Age-related effects of exercise training on diastolic function in heart failure with reduced ejection fraction: the Leipzig Exercise Intervention in Chronic Heart Failure and Aging (LEICA) Diastolic Dysfunction Study.
Diastolic dysfunction (decreased filling of left ventricle, DD) is a known predictor of poor prognosis in heart failure (HF) with reduced ejection fraction (EF<40%). This study assessed if DD is improved by 4 weeks of intensive exercise training, and if the training effect is significant in elderly HF-patients (>65 years). Evaluation of effect was assessed by (blinded) echocardiographic assessment.
The exercise intervention consisted of 4 supervised training sessions per weekday (!), each for 20 min, using a bicycle ergometer. Rest interval was at least 60 min. Workloads were adjusted to heart rate so that 70% of the symptom-limited maximum oxygen uptake was reached. Training heart rate was not adjusted during the course of the training program, because of short duration and B-blockade. Group training sessions consisted of walking, calisthenics and ball games, once per week.
Results: maximal exercise capacity increased by 31% in the <55y group and by 37% in the >65y group. Maximal oxygen uptake increased by 26% in the younger group and 19% in the elderly. Both age groups showed an improvement of LVEF of +7%. Initial fears that the extra workload, imposed by exercise training on the left ventricle may further reduce contractile function, were unfounded.
These results have significant implications for the current practice of rehabilitation medicine in HF, where the age group with the highest HF prevalence is clearly underrepresented and not offered cardiac rehab > From Sandri et al., Eur Heart J 33 (2012) 1758-1768. All rights reserved to the European Society of Cardiology.
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