Response to Endurance Exercise Training in Older Adults with Heart Failure with Preserved or Reduced Ejection Fraction

Ambarish Pandey, Dalane W. Kitzman, Peter Brubaker, Mark J. Haykowsky, Timothy Morgan, J. Thomas Becton, Jarett D. Berry

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objectives: To systematically examine the relative magnitude and predictors of responses to exercise training in older adult with heart failure (HF) with reduced ejection fraction (HFrEF), and preserved EF (HFpEF). Design: Secondary analysis of a randomized controlled trial. Setting: Outpatient cardiac rehabilitation program. Participants: Individuals with HF (24 HFrEF, 24 HFpEF) who underwent supervised exercise training. Measurements: The study included individual-level data from the exercise training arms of a randomized controlled trial that evaluated the effect of 16 weeks of supervised moderate-intensity endurance exercise training in older adults with chronic, stable HFpEF and HFrEF. Changes in peak oxygen uptake (VO2peak) in response to supervised training in individuals with HFpEF were compared with that of individuals with HFrEF. The significant clinical predictors of changes in VO2peak with exercise training were assessed using univariate and multivariate regression models. Results: Training-related improvement in VO2peak was higher in participants with HFpEF than in those with HFrEF (change: 18.7 ± 17.6% vs -0.3 ± 15.4%, P < .001). In univariate analysis, echocardiographic abnormalities in left ventricular structure and function and lower body mass index were associated with blunted response of VO2peak with exercise training. In multivariate regression analysis using stepwise selection, submaximal exercise systolic blood pressure, and resting early deceleration time were independent predictors of change in VO2peak. Conclusion: The change in VO2peak in response to endurance exercise training in older adults with HF differs significantly according to HF subtype, with greater VO2peak improvement in HFpEF than HFrEF. These results suggest that the current Centers for Medicare and Medicaid Services policy excluding individuals with HFpEF from reimbursement from cardiac rehabilitation may need to be revisited.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - 2017

Fingerprint

Heart Failure
Exercise
Randomized Controlled Trials
Blood Pressure
Centers for Medicare and Medicaid Services (U.S.)
Deceleration
Left Ventricular Function
Body Mass Index
Outpatients
Multivariate Analysis
Regression Analysis
Oxygen

Keywords

  • Cardiorespiratory fitness
  • Exercise training
  • Heart failure

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Response to Endurance Exercise Training in Older Adults with Heart Failure with Preserved or Reduced Ejection Fraction. / Pandey, Ambarish; Kitzman, Dalane W.; Brubaker, Peter; Haykowsky, Mark J.; Morgan, Timothy; Becton, J. Thomas; Berry, Jarett D.

In: Journal of the American Geriatrics Society, 2017.

Research output: Contribution to journalArticle

Pandey, Ambarish ; Kitzman, Dalane W. ; Brubaker, Peter ; Haykowsky, Mark J. ; Morgan, Timothy ; Becton, J. Thomas ; Berry, Jarett D. / Response to Endurance Exercise Training in Older Adults with Heart Failure with Preserved or Reduced Ejection Fraction. In: Journal of the American Geriatrics Society. 2017.
@article{33e511d16c654cbcaefeaf6f1b6e810f,
title = "Response to Endurance Exercise Training in Older Adults with Heart Failure with Preserved or Reduced Ejection Fraction",
abstract = "Objectives: To systematically examine the relative magnitude and predictors of responses to exercise training in older adult with heart failure (HF) with reduced ejection fraction (HFrEF), and preserved EF (HFpEF). Design: Secondary analysis of a randomized controlled trial. Setting: Outpatient cardiac rehabilitation program. Participants: Individuals with HF (24 HFrEF, 24 HFpEF) who underwent supervised exercise training. Measurements: The study included individual-level data from the exercise training arms of a randomized controlled trial that evaluated the effect of 16 weeks of supervised moderate-intensity endurance exercise training in older adults with chronic, stable HFpEF and HFrEF. Changes in peak oxygen uptake (VO2peak) in response to supervised training in individuals with HFpEF were compared with that of individuals with HFrEF. The significant clinical predictors of changes in VO2peak with exercise training were assessed using univariate and multivariate regression models. Results: Training-related improvement in VO2peak was higher in participants with HFpEF than in those with HFrEF (change: 18.7 ± 17.6{\%} vs -0.3 ± 15.4{\%}, P < .001). In univariate analysis, echocardiographic abnormalities in left ventricular structure and function and lower body mass index were associated with blunted response of VO2peak with exercise training. In multivariate regression analysis using stepwise selection, submaximal exercise systolic blood pressure, and resting early deceleration time were independent predictors of change in VO2peak. Conclusion: The change in VO2peak in response to endurance exercise training in older adults with HF differs significantly according to HF subtype, with greater VO2peak improvement in HFpEF than HFrEF. These results suggest that the current Centers for Medicare and Medicaid Services policy excluding individuals with HFpEF from reimbursement from cardiac rehabilitation may need to be revisited.",
keywords = "Cardiorespiratory fitness, Exercise training, Heart failure",
author = "Ambarish Pandey and Kitzman, {Dalane W.} and Peter Brubaker and Haykowsky, {Mark J.} and Timothy Morgan and Becton, {J. Thomas} and Berry, {Jarett D.}",
year = "2017",
doi = "10.1111/jgs.14867",
language = "English (US)",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Response to Endurance Exercise Training in Older Adults with Heart Failure with Preserved or Reduced Ejection Fraction

