Diet and Exercise Program in Patients with Heart Failure and Preserved Ejection Fraction

January 26, 2016

Diet and Exercise Program in Patients with Heart Failure and Preserved Ejection Fraction

  1. Kirsten E. Fleischmann, MD, MPH

Patients lost weight, and their exercise capacity increased.

  1. Kirsten E. Fleischmann, MD, MPH

Most patients with heart failure and preserved ejection fraction are overweight or obese, and effective pharmacologic therapies are limited. In this study, 100 such patients (mean age, 67; 81 women) without substantial comorbidities were randomized to 20 weeks of diet only, exercise only, both interventions, or an “attention” control group (telephone calls every 2 weeks). Heart failure was symptomatic in all patients.

Exercise capacity, as measured by peak oxygen consumption during cardiopulmonary exercise testing, increased significantly from baseline in both single-intervention groups; the combination group achieved additive effects. Body weight decreased by 7% with diet only, 3% with exercise only, 10% with exercise and diet, and 1% in controls. No statistically significant changes were noted in health-related quality of life (QOL) as measured by the Minnesota Living with Heart Failure Questionnaire, but two other standardized measures (defined as “exploratory” in this study) showed significant improvement in some groups.

Comment — General Medicine

Diet, exercise, and particularly the combination reduced body weight and significantly improved peak oxygen consumption during stress testing. Lack of a consistent improvement in measures of QOL could be explained by the small cohort size, varying sensitivity among QOL instruments, a disconnect between physiologic measures and QOL, or, as an editorialist notes, patients continuing to push themselves until symptoms occurred. The authors emphasize that future studies should be designed to examine clinical events, particularly because some trials have reported lower mortality for overweight and obese heart failure patients (the “heart failure obesity paradox”). In the meantime, I will continue to advocate for healthy diet and activity in my patients with heart failure and preserved ejection fraction.

Comment — Cardiology

  1. Harlan M. Krumholz, MD, SM

This fairly small study shows that the interventions change a measure of fitness but in a way that is imperceptible to the patient. There may be many reasons why the interventions failed to help people improve their health status — including the insensitivity of the measure itself — but the upshot is that the study offers little support for diet and exercise as important means to improve patient outcomes in this group.

Editor Disclosures at Time of Publication

  • Disclosures for Kirsten E. Fleischmann, MD, MPH at time of publication Grant / Research support NIH/NHLBI; Bluefield Project to Cure Frontotemporal Dementia Leadership positions in professional societies American College of Cardiology and American Heart Association (Vice Chair, Writing Committee for Guidance on Cardiovascular Evaluation and Care for Noncardiac Surgery)

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Reader Comments (2)

SCOTT ANDES Physician, Internal Medicine, office

Interesting article and it makes sense

Thomas Smith Physician, Family Medicine/General Practice, small town, single specialty, group practice

Add heart failure to the list of conditions that improve with healthy diet, regular exercise and weight loss. From depression to cancer. From pediatrics to geriatrics. We need to advocate and model healthy lifestyle choices.

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