27, p=0.02) |
| CR (24) | -400 kcal/d CR | ||||||||||
| CR+ ET (22) | -350 kcal/d CR + Walk | Main effects CR: ↑VO2peak, 6MWD, leg muscle quality, QoL (KCCQ), rest E/A; ↓ peak DBP, body weight, non-bone lean, fat (abdominal, subcut, visceral; thigh subcut), thigh SM; NYHA Class, rest LVM, h/R | |||||||||
| Con (22) | |||||||||||
| Smart et al. 2012[28] | ET (12) | 67 | 42 | 59 | CYC | 3 | 60–70 % VO2peak | 30 | 16 | ↑ VO2peak; ↓ VE/VCO2 slope; ↔ peak HR, LVEF, CO, E, A, E/A, E, S, E/e’, DT, strain, strain rate | |
| Con (13) | 62 | 54 | 57 |
↑ increase = ↓ decrease; 1RM = one-repetition maximum; 6MWD = six-minute walk distance; A = atrial filling velocity; AE = arm ergometry; a–vO2Diff = arteriovenous oxygen difference; CI = cardiac index; CO = cardiac output; CR = caloric restriction; CYC = cycle; DBP = diastolic blood pressure; DD = diastolic dysfunction grade; DT = deceleration time; E = early filling velocity; e’ = early diastolic velocity of the mitral annulus; E/A = early to atrial filling velocity ratio; E/e’ = early mitral inflow velocity to early diastolic mitral annulus velocity ratio; EDV = end-diastolic volume; EF = ejection fraction; ESV = end-systolic volume; ET = exercise training; Freq = frequency; HFpEF = heart failure and preserved ejection fraction; HIIT = high-intensity interval training; h/R = relative wall thickness; HR = heart rate; HRmax = maximal heart rate; HRpeak = peak heart rate; HRR = heart rate reserve; IMF = intermuscular fat; IVTR = isovolumic relaxation time; KCCQ = Kansas City Cardiomyopathy Questionnaire; LAD = left atrial diameter; LAVI = left atrial volume index; LVEDVI = left ventricular end-diastolic volume index; LVEF = left ventricular ejection fraction; LVIDd = left ventricular internal diameter in diastole; LVIDs = left ventricular internal diameter in systole; LVM = left ventricular mass; LVMI = left ventricular mass index; MICT = moderate-intensity continuous training; NT-proBNP = NYHA, New York Heart Association; QoL = quality of life; Reps = repetitions; S = systolic annular velocity; SM = skeletal muscle; Subcut = subcutaneous; SV = stroke volume; SVI = stroke volume index; TM = treadmill; VE/VCO2 = ventilation to carbon dioxide production slope; VL = vastus lateralis; Vnt = ventilator threshold; VO2peak = peak oxygen uptake.
*Whole group mean;
asame cohort as Kitzman et al. (2010).