https://doi.org/10.4081/monaldi.2024.3030
Exercise training for patients with heart failure and preserved ejection fraction. A narrative review
Published: July 23, 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Heart failure with preserved ejection fraction (HFpEF) remains a significant global health challenge, accounting for up to 50% of all heart failure cases and predominantly affecting the elderly and women. Despite advancements in therapeutic strategies, HFpEF's complexity poses substantial challenges in management, particularly due to its high comorbidity burden, including renal failure, atrial fibrillation, and obesity, among others. These comorbidities not only complicate the pathophysiology of HFpEF but also exacerbate its symptoms, necessitating a personalized approach to treatment focused on comorbidity management and symptom alleviation. In heart failure with reduced ejection fraction, exercise training (ET) was effective in improving exercise tolerance, quality of life, and reducing hospitalizations. However, the efficacy of ET in HFpEF patients remains less understood, with limited studies showing mixed results. Exercise intolerance is a key symptom in HFpEF patients, and it has a multifactorial origin since both central and peripheral oxygen mechanisms of transport and utilization are often compromised. Recent evidence underscores the potential of supervised ET in enhancing exercise tolerance and quality of life among HFpEF patients; however, the literature remains sparse and predominantly consists of small-scale studies. This review highlights the critical role of exercise intolerance in HFpEF and synthesizes current knowledge on the benefits of ET. It also calls for a deeper understanding and further research into exercise-based interventions and their underlying mechanisms, emphasizing the need for larger, well-designed studies to evaluate the effectiveness of ET in improving outcomes for HFpEF patients.
Redfield MM, Jacobsen SJ, Burnett JC, et al. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA2003;289:194-202.
DOI: https://doi.org/10.1001/jama.289.2.194
Virani SS, Alonso A, Aparicio HJ, et al. Heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation 2021;143:e254-743.
Pieske B, Tschöpe C, de Boer RA, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J 2019;40:3297-317.
DOI: https://doi.org/10.1093/eurheartj/ehz641
Gomez-Soto FM, Andrey JL, Garcia-Egido AA, et al. Incidence and mortality of heart failure: A community-based study. Int J Cardiol 2011;151:40-5.
DOI: https://doi.org/10.1016/j.ijcard.2010.04.055
Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev 2017;3:7-11.
DOI: https://doi.org/10.15420/cfr.2016:25:2
Gard E, Nanayakkara S, Kaye D, Gibbs H. Management of heart failure with preserved ejection fraction. Aust Prescr 2020;43:12-7.
DOI: https://doi.org/10.18773/austprescr.2020.006
Morris JH, Chen L. Exercise training and heart failure: a review of the literature. Card Fail Rev 2019;5:57-61.
DOI: https://doi.org/10.15420/cfr.2018.31.1
O’Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 2009;301:1439-50.
DOI: https://doi.org/10.1001/jama.2009.454
Upadhya B, Haykowsky MJ, Eggebeen J, Kitzman DW. Exercise intolerance in heart failure with preserved ejection fraction: more than a heart problem. J Geriatr Cardiol 2015;12:294-304.
DOI: https://doi.org/10.1007/s11897-015-0257-5
Kitzman DW, Higginbotham MB, Cobb FR, et al. Exercise intolerance in patients with heart failure and preserved left ventricular systolic function: failure of the Frank-Starling mechanism. J Am Coll Cardiol 1991;17:1065-72.
DOI: https://doi.org/10.1016/0735-1097(91)90832-T
Houstis NE, Eisman AS, Pappagianopoulos PP, et al. Exercise intolerance in heart failure Withpreserved ejection fraction: diagnosing and ranking its causes using personalized O2pathway analysis. Circulation 2018;137:148-61.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.117.029058
Dhakal BP, Malhotra R, Murphy RM, et al. Mechanisms of exercise intolerance in heart failure with preserved ejection fraction: the role of abnormal peripheral oxygen extraction. Circ Heart Fail 2015;8:286-94.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.114.001825
Hearon CM Jr, Sarma S, Dias KA, et al. Impaired oxygen uptake kinetics in heart failure with preserved ejection fraction. Heart 2019;105:1552-8.