AU - Pandey, Ambarish

AU - Kitzman, Dalane W.

AU - Brubaker, Peter

AU - Haykowsky, Mark J.

AU - Morgan, Timothy

AU - Becton, J. Thomas

AU - Berry, Jarett D.

PY - 2017

Y1 - 2017

N2 - Objectives: To systematically examine the relative magnitude and predictors of responses to exercise training in older adult with heart failure (HF) with reduced ejection fraction (HFrEF), and preserved EF (HFpEF). Design: Secondary analysis of a randomized controlled trial. Setting: Outpatient cardiac rehabilitation program. Participants: Individuals with HF (24 HFrEF, 24 HFpEF) who underwent supervised exercise training. Measurements: The study included individual-level data from the exercise training arms of a randomized controlled trial that evaluated the effect of 16 weeks of supervised moderate-intensity endurance exercise training in older adults with chronic, stable HFpEF and HFrEF. Changes in peak oxygen uptake (VO2peak) in response to supervised training in individuals with HFpEF were compared with that of individuals with HFrEF. The significant clinical predictors of changes in VO2peak with exercise training were assessed using univariate and multivariate regression models. Results: Training-related improvement in VO2peak was higher in participants with HFpEF than in those with HFrEF (change: 18.7 ± 17.6% vs -0.3 ± 15.4%, P < .001). In univariate analysis, echocardiographic abnormalities in left ventricular structure and function and lower body mass index were associated with blunted response of VO2peak with exercise training. In multivariate regression analysis using stepwise selection, submaximal exercise systolic blood pressure, and resting early deceleration time were independent predictors of change in VO2peak. Conclusion: The change in VO2peak in response to endurance exercise training in older adults with HF differs significantly according to HF subtype, with greater VO2peak improvement in HFpEF than HFrEF. These results suggest that the current Centers for Medicare and Medicaid Services policy excluding individuals with HFpEF from reimbursement from cardiac rehabilitation may need to be revisited.

AB - Objectives: To systematically examine the relative magnitude and predictors of responses to exercise training in older adult with heart failure (HF) with reduced ejection fraction (HFrEF), and preserved EF (HFpEF). Design: Secondary analysis of a randomized controlled trial. Setting: Outpatient cardiac rehabilitation program. Participants: Individuals with HF (24 HFrEF, 24 HFpEF) who underwent supervised exercise training. Measurements: The study included individual-level data from the exercise training arms of a randomized controlled trial that evaluated the effect of 16 weeks of supervised moderate-intensity endurance exercise training in older adults with chronic, stable HFpEF and HFrEF. Changes in peak oxygen uptake (VO2peak) in response to supervised training in individuals with HFpEF were compared with that of individuals with HFrEF. The significant clinical predictors of changes in VO2peak with exercise training were assessed using univariate and multivariate regression models. Results: Training-related improvement in VO2peak was higher in participants with HFpEF than in those with HFrEF (change: 18.7 ± 17.6% vs -0.3 ± 15.4%, P < .001). In univariate analysis, echocardiographic abnormalities in left ventricular structure and function and lower body mass index were associated with blunted response of VO2peak with exercise training. In multivariate regression analysis using stepwise selection, submaximal exercise systolic blood pressure, and resting early deceleration time were independent predictors of change in VO2peak. Conclusion: The change in VO2peak in response to endurance exercise training in older adults with HF differs significantly according to HF subtype, with greater VO2peak improvement in HFpEF than HFrEF. These results suggest that the current Centers for Medicare and Medicaid Services policy excluding individuals with HFpEF from reimbursement from cardiac rehabilitation may need to be revisited.

KW - Cardiorespiratory fitness

KW - Exercise training

KW - Heart failure

UR - http://www.scopus.com/inward/record.url?scp=85016559547&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85016559547&partnerID=8YFLogxK

U2 - 10.1111/jgs.14867

DO - 10.1111/jgs.14867

M3 - Article

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

ER -