Disclosures: Halle reports he received grants from Deutsche Forschungsgemeinschaft. Pandey and Kitzman report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
February 12, 2021
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High-intensity interval training not superior to moderate training in HFpEF

Disclosures: Halle reports he received grants from Deutsche Forschungsgemeinschaft. Pandey and Kitzman report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Compared with moderate training, high-intensity interval training yielded no significant difference in peak oxygen consumption after 3 months in patients with HF with preserved ejection fraction, researchers reported.

Martin Halle

“[Patients with HFpEF] are sedentary and obese. Therefore, the concept of start low/go slow is important,” Martin Halle, MD, professor in the department of prevention and sports medicine at the Accredited Center for Sports Cardiology/EAPC at the School of Medicine at the University Hospital Klinikum rechts der Isar at the Technical University of Munich, Germany, told Healio. “Patients may even start with two 5-minute walks per day (cycling on an ergometer in case of obesity and orthopedic problems).”

running on the treadmill
Source: Adobe Stock

Training in sedentary patients

The randomized OptimEx-Clin clinical trial included 180 sedentary patients with chronic, stable HFpEF (mean age, 70 years; 67% women) enrolled from July 2014 to September 2018. Patients were randomly assigned to high-intensity interval training for 38 minutes thrice daily (n = 60), moderate continuous training for 40 minutes five times per week (n = 60) or guideline control consisting of one-time advice on physical activity according to current guidelines (n = 60) for 12 months. Patients assigned to the high-intensity intervention had supervised training the first 3 months and exercised at home thereafter.

The primary endpoint was change in peak oxygen consumption (peak VO2) after 3 months. Secondary outcomes included changes in cardiorespiratory fitness, diastolic function and natriuretic peptides at 3 and 12 months.

Change in peak VO2 during 3 months for patients in the high-intensity interval training group was 1.1 mL/kg/min compared with –0.6 mL/kg/min for the guideline control group and 1.6 mL/kg/min in the moderate continuous training group (difference in high-intensity vs. control, 1.5 mL/kg/min; 95% CI, 0.4-2.7; difference in moderate vs. control, 2 mL/kg/min; 95% CI, 0.9-3.1; difference in high-intensity vs. moderate, –0.4 mL/kg/min; 95% CI, –1.4 to 0.6). At 12 months, there were no significant differences between the groups.

There were no significant changes in diastolic function or natriuretic peptides.

ACS occurred in 7% of the high-intensity group, 5% of the moderate group and 8% of the control group.

Halle told Healio that clinicians should advise their patients with HFpEF to exercise daily. “Some patients can even be cured from HFpEF if they exercise and lose weight,” he said. “Lifestyle intervention should start as early as possible in prediabetics and hypertensive patients, who will develop HFpEF.”

‘Important future directions’

Ambarish Pandey

In an accompanying editorial, Ambarish Pandey, MD, assistant professor of internal medicine (cardiology) at UT Southwestern Medical Center, and Dalane W. Kitzman, MD, professor of medicine (cardiology) at Wake Forest School of Medicine, noted that this study provides the most comprehensive assessment of safety and long-term adherence to exercise training among these patients and highlights challenges that need consideration in designing future trials.

“[This study] is an important attempt to improve the effectiveness of exercise training, one of the only interventions proven to improve symptoms in the growing population of patients with HFpEF,” Pandey and Kitzman wrote. “Although high-intensity interval training was not found more effective than moderate continuous training, the trial results highlight important future directions: incorporating strategies to enhance long-term adherence and optimizing effects on extracardiac contributors to exercise intolerance.”

For more information:

Martin Halle, MD, can be reached at martin.halle@mri.tum.de.

Reference:

Pandey A, et al. JAMA. 2021;doi:10.1001/jama.2020.26347.