Comparative efficacy of resistance and aerobic training on functional status and cardiac parameters in hypertensive patients with diastolic heart failure with preserved ejection fraction

Abstract

Exercise has been shown to be a beneficiary in pts with systolic heart failure. Yet little data regarding heart failure with preserved ejection fraction (HFPEF) are available. We compare the influence of two exercise modalities on cardiac parameters and functional status in pts with HFPEF. Methods: 139 pts with HFPEF NYHA IV, 65±12 years (43 female) were randomized to three groups in order to receive resistance (RT, n=47) or aerobic (AT, n=47) training for 4 weeks or passive group (PG, n=45). Medications (ACEI, β-blockers, Ca2+ channel lockers, diuretics) were evenly distributed in groups. The study started after one week pre-training adaptation. Aerobic training (AT) was performed on treadmill four times per week with 30 min duration (excluding 5 min warm up and cooling down) and 70% maximum oxygen uptake. Resistance training (RT) was implemented as a weight lifting of 10 predetermined exercises of the upper and the lower body (2 set of 10 repetitions) for the same duration and frequency with the intensity of 50% of the one repetition maximum. EchoCG parameters as EF, indexes of LV EDV, ESV, maximal LA volume (LAVI), E/Em septal, LV diastolic wall strain (DWS) as (PWs – PWd)/PWs, as well as NTproBNP levels were obtained at the onset and the end of the study. Baseline parameters were comparable between groups. Results: Both exercises interventions significantly improve E/Em and NTproBNP levels compare to baseline and PG end-study parameters which remained unchanged (E/Em: AT 13.9±2.2 vs 11.6±1.3, p<0.05; RT: 13.7±2.1 vs 9.4±1.2, p<0.03; NTproBNP: AT 1592±193 vs 923±62 pg/ml, p<0.05; RT 1587±191 vs 531±37 pg/ml, p<0.02) without changes in EF, EDVI and ESVI. The RT group reduced E/EM, NTproBNP in greater degree compared with AT group (E/Em 11.6±1.3 vs 9.4±1.2, p<0.05; NTproBNP 923±62 vs 531±37 pg/ml, p<0.05). Also in RT group LAVI reduced in a greater degree compare with AT (29±4 vs 34±6, p<0.05) whereas in PG remained unchanged. DWS significantly improved in both AT and RT to a greater degree in RT (0.37±0.3 vs 0.31±0.2, p<0.05) without changes in PG. 37 pts (78%) in RT and 38 pts (80%) in AT improved their functional status compare with baseline as assessed on 9 min self-powered treadmill test peak VO2 consumption (AT: 13.7±1.4 to 18.3±1.6 ml/kg/min, p<0.05; RT: 13.6±1.4 to 18.6±1.7 ml/kg/min, p<0.05). Conclusion: Both exercise modalities are beneficial in hypertensive pts with HFPEF. RT appears to be a better choice probably because of better improvement of LV diastolic function and alteration of LA remodeling.