Chronic Lack of exercise linked to diminished cardiorespiratory fitness in patients with HFpEF: JACC

Increasing physical activity levels could be an effective preventive strategy for these sedentary individuals, significantly younger and middle-aged.

"There is a strong link between measures of cardiorespiratory fitness and quality of life, burden of symptoms, and prognosis across different spectrums of cardiac pathologies and cardiac function," Andre La Gerche, National Centre for Sports Cardiology, Fitzroy, Victoria, Australia, and colleagues wrote in their study.

In the article, the researchers contended a strong link between physical activity, cardiorespiratory fitness, and cardiac function. They argued that a chronic lack of exercise is a significant risk factor for HFpEF in some patients.

The researchers supported the hypothesis that physical activity is linked with more significant stroke volumes, greater cardiac mass, peak oxygen consumption, greater cardiac output, and fewer clinical events. Conversely, physical inactivity reduces output, cardiac atrophy, decreased ability to augment cardiac performance with exercise and reduced chamber size. Also, physical inactivity is a strong predictor of heart failure and death.

In summary, exercise deficiency should be considered part of the broad phenotype of heart failure with preserved ejection fraction.

The following are the highlights of the study:

The following are the highlights of the study:

• Physical activity is linked with increases in cardiac mass, cardiac output, stroke volume, peak oxygen consumption, and reduction of clinical events.
• Inactivity results in cardiac atrophy, impaired augmentation of cardiac performance during exercise, and reduced cardiac output and chamber size.
• A chronic lack of exercise is a risk factor for HFpEF in certain people.
• Lifelong physical activity improves cardiorespiratory fitness in middle life and can allow for an average age-related decrease in cardiac function without disability.

Regular exercise meeting or exceeding the current guidelines on physical activity is associated with a decreased cardiovascular disease (CVD) and mortality risk. Therefore, exercise training is critical in primary and secondary CVD prevention.

In the first part of the 4-part focus seminar series, the researchers highlight the mechanisms and physiological adaptations responsible for the exercise's cardioprotective effects. This includes increased cardiorespiratory fitness secondary to vascular, cardiac, and skeletal muscle adaptations and improved traditional and nontraditional CVD risk factors by exercise training.

In patients with CVDs, those extend to the role of exercise and its prescription with particular stress on the dosage, optimal mode, intensity of exercise, and duration to reduce the risk of CVD and improve clinical outcomes in these patients.

Reference:

1) Exercise for Primary and Secondary Prevention of Cardiovascular Disease: JACC Focus Seminar 1/4.

2) Heart Failure With Preserved Ejection Fraction as an Exercise Deficiency Syndrome: JACC Focus Seminar 2/4.