DALLAS — For people dealing with heart failure, a new report has some relieving news about what they can and cannot do physically. In a scientific statement, researchers working with the American Heart Association explain that supervised exercise therapy is safe and improve symptoms among people suffering from heart failure with preserved ejection fraction (HFpEF).
Heart failure is a condition in which the heart can’t pump blood to sustain the needs of the body due to stiffening of the heart or the organ losing its ability to pump. The latter is medically referred to as heart failure with reduced ejection fraction (HFrEF). In HFpEF, however, pumping strength is not affected. For these patients, treatments focus on reducing common symptoms like shortness of breath, fatigue, and delaying overall progression to maintain quality of life as much as possible.
“The prevalence of heart failure with preserved ejection fraction continues to increase due to aging of the population and the growing prevalence of risk factors such as obesity and Type 2 diabetes,” says Vandana Sachdev, M.D., chair of the scientific statement writing committee, in a media release. “Improved management of this large population of patients who have HFpEF, many of whom may be undertreated, represents an urgent unmet need.”
Currently, Medicare only reimburses cardiac rehabilitation for people with heart failure with HFrEF, which puts up barriers for those with HFpEF.
“Exercising helps improve the heart’s pumping ability, decreases blood vessel stiffness and improves the function and energy capacity of skeletal muscle,” explains Sachdev. “Exercise capacity is an independent, clinically meaningful patient outcome, and research has indicated that guided exercise therapy is actually more effective at improving quality of life for people who have HFpEF than most medications.”
In April 2022, the American Heart Association and the American College of Cardiology released recommendations for supervised exercise training for people with any type of heart failure. The writers investigated research published since 2010 to find the most up-to-date scientific data on the impact of exercise therapy in people with HFpEF. The studies looked at activities like walking, stationary cycling, high-intensity interval training, strength training and dancing in both medical facility and home-based settings. Generally, participants engaged in therapy three times weekly in each study, and the programs ran from one to eight months.
Here’s what the committee came away regarding supervised exercise therapy:
- Peak oxygen uptake increased by 12-14% — an increase of more than 6-7% is considered clinically significant
- Total exercise time increased by 21% — a 10% increase is considered clinically significant
- Quality of life scores on the Minnesota Living with Heart Failure questionnaire improved by 4–9 points
“Overall, we did find that in people with chronic, stable heart failure and preserved ejection fraction, supervised exercise training is safe and provides substantial improvements in exercise capacity and quality of life,” says Sachdev.
“Future work is needed to improve referral of appropriate patients to supervised exercise programs, and better strategies to improve long-term adherence to exercise training is needed. Hybrid programs combining supervised and home-based training may also be beneficial. Further, implementation efforts will need to include coverage by Medicare and other insurers.”
The guidelines are available in the journal Circulation.