Supervised Exercise Training for Chronic Heart Failure With Preserved Ejection Fraction : A Scientific Statement From the American Heart Association and American College of Cardiology
Heart failure with preserved ejection fraction (HFpEF) is one of the most common forms of heart failure; its prevalence is increasing, and outcomes are worsening. Affected patients often experience severe exertional dyspnea and debilitating fatigue, as well as poor quality of life, frequent hospitalizations, and a high mortality rate. Until recently, most pharmacological intervention trials for HFpEF yielded neutral primary outcomes. In contrast, trials of exercise-based interventions have consistently demonstrated large, significant, clinically meaningful improvements in symptoms, objectively determined exercise capacity, and usually quality of life. This success may be attributed, at least in part, to the pleiotropic effects of exercise, which may favorably affect the full range of abnormalities-peripheral vascular, skeletal muscle, and cardiovascular-that contribute to exercise intolerance in HFpEF. Accordingly, this scientific statement critically examines the currently available literature on the effects of exercise-based therapies for chronic stable HFpEF, potential mechanisms for improvement of exercise capacity and symptoms, and how these data compare with exercise therapy for other cardiovascular conditions. Specifically, data reviewed herein demonstrate a comparable or larger magnitude of improvement in exercise capacity from supervised exercise training in patients with chronic HFpEF compared with those with heart failure with reduced ejection fraction, although Medicare reimbursement is available only for the latter group. Finally, critical gaps in implementation of exercise-based therapies for patients with HFpEF, including exercise setting, training modalities, combinations with other strategies such as diet and medications, long-term adherence, incorporation of innovative and more accessible delivery methods, and management of recently hospitalized patients are highlighted to provide guidance for future research.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:147 |
|---|---|
| Enthalten in: |
Circulation - 147(2023), 16 vom: 18. Apr., Seite e699-e715 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Sachdev, Vandana [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
AHA Scientific Statements |
|---|
| Anmerkungen: |
Date Completed 19.04.2023 Date Revised 07.05.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1161/CIR.0000000000001122 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM354492675 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM354492675 | ||
| 003 | DE-627 | ||
| 005 | 20231226062336.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1161/CIR.0000000000001122 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1181.xml |
| 035 | |a (DE-627)NLM354492675 | ||
| 035 | |a (NLM)36943925 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Sachdev, Vandana |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Supervised Exercise Training for Chronic Heart Failure With Preserved Ejection Fraction |b A Scientific Statement From the American Heart Association and American College of Cardiology |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 19.04.2023 | ||
| 500 | |a Date Revised 07.05.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Heart failure with preserved ejection fraction (HFpEF) is one of the most common forms of heart failure; its prevalence is increasing, and outcomes are worsening. Affected patients often experience severe exertional dyspnea and debilitating fatigue, as well as poor quality of life, frequent hospitalizations, and a high mortality rate. Until recently, most pharmacological intervention trials for HFpEF yielded neutral primary outcomes. In contrast, trials of exercise-based interventions have consistently demonstrated large, significant, clinically meaningful improvements in symptoms, objectively determined exercise capacity, and usually quality of life. This success may be attributed, at least in part, to the pleiotropic effects of exercise, which may favorably affect the full range of abnormalities-peripheral vascular, skeletal muscle, and cardiovascular-that contribute to exercise intolerance in HFpEF. Accordingly, this scientific statement critically examines the currently available literature on the effects of exercise-based therapies for chronic stable HFpEF, potential mechanisms for improvement of exercise capacity and symptoms, and how these data compare with exercise therapy for other cardiovascular conditions. Specifically, data reviewed herein demonstrate a comparable or larger magnitude of improvement in exercise capacity from supervised exercise training in patients with chronic HFpEF compared with those with heart failure with reduced ejection fraction, although Medicare reimbursement is available only for the latter group. Finally, critical gaps in implementation of exercise-based therapies for patients with HFpEF, including exercise setting, training modalities, combinations with other strategies such as diet and medications, long-term adherence, incorporation of innovative and more accessible delivery methods, and management of recently hospitalized patients are highlighted to provide guidance for future research | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a AHA Scientific Statements | |
| 650 | 4 | |a aged | |
| 650 | 4 | |a cardiac rehabilitation | |
| 650 | 4 | |a exercise therapy | |
| 650 | 4 | |a exercise tolerance | |
| 650 | 4 | |a heart failure | |
| 700 | 1 | |a Sharma, Kavita |e verfasserin |4 aut | |
| 700 | 1 | |a Keteyian, Steven J |e verfasserin |4 aut | |
| 700 | 1 | |a Alcain, Charina F |e verfasserin |4 aut | |
| 700 | 1 | |a Desvigne-Nickens, Patrice |e verfasserin |4 aut | |
| 700 | 1 | |a Fleg, Jerome L |e verfasserin |4 aut | |
| 700 | 1 | |a Florea, Viorel G |e verfasserin |4 aut | |
| 700 | 1 | |a Franklin, Barry A |e verfasserin |4 aut | |
| 700 | 1 | |a Guglin, Maya |e verfasserin |4 aut | |
| 700 | 1 | |a Halle, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Leifer, Eric S |e verfasserin |4 aut | |
| 700 | 1 | |a Panjrath, Gurusher |e verfasserin |4 aut | |
| 700 | 1 | |a Tinsley, Emily A |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Renee P |e verfasserin |4 aut | |
| 700 | 1 | |a Kitzman, Dalane W |e verfasserin |4 aut | |
| 700 | 0 | |a American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; and American College of Cardiology |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Circulation |d 1950 |g 147(2023), 16 vom: 18. Apr., Seite e699-e715 |w (DE-627)NLM000039020 |x 1524-4539 |7 nnns |
| 773 | 1 | 8 | |g volume:147 |g year:2023 |g number:16 |g day:18 |g month:04 |g pages:e699-e715 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1161/CIR.0000000000001122 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 147 |j 2023 |e 16 |b 18 |c 04 |h e699-e715 | ||