Effect of exercise training in patients with chronotropic incompetence and heart failure with preserved ejection fraction: the TRAINING-HR randomized clinical trial
Aims Chronotropic incompetence (ChI) in heart failure with preserved ejection fraction (HFpEF) is associated with a reduced exercise capacity. The role of exercise training in improving chronotropic response (ChR) and functional capacity in these patients remains uncertain. This study assessed the e...
| Autores: | , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | INCLIVA |
| Repositorio: | r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA |
| OAI Identifier: | oai:incliva.fundanetsuite.com:p19936 |
| Acceso en línea: | https://incliva.portalinvestigacion.com/publicaciones/19936 |
| Access Level: | acceso abierto |
| Palabra clave: | HFpEF Chronotropic incompetence Exercise training Chronotropic response to exercise PeakVO(2) Per cent predicted peakVO(2) |
| Sumario: | Aims Chronotropic incompetence (ChI) in heart failure with preserved ejection fraction (HFpEF) is associated with a reduced exercise capacity. The role of exercise training in improving chronotropic response (ChR) and functional capacity in these patients remains uncertain. This study assessed the effects of four different exercise programmes on peak oxygen consumption (peakVO(2)), Kansas City Cardiomyopathy Questionnaire (KCCQ) score, and ChR in patients with the ChI HFpEF phenotype. Methods and results In this randomized clinical trial, 80 symptomatic (NYHA classes II-III/IV) patients with the ChI HFpEF phenotype were randomized (1:1:1:1) to one of four interventions: (i) a 12-week supervised aerobic training (AT) programme, (ii) AT with low-intensity strength training (AT/LRT), (iii) AT with moderate- to high-intensity strength training (AT/HRT), or (iv) non-supervised exercise recommendations (ER). The primary endpoint was the change in peakVO(2) at 12 weeks. Secondary endpoints included changes in ChR and KCCQ. A linear regression model was used. The mean age of 80 participants was 75.1 +/- 7.2 years, and 59.6% were women. Baseline values for peakVO(2), chronotropic index, and KCCQ were 11.8 +/- 2.6 mL/kg/min, 0.4 +/- 0.2, and 63.5 +/- 17.9, respectively, with no significant differences across arms. All supervised training programmes led to significant improvements in peakVO(2) compared to ER: AT/HRT: Delta + 4.0 [95% confidence interval (CI): 2.9-5.1, P < 0.001], AT/LRT: Delta + 3.6 (95% CI: 2.5-4.6, P < 0.001), and AT: Delta + 2.9 (95% CI: 1.9-4.0, P < 0.001). AT/HRT was superior over AT alone: Delta + 1.1 (95% CI, 0.1-2.2, P = 0.046). Likewise, supervised exercise improved ChR and KCCQ without statistical differences between groups. Conclusion Different supervised exercise training improved peakVO(2), ChR, and KCCQ in patients with ChI HFpEF phenotype. Registration ClinicalTrials.gov (NCT05649787). Lay summary This study investigates the impact of different exercise interventions on improving functional capacity, heart rate response, and quality of life in patients with heart failure with preserved ejection fraction and chronotropic incompetence. center dot Supervised exercise training significantly improved peak oxygen consumption, heart rate response during exercise, and quality of life compared to non-supervised recommendations. center dot Programmes combining aerobic and moderate-to high-intensity strength training offered the most pronounced benefits, highlighting the importance of tailored, multidimensional exercise interventions for this patient population. |
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