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

Sandri, Monica; Kozarez, Irina; Adams, Volker; Mangner, Norman; Höllriegel, Robert; Erbs, Sandra; Linke, Axel; Möbius‐Winkler, Sven; Thiery, Joachim; Kratzsch, Jürgen; Teupser, Daniel; Mende, Meinhard; Hambrecht, Rainer; Schuler, Gerhard; Gielen, Stephan

doi:10.1093/eurheartj/ehr469

Cited by 78 publications

(70 citation statements)

References 37 publications

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“…Only 5 [47][48][49][50][51] and 4 [52][53][54][55] articles, respectively, met the eligibility criteria for NTproBNP and VE/VCO 2 slope. Figure 1 shows the flow diagram of studies in this review.…”

Section: Resultsmentioning

confidence: 99%

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Aerobic exercise effect on prognostic markers for systolic heart failure patients: a systematic review and meta-analysis

Cipriano

Silva

et al. 2013

Heart Fail Rev

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From previous systematic reviews and meta-analyses, there is consensus about the positive effect of exercise training on exercise capacity for systolic heart failure (HF); however, the effect on actual prognostic markers such as NTproBNP and minute ventilation/carbon dioxide production (VE/VCO2) slope has not been evaluated. The primary aim of the proposed study is to determine the effect of aerobic exercise training (AEX) on the VE/VCO2 slope and NTproBNP. The following databases (up to February 30, 2013) were searched with no language limitations: CENTRAL (The Cochrane Library 2013, issue 2), MEDLINE (from January 1966), EMBASE (from January 1980), and Physiotherapy Evidence Database (PEDro) (from January 1929). We screened reference lists of articles and also conducted an extensive hand search of the literature. Randomized controlled trials of exercise-based interventions with 2-month follow-up or longer compared to usual medical care or placebo were included. The study population comprised adults aged between 18 and 65 years, with evidence of chronic systolic heart failure (LVEF < 45 % and baseline NTproBNP > 300 pg/ml). Two review authors independently extracted data on study design, participants, interventions, and outcomes. We assessed the risk of bias using PEDro scale. We calculated mean differences (MD) or standardized mean differences between intervention and control groups for outcomes with sufficient data; for other outcomes, we described findings from individual studies. Eight studies involving a total of 408 participants met the inclusion criteria across the NTproBNP (5 studies with 191 patients) and VE/VCO2 slope (4 studies with 217 patients). Aerobic exercise significantly improved NTproBNP by a MD of -817.75 [95 % confidence interval (CI) -929.31 to -706.19]. Mean differences across VE/VCO2 slope were -6.55 (95 % CI -7.24 to -5.87). Those patients' characteristics and exercise were similar (frequency = 3-5 times/week; duration = 20-50 min/day; intensity = 60-80 % of VO2 peak) on the included studies. Moreover, the risk of bias across all studies was homogeneous (PEDro scale = 7-8 points). However, based on the statistical analysis, the heterogeneity among the studies was still high, which is related to the variable characteristics of the studies. Aerobic exercise may be effective at improving NTproBNP and the VE/VCO2 slope in systolic HF patients, but these effects are limited to a specific HF population meeting specific inclusion criterion in a limited number of studies. Future randomized controlled studies including diastolic and HF overleap with pulmonary diseases are needed to better understand the exact influence of AEX.