DOI: https://doi.org/10.1136/heartjnl-2019-314797
Salzano A, De Luca M, Israr MZ, et al. Exercise intolerance in heart failure with preserved ejection fraction. Heart Fail Clin. 2021;17:397-413.
DOI: https://doi.org/10.1016/j.hfc.2021.03.004
Montero D, Diaz-Cañestro C. Determinants of exercise intolerance in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Int J Cardiol 2018;254:224-9.
DOI: https://doi.org/10.1016/j.ijcard.2017.10.114
Pandey A, Khera R, Park B, et al. Relative impairments in hemodynamic exercise reserve parameters in heart failure with preserved ejection fraction: a study-level pooled analysis. JACC Heart Fail 2018;6:117-26.
DOI: https://doi.org/10.1016/j.jchf.2017.10.014
Sarma S, Stoller D, Hendrix J, et al. Mechanisms of chronotropic incompetence in heart failure with preserved ejection fraction. Circ Heart Fail 2020;13:e006331.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.119.006331
Dominguez E, Palau P, Nunez E, et al. Heart rate response and functional capacity in patients with chronic heart failure with preserved ejection fraction. ESC Heart Fail 2018;5:579-85.
DOI: https://doi.org/10.1002/ehf2.12281
Nayor M, Houstis NE, Namasivayam M, et al. Impaired exercise tolerance in heart failure with preserved ejection fraction: quantification of multiorgan system reserve capacity. JACC Heart Fail 2020;8:605-17.
DOI: https://doi.org/10.1016/j.jchf.2020.03.008
Olson TP, Johnson BD, Borlaug BA. Impaired pulmonary diffusion in heart failure with preserved ejection fraction. JACC Heart Fail 2016;4:490-8.
DOI: https://doi.org/10.1016/j.jchf.2016.03.001
Mooney L, Hawkins NM, Jhund PS, et al. Impact of chronic obstructive pulmonary disease in patients with heart failure with preserved ejection fraction: insights from PARAGON-HF. J Am Heart Assoc 2021;10:e021494.
DOI: https://doi.org/10.1161/JAHA.121.021494
Eckhardt CM, Balte PP, Barr RG, et al. Lung function impairment and risk of incident heart failure: the NHLBI Pooled Cohort Study. Eur Heart J 2022;43:2196-208.
DOI: https://doi.org/10.1093/eurheartj/ehac205
Andrea R, Lopez-Giraldo A, Falces C, et al. Lung function abnormalities are highly frequent in patients with heart failure and preserved ejection fraction. Heart Lung Circ 2014;23:273-9.
DOI: https://doi.org/10.1016/j.hlc.2013.08.003
Omar M, Omote K, Sorimachi H, et al. Hypoxaemia in patients with heart failure and preserved ejection fraction. Eur J Heart Fail 2023;25:1593-603.
DOI: https://doi.org/10.1002/ejhf.2930
Haykowsky MJ, Brubaker PH, John JM, et al. Determinants of exercise intolerance in elderly heart failure patients with preserved ejection fraction. J Am Coll Cardiol 2011;58:265-74.
DOI: https://doi.org/10.1016/j.jacc.2011.02.055
Middlekauff HR. Making the case for skeletal myopathy as the major limitation of exercise capacity in heart failure. Circ Heart Fail 2010;3:537-46.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.109.903773
Kitzman DW, Haykowsky MJ, Tomczak CR. Making the case for skeletal muscle myopathy and its contribution to exercise intolerance in heart failure with preserved ejection fraction. Circ Heart Fail 2017;10:e004281.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.117.004281
Molina AJA, Bharadwaj MS, Van Horn C, et al. Skeletal muscle mitochondrial content, oxidative capacity, and Mfn2 expression are reduced in older patients with heart failure and preserved ejection fraction and are related to exercise intolerance. JACC Heart Fail2016;4:636-45.
DOI: https://doi.org/10.1016/j.jchf.2016.03.011
Tucker WJ, Haykowsky MJ, Seo Y, et al. Impaired exercise tolerance in heart failure: role of skeletal muscle morphology and function. Curr Heart Fail Rep 2018;15:323-31.
