Format

Send to

Choose Destination
Circulation. 2018 Apr 10;137(15):1549-1560. doi: 10.1161/CIRCULATIONAHA.117.030617. Epub 2018 Jan 8.

Reversing the Cardiac Effects of Sedentary Aging in Middle Age-A Randomized Controlled Trial: Implications For Heart Failure Prevention.

Author information

1
Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (E.J.H., S.S., J.S.L., M.O., W.C., D.S., M.A.U., B.D.L.).
2
University of Texas Southwestern Medical Center, Dallas (E.J.H., S.S., J.S.L., D.S., M.A.U., B.A.-H., B.D.L.).
3
The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (E.J.H.).
4
Stanford University, CA (M.O.).
5
University of Colorado Anschutz Medical Campus, Aurora (W.C.).
6
Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (E.J.H., S.S., J.S.L., M.O., W.C., D.S., M.A.U., B.D.L.). benjaminlevine@texashealth.org.

Abstract

BACKGROUND:

Poor fitness in middle age is a risk factor for heart failure, particularly heart failure with a preserved ejection fraction. The development of heart failure with a preserved ejection fraction is likely mediated through increased left ventricular (LV) stiffness, a consequence of sedentary aging. In a prospective, parallel group, randomized controlled trial, we examined the effect of 2 years of supervised high-intensity exercise training on LV stiffness.

METHODS:

Sixty-one (48% male) healthy, sedentary, middle-aged participants (53±5 years) were randomly assigned to either 2 years of exercise training (n=34) or attention control (control; n=27). Right heart catheterization and 3-dimensional echocardiography were performed with preload manipulations to define LV end-diastolic pressure-volume relationships and Frank-Starling curves. LV stiffness was calculated by curve fit of the diastolic pressure-volume curve. Maximal oxygen uptake (Vo2max) was measured to quantify changes in fitness.

RESULTS:

Fifty-three participants completed the study. Adherence to prescribed exercise sessions was 88±11%. Vo2max increased by 18% (exercise training: pre 29.0±4.8 to post 34.4±6.4; control: pre 29.5±5.3 to post 28.7±5.4, group×time P<0.001) and LV stiffness was reduced (right/downward shift in the end-diastolic pressure-volume relationships; preexercise training stiffness constant 0.072±0.037 to postexercise training 0.051±0.0268, P=0.0018), whereas there was no change in controls (group×time P<0.001; pre stiffness constant 0.0635±0.026 to post 0.062±0.031, P=0.83). Exercise increased LV end-diastolic volume (group×time P<0.001), whereas pulmonary capillary wedge pressure was unchanged, providing greater stroke volume for any given filling pressure (loading×group×time P=0.007).

CONCLUSIONS:

In previously sedentary healthy middle-aged adults, 2 years of exercise training improved maximal oxygen uptake and decreased cardiac stiffness. Regular exercise training may provide protection against the future risk of heart failure with a preserved ejection fraction by preventing the increase in cardiac stiffness attributable to sedentary aging.

CLINICAL TRIAL REGISTRATION:

URL: https://www.clinicaltrials.gov. Unique identifier: NCT02039154.

KEYWORDS:

catheterization; diastole; exercise; humans; monitoring, physiological; prevention & control; ventricular function; ventricular remodeling

PMID:
29311053
PMCID:
PMC5893372
[Available on 2019-04-10]
DOI:
10.1161/CIRCULATIONAHA.117.030617

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center