Nav: Home

Exercise, diet improves ability to exercise for patients with common type of heart failure

January 05, 2016

Among obese older patients with a common type of heart failure, calorie restriction or aerobic exercise training improved their ability to exercise without experiencing shortness of breath, although neither intervention had a significant effect on a measure of quality of life, according to a study in the January 5 issue of JAMA.

Heart failure with preserved ejection fraction (a measure of how well the left ventricle of the heart pumps with each contraction) is the most rapidly increasing form of heart failure, occurs primarily in older women, and is associated with high rates of illness, death, and health care expenditures. More than 80 percent of patients with heart failure with preserved ejection fraction (HFPEF) are overweight or obese. Exercise intolerance is the primary symptom of chronic HFPEF and a major determinant of reduced quality of life (QOL).

Dalane W. Kitzman, M.D., of the Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues randomly assigned 100 older obese participants (average age, 67 years) with chronic, stable HFPEF to 20 weeks of diet, exercise, or both, or a control group. The researchers measured exercise capacity (peak oxygen consumption [Vo2]) and QOL (with the Minnesota Living with Heart Failure Questionnaire; MLHF).

Of the study participants, 26 were assigned to exercise; 24 to diet; 25 to exercise + diet; 25 to control. Of these, 92 completed the trial. The authors found that peak Vo2 was increased significantly by both exercise and diet, and the combination of diet with exercise produced an even greater increase in exercise capacity. The change in peak Vo2 was positively correlated with the change in percent lean body mass. Body weight decreased by 7 percent in the diet group, 3 percent in the exercise group, 10 percent in the exercise + diet group, and 1 percent in the control group.

There was no significant change in the MLHF score with exercise or diet.

The researchers note that because of the reported "heart failure obesity paradox" (lower mortality observed in overweight or obese individuals), before diet can be recommended for obese patients with HFPEF, further studies likely are needed to determine whether these favorable changes are associated with reduced clinical events.

(doi:10.1001/jama.2015.17346; Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Lifestyle Interventions to Improve Exercise Tolerance in Obese Older Patients With Heart Failure and Preserved Ejection Fraction

"This innovative report by Kitzman et al provides applicable evidence that dietary intervention (caloric restriction) alone or complemented by aerobic exercise training improves peak Vo2, increasing exercise capacity," writes Nanette K. Wenger, M.D., of the Emory University School of Medicine, Atlanta, in an accompanying editorial.

"The largest increase in exercise capacity was associated with a combination of the exercise + diet interventions. The hypothesis tested is intriguing, and worthy of further investigation in a community population, with longer follow-up, either with or without specific provision of meals to effect caloric restriction, although translation of this type of intervention to the community will be challenging. Whether nonprofessionally administered diet and nonmedically supervised exercise could safely attain similar benefit is uncertain but worthy of exploration."

(doi:10.1001/jama.2015.17347; Available pre-embargo to the media at

Editor's Note: Dr. Wenger has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

The JAMA Network Journals

Related Heart Failure Articles:

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.
Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.
How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.
Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.
NSAID impairs immune response in heart failure, worsens heart and kidney damage
Non-steroidal anti-inflammatory drugs, or NSAIDs, are widely known as pain-killers and can relieve pain and inflammation.
More Heart Failure News and Heart Failure Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...