DOI: https://doi.org/10.1007/s11897-018-0408-6
Yamada K, Kinugasa Y, Sota T, et al. Inspiratory muscle weakness is associated with exercise intolerance in patients with heart failure with preserved ejection fraction: apreliminary study. J Card Fail 2016;22:38-47.
DOI: https://doi.org/10.1016/j.cardfail.2015.10.010
Zern EK, Ho JE, Panah LG, et al. Exercise intolerance in heart failure with preserved ejection fraction: arterial stiffness and abnormal left ventricular hemodynamic responses during exercise. J Card Fail2021;27:625-34.
DOI: https://doi.org/10.1016/j.cardfail.2021.02.011
Desai AS, Mitchell GF, Fang JC, Creager MA. Central aortic stiffnessis increased in patients with heart failure and preserved ejection fraction. J Card Fail 2009;15:658-64.
DOI: https://doi.org/10.1016/j.cardfail.2009.03.006
Lewsey SC, Hays AG, Schär M, et al. Nitric oxide-mediated coronary endothelial function is impaired in patients with heart failure with preserved ejection fraction. Circ Heart Fail 2022;15:e009582.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.122.009582
Balmain S, Padmanabhan N, Ferrell WR, et al. Differences in arterial compliance, microvascular function and venous capacitance between patients with heart failure and either preserved or reduced left ventricular systolic function. Eur J Heart Fail 2007;9:865-71.
DOI: https://doi.org/10.1016/j.ejheart.2007.06.003
Hundley WG, Kitzman DW, Morgan TM, et al. Cardiac cycle-dependent changes in aortic area and distensibility are reduced in older patients with isolated diastolic heart failure and correlate with exercise intolerance. J Am Coll Cardiol 2001;38:796-802.
DOI: https://doi.org/10.1016/S0735-1097(01)01447-4
Mahfouz RA, Gouda M, Abdelhamid M. Relation of microvascular dysfunction and exercise tolerance in patients with heart failure with preserved ejection fraction. Echocardiography2020;37:1192-8.
DOI: https://doi.org/10.1111/echo.14799
Corrieri N, Del Torto A, Vignati C, et al. Cardiac output changes during exercise in heart failure patients: focus on mid-exercise. ESC Heart Fail 2021;8:55-62.
DOI: https://doi.org/10.1002/ehf2.13005
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019;48:16-31.
DOI: https://doi.org/10.1093/ageing/afy169
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Ser A 2001;56:M146-56.
DOI: https://doi.org/10.1093/gerona/56.3.M146
Xu J, Wan CS, Ktoris K, et al. Sarcopenia is associated with mortality in adults: a systematic review and meta-analysis. Gerontology 2022;68:361-76.
DOI: https://doi.org/10.1159/000517099
Chen R, Xu J, Wang Y, et al. Prevalence of sarcopenia and its association with clinical outcomes in heart failure: an updated meta-analysis and systematic review. Clin Cardiol 2023;46:260-8.
DOI: https://doi.org/10.1002/clc.23970
Bekfani T, Pellicori P, Morris DA, et al. Sarcopenia in patients with heart failure with preserved ejection fraction: Impact on muscle strength, exercise capacity and quality of life. Int J Cardiol 2016;222:41-6.
DOI: https://doi.org/10.1016/j.ijcard.2016.07.135
Haykowsky MJ, Kouba EJ, Brubaker PH, et al. Skeletal muscle composition and its relation to exercise intolerance in older patients with heart failure and preserved ejection fraction. Am J Cardiol 2014;113:1211-6.
DOI: https://doi.org/10.1016/j.amjcard.2013.12.031
Bekfani T, Bekhite Elsaied M, Derlien S, et al. Skeletal muscle function, structure, and metabolism in patients with heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. Circ Heart Fail 2020;13:e007198.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.120.007198
Konishi M, Kagiyama N, Kamiya K, et al. Impact of sarcopenia on prognosis in patients with heart failure with reduced and preserved ejection fraction. Eur J Prev Cardiol 2021;28:1022-9.
DOI: https://doi.org/10.1093/eurjpc/zwaa117
Bowen TS, Herz C, Rolim NPL, et al. Effects of endurance training on detrimental structural, cellular, and functional alterations in skeletal muscles of heart failure with preserved ejection fraction. J Card Fail 2018;24:603-13.
