American Heart Journal Plus (Oct 2022)

Moderate continuous or high intensity interval exercise in heart failure with reduced ejection fraction: Differences between ischemic and non-ischemic etiology

  • Martin Halle,
  • Eva Prescott,
  • Emeline M. Van Craenenbroeck,
  • Paul Beckers,
  • Vibeke Videm,
  • Trine Karlsen,
  • Patrick Feiereisen,
  • Ephraim B. Winzer,
  • Norman Mangner,
  • Martin Snoer,
  • Jeffrey W. Christle,
  • Håvard Dalen,
  • Asbjørn Støylen,
  • Katrin Esefeld,
  • Melanie Heitkamp,
  • Bianca Spanier,
  • Axel Linke,
  • Øyvind Ellingsen,
  • Charles Delagardelle

Journal volume & issue
Vol. 22
p. 100202

Abstract

Read online

Background: Exercise for heart failure (HF) with reduced ejection fraction (HFrEF) is recommended by guidelines, but exercise mode and intensities are not differentiated between HF etiologies. We, therefore, investigated the effect of moderate or high intensity exercise on left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and maximal exercise capacity (peak VO2) in patients with ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM). Methods: The Study of Myocardial Recovery after Exercise Training in Heart Failure (SMARTEX-HF) consecutively enrolled 231 patients with HFrEF (LVEF ≤ 35 %, NYHA II-III) in a 12-weeks supervised exercise program. Patients were stratified for HFrEF etiology (ICM versus NICM) and randomly assigned (1:1:1) to supervised exercise thrice weekly: a) moderate continuous training (MCT) at 60–70 % of peak heart rate (HR), b) high intensity interval training (HIIIT) at 90–95 % peak HR, or c) recommendation of regular exercise (RRE) according to guidelines. LVEDD, LVEF and peak VO2 were assessed at baseline, after 12 and 52 weeks. Results: 215 patients completed the intervention. ICM (59 %; n = 126) compared to NICM patients (41 %; n = 89) had significantly lower peak VO2 values at baseline and after 12 weeks (difference in peak VO2 2.2 mL/(kg*min); p < 0.0005) without differences between time points (p = 0.11) or training groups (p = 0.15). Etiology did not influence changes of LVEDD or LVEF (p = 0.30; p = 0.12), even when adjusting for sex, age and smoking status (p = 0.54; p = 0.12). Similar findings were observed after 52 weeks. Conclusions: Etiology of HFrEF did not influence the effects of moderate or high intensity exercise on cardiac dimensions, systolic function or exercise capacity. Clinical Trial Registration–URL: http://www.clinicaltrials.gov. Unique identifier: NCT00917046.

Keywords