Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of Heart Failure With Preserved Ejection Fraction: The TRAINING-HF Trial

Palau, Patricia; Domínguez, Eloy; López, Laura; Ramón, José; Heredia, Raquel; González, Jessika; Santas, Enrique; Bodı́, Vicent; Miñana, Gema; Valero, Ernesto; Mollar, Anna; Bertomeu-González, Vicente; Chorro, Francisco J.; Sanchís, Juan; Lupón, Josep; Bayés‐Genís, Antoni; Núñez, Julio

doi:10.1016/j.rec.2018.01.010

Cited by 23 publications

(73 citation statements)

References 29 publications

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“…Similar results were reported in the TRAINING-HF trial. [ 36 ] Specifically, 12-week functional electrical stimulation did not significantly change cardiac function or structure; there was no significant difference in changes of E/e’ or left atrial volume index between the stimulation and control groups. Despite the neutral effect on cardiac structure or function, functional electrical stimulation improved peak VO 2 (2.93 ml/min/kg; p<0.001) compared with the control group.…”

Section: Effect Of Exercise Training In Heart Failure With Preserved mentioning

confidence: 96%

“…The effect of inspiratory muscle training on LV structure and function, as well as exercise capacity in HFpEF, has been examined in two RCTs ( Table 2 ). [ 35 , 36 ] Specifically, Palau et al reported that 12-week inspiratory muscle training did not significantly change LV diastolic function; there was no significant difference in changes of e’ or E/e’ between the training and control groups. Similarly, the training did not significantly change LV systolic function or LV structure; there was no significant difference in changes of LVEF or LV mass between the training and control groups.…”

Section: Effect Of Exercise Training In Heart Failure With Preserved mentioning

confidence: 99%

“…Similar results have been reported recently by the same investigators. [ 36 ] In the Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of HFpEF (TRAINING-HF) trial, 12-week inspiratory muscle training did not change cardiac function or structure; there was no significant difference in changes of E/e’ or left atrial volume index between exercise training and control groups. Despite the neutral effect on cardiac structure or function, inspiratory muscle training improved peak VO 2 (2.98 ml/min/kg; p<0.001) compared with the control group.…”

Section: Effect Of Exercise Training In Heart Failure With Preserved mentioning

confidence: 99%

“…The reported improvement in peak VO 2 with inspiratory muscle training is greater compared to that with cycling or walking. [ 35 , 36 ] However, there are no RCTs comparing the effect of inspiratory muscle training versus cycling or walking on exercise capacity in HFpEF patients. The comparative effectiveness of inspiratory muscle training and cycling or walking in HFpEF patients merits further investigation.…”

Section: Effect Of Exercise Training In Heart Failure With Preserved mentioning

confidence: 99%

“…The effect of functional electrical stimulation of the lower limbs on cardiac structure and function as well as exercise capacity in HFpEF has been examined in two RCTs ( Table 3 ). [ 36 , 39 ] Specifically, Karavidas et al reported that 6-week functional electrical stimulation did not significantly change cardiac function or structure; there was no significant difference in changes of E/A, E/e’ or left atrial volume between the stimulation and control groups. [ 39 ] Despite the neutral effect on cardiac structure or function, functional electrical stimulation improved 6MWD (52.8 m; p<0.01) compared with control group.…”

Section: Effect Of Exercise Training In Heart Failure With Preserved mentioning

confidence: 99%

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Effects of Exercise Training on Cardiac Function in Heart Failure with Preserved Ejection Fraction

Fukuta

2020

Card Fail Rev

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Nearly half of patients with heart failure in the community have heart failure with preserved ejection fraction (HFpEF). Patients with HFpEF are often elderly and their primary chronic symptom is severe exercise intolerance. Left ventricular diastolic dysfunction is associated with the pathophysiology of HFpEF and is an important contributor to exercise intolerance in HFpEF patients. The effects of exercise training on left ventricular diastolic function in HFpEF patients have been examined in several randomised clinical trials. Meta-analysis of the trials indicates that exercise training can provide clinically relevant improvements in exercise capacity without significant change in left ventricular structure or function in HFpEF patients. Further studies are necessary to elucidate the exact mechanisms of exercise intolerance in HFpEF patients and to develop recommendations regarding the most effective type, intensity, frequency, and duration of training in this group.