DOI: https://doi.org/10.1016/j.cardfail.2018.08.009
Espino-Gonzalez E, Tickle PG, Benson AP, et al. Abnormal skeletal muscle blood flow, contractile mechanics and fibre morphology in a rat model of obese-HFpEF. J Physiol 2021;599:981-1001.
DOI: https://doi.org/10.1113/JP280899
Glezeva N, Baugh JA. Role of inflammation in the pathogenesis of heart failure with preserved ejection fraction and its potential as a therapeutic target. Heart Fail Rev 2014;19:681-94.
DOI: https://doi.org/10.1007/s10741-013-9405-8
Seiler M, Bowen TS, Rolim N, et al. Skeletal muscle alterations are exacerbated in heart failure with reduced compared with preserved ejection fraction. Circ Heart Fail 2016;9:e003027.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.116.003027
Kitajima Y, Yoshioka K, Suzuki N. The ubiquitin-proteasome system in regulation of the skeletal muscle homeostasis and atrophy: from basic science to disorders. J Physiol Sci 2020;70:40.
DOI: https://doi.org/10.1186/s12576-020-00768-9
Bodine SC, Latres E, Baumhueter S, et al. Identification of ubiquitin ligases required for skeletal muscle atrophy. Science 2001;294:1704-8.
DOI: https://doi.org/10.1126/science.1065874
Cai D, Frantz JD, Tawa NE, et al. IKKbeta/NF-kappaB activation causes severe muscle wasting in mice. Cell 2004;119:285-98.
DOI: https://doi.org/10.1016/j.cell.2004.09.027
Schiaffino S, Mammucari C. Regulation of skeletal muscle growth by the IGF1-Akt/PKB pathway: insights from genetic models. Skelet Muscle 2011;1:4.
DOI: https://doi.org/10.1186/2044-5040-1-4
Chen P, Liu Z, Luo Y, et al. Predictive value of serum myostatin for the severity and clinical outcome of heart failure. Eur J Intern Med 2019;64:33-40.
DOI: https://doi.org/10.1016/j.ejim.2019.04.017
Yoshida T, Delafontaine P. Mechanisms of IGF-1-mediated regulation of skeletal muscle hypertrophy and atrophy. Cells 2020;9:1970.
DOI: https://doi.org/10.3390/cells9091970
Sartori R, Milan G, Patron M, et al. Smad2 and 3 transcription factors control muscle mass in adulthood. Am J Physiol Cell Physiol 2009;296:C1248-57.
DOI: https://doi.org/10.1152/ajpcell.00104.2009
Trendelenburg AU, Meyer A, Rohner D, et al. Myostatin reduces Akt/TORC1/p70S6K signaling, inhibiting myoblast differentiation and myotube size. Am J Physiol Cell Physiol 2009;296:C1258-70.
DOI: https://doi.org/10.1152/ajpcell.00105.2009
Yang Y, Zheng L, Zheng X, Ge L. Autophagosomal membrane origin and formation. Adv Exp Med Biol 2021;1208:17-42.
DOI: https://doi.org/10.1007/978-981-16-2830-6_2
Tanida I, Ueno T, Kominami E. LC3 and autophagy. Methods Mol Biol 2008;445:77-88.
DOI: https://doi.org/10.1007/978-1-59745-157-4_4
Goto K, Schauer A, Augstein A, et al. Muscular changes in animal models of heart failure with preserved ejection fraction: what comes closest to the patient?. ESC Heart Fail 2021;8:139-50.
DOI: https://doi.org/10.1002/ehf2.13142
Bowen TS, Rolim NP, Fischer T, et al. Heart failure with preserved ejection fraction induces molecular, mitochondrial, histological, and functional alterations in rat respiratory and limb skeletal muscle. Eur J Heart Fail 2015;17:263-72.
DOI: https://doi.org/10.1002/ejhf.239
Weiss K, Schär M, Panjrath GS, et al. Fatigability, exercise intolerance, and abnormal skeletal muscle energetics in heart failure. Circ Heart Fail 2017;10:e004129.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.117.004129
Kelley RC, Betancourt L, Noriega AM, et al. Skeletal myopathy in a rat model of postmenopausal heart failure with preserved ejection fraction. J Appl Physiol (1985) 2022;132:106-25.
