• Researchers investigated whether supervised exercise therapy could benefit those with heart failure.
• They found that supervised exercise therapy improves exercise capacity and quality of life among patients.
• They noted future research is needed to ensure long-term adherence to exercise programs.

Heart failure occurs when the heart can no longer pump blood and oxygen around the body. The condition represents around 8.5% of heart disease deaths in the United States.

Heart failure with preserved ejection fraction (HFpEF) causes around half of heart failure cases in the U.S. It happens when the heart’s left ventricle stiffens, increasing pressure inside the heart.

Studies show that exercise improves physical and cardiac function in patients with HFpEF and may lead to better outcomes than medication.

Understanding more about how exercise could benefit those with heart failure could help physicians improve treatment plans for the condition.

Recently, researchers reviewed recent studies investigating the impact of supervised exercise therapy on those with chronic, stable HFpEF.

They found that supervised exercise therapy improves exercise capacity and quality of life among patients with heart HFpEF.

“Currently in the United States, 1 in 2 Americans has diabetes or prediabetes and 3 in 4 are overweight or obese,” said Dr. Melody H. Hermel, a cardiologist at United Medical Doctors in La Jolla, CA, not involved in the study, in an interview with Medical News Today.

“To truly combat the comorbid conditions patients face, we need to combine traditional medication and procedures with nutrition, exercise, stress management, and preventative care to best address patients’ underlying risk factors and truly get at the heart of the matter,” Dr. Hermel added.

Dr. Vandana Sachdev, a senior research clinician and the director of the Echocardiography Laboratory in the Division of Intramural Research at the National Heart, Lung, and Blood Institute (NHLBI), first author of the study, said in a press release:

“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 study was published in Circulation.

Exercise therapy for people with heart failure 

For the study, the researchers analyzed results from 11 randomized controlled trials investigating supervised exercise therapy on HFpEF outcomes.

The studies included over 700 participants, mostly aged between 60 and 70 years old. Participants engaged in various activities, including walking, Greek dancing, and high intensity training three times per week for 1-8 months.

The researchers found that supervised exercise training increased total exercise time by 21% and peak oxygen uptake by 12%-14%.

Peak oxygen intake is the total amount of oxygen a person can inhale into their lungs during physical exertion. Those with HDpEF can inhale 30% less oxygen than healthy people.

Supervised exercise training also improved quality of life scores on the 21-point Minnesota Living with Heart Failure questionnaire by 4-9 points.

“Exercising helps improve the heart’s pumping ability, decreases blood vessel stiffness and improves the function and energy capacity of skeletal muscle,” said Dr. 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,” she added.

Exercise beneficial to heart failure recovery

“Supervised exercise allows people to have their blood pressure, heart rate, breathing capacity observed when they are recovering from an illness or a procedure and there is uncertainty about their basic skills in exercise, ability to perform exercise or their ability to increase the intensity of exercise or to perform some types of exercise correctly,” Dr. Charlie Porter, Cardio-oncologist at The University of Kansas Health System, not involved in the study, told MNT.

“The benefits of exercise cannot be duplicated by medication or procedures. Regular exercise of 2.5 hours weekly or that equivalent increases life expectancy, reduces the incidence of heart disease complications, and has been linked to reduced risk for some cancers, such as colon. Improved sense of well-being or quality of life is consistently demonstrated in studies of sustained safe exercise,” he added.

“Increasing evidence indicates that resistance exercise is helpful in some neurologic disorders. Early signals suggest that resistance exercise may improve decline in cognitive function over time. There is no other intervention that can provide this array of established and probable benefits. There are no other interventions that can offer this array of established or probable benefits,” he noted.

Should you partake in supervised exercise programs?

“There are so many benefits to supervised exercise for many people, but there may be particular benefits for people who also have diabetes, are overweight or depressed,” Dr. Martha Abshire Saylor, Ph.D., assistant professor at the Johns Hopkins School of Nursing, not involved in the study, told MNT.

“Starting a supervised exercise program may have social support benefits, including encouragement and accountability for participation, but also will help with physiologic benefits like reducing inflammation and lipid levels,” Dr. Saylor added.

Dr. Saylor cautioned, however, that supervision is key as vigorous physical activity can trigger acute cardiovascular events in those who are unfit, inactive, or with coronary artery disease.

Dr. Hermel added:

“Supervised exercise programs such as cardiac rehab have demonstrated significant benefit for patients with recent heart attack or another acute coronary syndrome, chronic stable angina, congestive heart failure, pulmonary hypertension, after stent placement, coronary artery bypass surgery, heart valve surgery or cardiac transplant.”

MNT also spoke to Dr. Yu-Ming Ni, a cardiologist of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, who was not involved in the study. Dr. Ni noted that the “biggest obstacle to successful use of supervised exercise programs is adherence to exercise sessions.”

“Unlike in clinical trials, patients in real life are less likely to come to exercise sessions, and are not always committed to staying for the entire hour of exercise. Thus, patients who stand to gain the most from supervised exercise programs are those who are motivated to attend,” he said.

Study limitations and implications

When asked about limitations to the findings, Dr. Mirza Baig, a cardiologist with Memorial Hermann in Houston, Texas, not involved in the study, noted that the different studies included in the analyses had different selection criteria and endpoints.

Dr. Robert Segal, board certified cardiologist and founder of Manhattan Cardiology, Medical Offices of Manhattan, and co-founder of LabFinder, not involved in the study, also told MNT:

“Women, low socioeconomic status, minority racial and ethnic groups were small percentages of the demographic that were studied. Most of the studies don’t specify which type of heart failure (HFpEF vs Heart Failure With Reduced Ejection Fraction [HFrEF]) they are analyzing. The studies are short-term studies, a year or less. There were also issues with adherence to the exercise programs.”

Dr. Adedapo Iluyomade, a preventive cardiologist at Baptist Health Miami Cardiac & Vascular Institute, also not involved in the study, told MNT:

“There are several evidence gaps that need to be addressed, including the optimal exercise modalities, strategies to increase long-term adherence, and the use of exercise therapy for patients recently hospitalized with acute, decompensated heart failure.”

“Further research is needed to determine the potential effects of exercise-based therapies on hospitalization, death, cardiovascular events, and healthcare expenditures, as well as in the prevention of HFpEF in patients with multiple risk factors,” Dr. Illuyomade noted.

“This statement makes it clear that it is time for Medicare and Health plans to support the provision of supervised exercise programs to patients with HFpEF. The body of knowledge cited in this report indicates that further delays in expanding access to this important component of care is unwarranted,” noted Dr. Porter.

Dr. Ni added:

“Physicians should recommend supervised exercise programs to patients with heart failure with preserved fractions who are willing to attend regularly. If not qualified by insurance, physicians should recommend home exercise for patients with heart failure, as there are certainly enough benefits from exercise to justify routinely recommending it.

Patients with heart failure should take advantage of exercise programs covered by insurance to improve exercise capacity and quality of life.”

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