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Section: Effect Of Exercise Training In Heart Failure With Preserved mentioning

confidence: 96%

Section: Effect Of Exercise Training In Heart Failure With Preserved mentioning

confidence: 99%

Section: Effect Of Exercise Training In Heart Failure With Preserved mentioning

confidence: 99%

Section: Effect Of Exercise Training In Heart Failure With Preserved mentioning

confidence: 99%

Section: Effect Of Exercise Training In Heart Failure With Preserved mentioning

confidence: 99%

See 3 more Smart Citations

Effects of Exercise Training on Cardiac Function in Heart Failure with Preserved Ejection Fraction

Fukuta

2020

Card Fail Rev

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Exercise training response according to baseline ferrokinetics in heart failure with preserved ejection fraction: A substudy of the TRAINING‐HF trial

Palau,

López,

Domínguez

et al. 2024

J cachexia sarcopenia muscle

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BackgroundIron deficiency (ID) is associated with impaired functional capacity in patients with heart failure (HF), even in those with preserved ejection fraction (HFpEF). This study aimed to evaluate the effect of baseline ferrokinetics on peak oxygen consumption (peakVO2) improvement after a 12‐week physical therapy programme in patients with stable HFpEF.MethodsThis study is a post‐hoc sub‐analysis of a randomized clinical trial in which 59 stable patients with HFpEF were randomized to receive a 12‐week programme of inspiratory muscle training (IMT), functional electrical stimulation (FES), IMT + FES or usual care (UC) to evaluate change in peakVO2 (NCT02638961). Serum ferritin and transferrin saturation (TSAT) determinations were assessed at baseline. ID was defined as ferritin <100 ng/mL and/or TSAT <20% if ferritin was within 100–299 ng/mL. We used a linear mixed regression model to analyse between‐treatment changes in peakVO2 across ferrokinetics status at 12 and 24 weeks.ResultsThe mean age was 74 ± 9 years, and 36 (61%) had ID. The mean of peakVO2 was 9.9 ± 2.5 mL/kg/min. The median of ferritin and transferrin saturation (TSAT) was 91 (50–181) ng/mL and 23% (16–30), respectively. A total of 52 patients completed the trial (13 patients per arm). Compared with those patients on UC, patients allocated to any of the active arms showed less improvement in peak VO2 when they showed ID (P‐value for interaction <0.001), lower values of ferritin (P‐value for interaction <0.001), or TSAT (P‐value for interaction <0.001).ConclusionsFerrokinetics status plays an essential role in modifying the aerobic capacity response to physical therapies in patients with HFpEF. Further studies are required to confirm these findings.

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The effect of exercise training and physiotherapy on left and right heart function in heart failure with preserved ejection fraction: a systematic literature review

et al. 2022

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The impact of exercise training and physiotherapy on heart function and pulmonary circulation parameters in heart failure with preserved ejection fraction (HFpEF) patients is uncertain. Hence, we performed a systematic review of published trials studying physical training in HFpEF population, with a focus on exercise and physiotherapy effect on left ventricular (LV), right ventricular (RV) morphological, functional, and pulmonary circulation parameters. We searched Cochrane Library and MEDLINE/PubMed for trials that evaluated the effect of exercise training and/or physiotherapy in adult HFpEF patients (defined as LVEF ≥ 45%), including publications until March 2021. Our systematic review identified eighteen articles (n = 418 trained subjects, 4 to 52 weeks of training) and covered heterogeneous trials with various populations, designs, methodologies, and interventions. Five of twelve trials revealed a significant reduction of mitral E/e’ ratio after the training (− 1.2 to − 4.9). Seven studies examined left atrial volume index; three of them showed its decrease (− 3.7 to − 8 ml/m2). Findings were inconsistent regarding improvement of cardiac output, E/A ratio, and E wave DecT and uncertain for RV function and pulmonary hypertension parameters. For now, no reliable evidence about rehabilitation effect on HFpEF cardiac mechanisms is available. There are some hypotheses generating findings on potential positive effects to parameters of LV filling pressure (E/e’), left atrium size, cardiac output, and RV function. This encourages a broader and more complex assessment of parameters reflecting cardiac function in future HFpEF exercise training studies.

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Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of Heart Failure With Preserved Ejection Fraction: The TRAINING-HF Trial

Cited by 23 publications

References 29 publications

Effects of Exercise Training on Cardiac Function in Heart Failure with Preserved Ejection Fraction

Effects of Exercise Training on Cardiac Function in Heart Failure with Preserved Ejection Fraction

Exercise training response according to baseline ferrokinetics in heart failure with preserved ejection fraction: A substudy of the TRAINING‐HF trial

The effect of exercise training and physiotherapy on left and right heart function in heart failure with preserved ejection fraction: a systematic literature review

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