DOI: https://doi.org/10.1152/japplphysiol.00170.2021
Scandalis L, Kitzman DW, Nicklas BJ, et al. Skeletal muscle mitochondrial respiration and exercise intolerance in patients with heart failure with preserved ejection fraction. JAMA Cardiol 2023;8:575-84.
DOI: https://doi.org/10.1001/jamacardio.2023.0957
Long L, Mordi IR, Bridges C, et al. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev2019;1:CD003331.
DOI: https://doi.org/10.1002/14651858.CD003331.pub5
Gomes-Neto M, Durães AR, Conceição LSR, et al. Effect of aerobic exercise on peak oxygen consumption, VE/VCO2 slope, and health-related quality of life in patients with heart failure with preserved left ventricular ejection fraction: a systematic review and meta-analysis. Curr Atheroscler Rep 2019;21:45.
DOI: https://doi.org/10.1007/s11883-019-0806-6
Pandey A, Parashar A, Kumbhani D, et al. Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials. Circ Heart Fail 2015;8:33-40.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.114.001615
Sebastian SA, Padda I, Johal G. Supervised exercise training in heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials. Curr Probl Cardiol 2024;49:102426.
DOI: https://doi.org/10.1016/j.cpcardiol.2024.102426
Fukuta H, Goto T, Wakami K, et al. Effects of exercise training on cardiac function, exercise capacity, and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Heart Fail Rev 2019;24:535-47.
DOI: https://doi.org/10.1007/s10741-019-09774-5
Edelmann F, Gelbrich G, Dungen HD, et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol 2011;58:1780-91.
DOI: https://doi.org/10.1016/j.jacc.2011.06.054
Smart NA, Haluska B, Jeffriess L, et al. Exercise training in heart failure with preserved systolic function: a randomized controlled trial of the effects on cardiac function and functional capacity. Congest Heart Fail 2012;18:295-301.
DOI: https://doi.org/10.1111/j.1751-7133.2012.00295.x
Alves AJ, Ribeiro F, Goldhammer E, et al. Exercise training improves diastolic function in heart failure patients. Med Sci Sports Exerc 2012;44:776-85.
DOI: https://doi.org/10.1249/MSS.0b013e31823cd16a
Kitzman DW, Brubaker PH, Morgan TM et al. Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. Circ Heart Fail 2010;3:659-67.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.110.958785
Hieda M, Sarma S, Hearon C M, et al. One-year committed exercise training reverses abnormal left ventricular myocardial stiffness in patients with stage B heart failure with preserved ejection fraction. Circulation 2021;144:934-46.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.121.054117
Marshall KD, Muller BN, Krenz M, et al. Heart failure with preserved ejection fraction: chronic low-intensity interval exercise training preserves myocardial O2 balance and diastolic function. J Appl Physiol (1985) 2013;114:131-47.
DOI: https://doi.org/10.1152/japplphysiol.01059.2012
Olver TD, Edwards JC, Ferguson BS, et al. Chronic interval exercise training prevents BKCa channel-mediated coronary vascular dysfunction in aortic-banded miniswine. J Appl Physiol (1985) 2018;125:86-96.
DOI: https://doi.org/10.1152/japplphysiol.01138.2017
Ouyang A, Olver TD, Emter CA, Fleenor BS. Chronic exercise training prevents coronary artery stiffening in aortic-banded miniswine: role of perivascular adipose-derived advanced glycation end products. J Appl Physiol (1985) 2019;127:816-27.
DOI: https://doi.org/10.1152/japplphysiol.00146.2019
Liu K, Ju W, Ouyang S, et al. Exercise training ameliorates myocardial phenotypes in heart failure with preserved ejection fraction by changing N6-methyladenosine modification in mice model. Front Cell Dev Biol 2022;10:954769.
DOI: https://doi.org/10.3389/fcell.2022.954769
Fu TC, Yang NI, Wang CH, et al. Aerobic interval training elicits different hemodynamic adaptations between heart failure patients with preserved and reduced ejection fraction. Am J Phys Med Rehabil 2016;95:15-27.