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Section: Resultsmentioning

confidence: 99%

“…Tables 1 and 2 summarize the characteristics of these studies. Among the included studies, they were all classified as RCTs [48][49][50][51][52][53][54][55]58]. The publications range from 2006 to 2012.…”

Section: Resultsmentioning

confidence: 99%

Aerobic exercise effect on prognostic markers for systolic heart failure patients: a systematic review and meta-analysis

Cipriano

Silva

et al. 2013

Heart Fail Rev

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“…Modulation of the autonomic nervous system with diminished sympathetic tone, increased vagal activity, and augmented baroreflex sensitivity in response to exercise training was identified as an underlying mechanism in animals and patients 73, 74. Restoration of autonomic balance in combination with improved peripheral endothelial function and decreased blood pressure reduces cardiac afterload and improves left ventricular diastolic function 42, 75, 76. Exercise training was shown to induce reverse cardiac remodeling in patients with heart failure with reduced left ventricular ejection fraction 75, 77.…”

Section: Adaptation Of the Heart And The Vasculature In Response To Ementioning

confidence: 99%

Physical Activity in the Prevention and Treatment of Coronary Artery Disease

Winzer

Woitek

Linke

2018

JAHA

158

112

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“…Regular physical activity and structured exercise training (ET) are a cornerstone of non‐pharmacological management in HF patients 4, 5. ET was found to be effective in improving cardiorespiratory fitness6, 7 and dimensions of quality of life in patients with HFpEF 8. Strikingly, ET as a mean of cardiovascular rehabilitation has also been associated to improved left ventricular diastolic function in patients with reduced6 and preserved7 ejection fraction.…”

Section: Introductionmentioning

confidence: 99%

Ghrelin and hormonal markers under exercise training in patients with heart failure with preserved ejection fraction: results from the Ex‐DHF pilot study

et al. 2016

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BackgroundOver 50% of patients with symptomatic heart failure (HF) experience HF with preserved ejection fraction (HFpEF). Exercise training (ET) is effective in improving cardiorespiratory fitness and dimensions of quality of life in patients with HFpEF. A systemic pro‐inflammatory state induced by comorbidities as the cause of myocardial structural and functional alterations has been proposed in HFpEF. ET modifies myocardial structure and has been related to inflammatory state. We investigated Ghrelin, related adipokines, markers of inflammation, and neuro‐hormonal activation in patients undergoing a structured ET vs. usual care are with HFpEF. Methods and resultsEx‐DHF‐P was a prospective, controlled, randomized multi‐centre trial on structured and supervised ET in patients with HFpEF. We performed a post hoc analysis in 62 patients from Ex‐DHF‐P. Ghrelin, adiponectin, leptin, IL‐1ß, IL‐6, IL‐10, tumour necrosis factor‐alpha, MR‐proANP, MR‐proADM, CT‐proET1, and CT‐proAVP were assessed to seize the impact of ET on these markers in patients with HFpEF. Thirty‐six (58%) patients were female, mean age was 64 years, and median ghrelin was 928 pg/mL (interquartile range 755–1156). When stratified for high versus low ghrelin, groups significantly differed at baseline in presence obesity, waist circumference, and adiponectin levels (P < 0.05, respectively). Overall, ghrelin levels rose significantly to 1013 pg/mL (interquartile range 813–1182) (P < 0.001). Analysis of covariance modelling for change in ghrelin identified ET (P = 0.013) and higher baseline adiponectin levels (P = 0.035) as influencing factors.ConclusionsExercise training tended to increase ghrelin levels in Ex‐DHF‐P. This increase was especially pronounced in patients with higher baseline adiponectin levels. Future trials are needed to investigate the effect of ET on endogenous ghrelin levels in regard to interactions with cardiac structure and clinically meaningful surrogate parameters.

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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

Abstract: In HFREF, diastolic function is significantly impaired in all age groups. Endurance training is highly effective in improving left ventricular diastolic function in HFREF patients regardless of age. This study is registered at ClinicalTrials.gov (number: NCT00176319).

Cited by 78 publications

References 37 publications

Aerobic exercise effect on prognostic markers for systolic heart failure patients: a systematic review and meta-analysis

Aerobic exercise effect on prognostic markers for systolic heart failure patients: a systematic review and meta-analysis

Physical Activity in the Prevention and Treatment of Coronary Artery Disease

Ghrelin and hormonal markers under exercise training in patients with heart failure with preserved ejection fraction: results from the Ex‐DHF pilot study

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