DOI: https://doi.org/10.1097/PHM.0000000000000312
Winzer EB, Augstein A, Schauer A, et al. Impact of different training modalities on molecular alterations in skeletal muscle of patients with heart failure with preserved ejection fraction: a substudy of the optimex trial. Circ Heart Fail 2022;15:e009124.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.121.009124
Kitzman DW, Brubaker PH, Herrington DM, et al. Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. J Am Coll Cardiol 2013;62:584-92.
DOI: https://doi.org/10.1016/j.jacc.2013.04.033
Adams V, Alves M, Fischer T, et al. High-intensity interval training attenuates endothelial dysfunction in a Dahl salt-sensitive rat model of heart failure with preserved ejection fraction. J ApplPhysiol (1985) 2015;119:745-52.
DOI: https://doi.org/10.1152/japplphysiol.01123.2014
Li P, Liu Z, Wan K, et al. Effects of regular aerobic exercise on vascular function in overweight or obese older adults: a systematic review and meta-analysis. J Exerc Sci Fit 2023;21:313-25.
DOI: https://doi.org/10.1016/j.jesf.2023.06.002
Kitzman DW, Brubaker P, Morgan T, et al. Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical trial. JAMA 2016;315:36-46.
DOI: https://doi.org/10.1001/jama.2015.17346
Brubaker PH, Nicklas BJ, Houston DK, et al. A randomized, controlled trial of resistance training added to caloric restriction plus aerobic exercise training in obese heart failure with preserved ejection fraction. Circ Heart Fail 2023;16:e010161.
DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.123.010419
Angadi SS, Mookadam F, Lee CD et al. High-intensity interval training vs. moderate-intensity continuous exercise training in heart failure with preserved ejection fraction: a pilot study. J Appl Physiol (1985) 2015;119:753-8.
DOI: https://doi.org/10.1152/japplphysiol.00518.2014
Donelli da Silveira A, Beust de Lima J, da Silva Piardi D, et al. High-intensity interval training is effective and superior to moderate continuous training in patients with heart failure with preserved ejection fraction: a randomized clinical trial. Eur J Prev Cardiol 2020;27:1733-43.
DOI: https://doi.org/10.1177/2047487319901206
Mueller S, Winzer EB, Duvinage A, et al. Effect of high-intensity interval training, moderate continuous training, or guideline-based physical activity advice on peak oxygen consumption in patients with heart failure with preserved ejection fraction: a randomized clinical trial. JAMA 2021;325:542-51.
DOI: https://doi.org/10.1001/jama.2020.26812
Siddiqi TJ, Rashid AM, Javaid SS, et al. High-intensity interval training versus moderate continuous training in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis. Curr Probl Cardiol 2023;48:101720.
DOI: https://doi.org/10.1016/j.cpcardiol.2023.101720
Bode D, Rolim NPL, Guthof T, et al. Effects of different exercise modalities on cardiac dysfunction in heart failure with preserved ejection fraction. ESC Heart Fail 2021;8:1806-18.
DOI: https://doi.org/10.1002/ehf2.13308
Palau P, Domínguez E, Núñez E, et al. Effects of inspiratory muscle training in patients with heart failure with preserved ejection fraction. Eur J Prev Cardiol 2014;21:1465-73.
DOI: https://doi.org/10.1177/2047487313498832
Li H, Tao L, Huang Y, et al. Inspiratory muscle training in patients with heart failure: a systematic review and meta-analysis. Front Cardiovasc Med 2022;9:993846.
DOI: https://doi.org/10.3389/fcvm.2022.993846
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599-726.
DOI: https://doi.org/10.1093/eurheartj/ehab670
How to Cite
Caminiti, Giuseppe, Maurizio Volterrani, Ferdinando Iellamo, Giuseppe Marazzi, Marco Silvestrini, Domenico Mario Giamundo, Valentina Morsella, Deborah Di Biasio, Alessio Franchini, and Marco Alfonso Perrone. 2024. “Exercise Training for Patients With Heart Failure and Preserved Ejection Fraction. A Narrative Review”. Monaldi Archives for Chest Disease, July. https://doi.org/10.4081/monaldi.2024.3030.
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