Chronic deficiency of exercise associated with HFpEF

A chronic lack of exercise – termed ‘exercise deficiency’ – is associated with cardiac atrophy, decreased cardiac output and chamber size, and decreased cardiorespiratory fitness (CRF) in a subgroup of patients with heart failure With preserved ejection fraction (HFpEF), researchers say.

They suggest that increasing the levels of physical activity for these sedentary individuals could be an effective preventive strategy, particularly for younger and middle-aged individuals.

Think of HFpEF as an exercise-deficiency syndrome that results in a small heart that “flys in the face of decades of cardiovascular education, because we’ve traditionally considered heart failure to be the big heart elastic,” Andre La Gerche, MBBS, PhD, said the Baker Heart and Diabetes Institute in Melbourne, Australia theheart.org | Medscape Heart.

“While it is true that some people with HFpEF have thick, hard hearts, we would suggest that another subgroup have a normal heart, it is small because they were not exercised sufficiently,” he said.

Article, Posted online September 5 as part of the Focus Seminar Series at Journal of the American College of Cardiology“It went viral on social media,” said Jason Kovacic, MBBS, of the Victor Chang Heart Research Institute, Darlinghurst, Australia, theheart.org | Medscape Heart.

Kovacic is a JACC Department Editor, Coordinator, and Senior Author of the series, which covers other issues related to physical activity, both in athletes and the general public.

“Coin Drop Moment”

To support their hypothesis that HFpEF is an exercise deficiency in certain patients, La Gerche and colleagues conducted a literature review highlighting the following points:

  • There is a strong association between physical activity and both CRF and cardiac function.

  • Exercise deficiency is a major risk factor for HFpEF in a subset of patients.

  • Increased physical activity is associated with increased heart mass, brain attack Volumes, cardiac output and peak oxygen consumption.

  • Physical inactivity leads to loss of heart muscle, reduced production and chamber size, and less ability to improve cardiac performance through exercise.

  • Aging leads to a smaller and stiffer heart. However, this effect is mitigated by regular exercise.

  • Individuals who have not been physically active throughout life cannot mitigate age-related decreased heart volume and increased chamber stiffness.

“When we explain it, it’s like a coin-drop moment, because it’s actually a really simple concept,” La Gerchy said. “A small heart has a small stroke volume. A patient with a small heart with a maximum stroke volume of 60ml can generate a cardiac output of 9 liters/min at a heart rate of 150 beats/min during exercise – an output that is just not enough.” It’s like trying to drive a truck with a 50cc motorcycle engine.”

“In addition, the lack of exercise also paves the way for comorbidities such as obesity, diabetes, and high blood pressure, all of which can eventually lead to HFpEF. “

La Gersch said that considering HFpEF an exercise-deficiency syndrome has two clinical implications. “First, it helps us understand the condition and diagnose more. For example, I think practitioners will begin to realize that shortness of breath in some of their patients is related to a small heart.”

“Secondly, if it’s exercise deficiency syndrome, the treatment is with exercise,” he said. “For most people, that means exercising regularly before age 60 to prevent HFpEF, because studies have found that after age 60, the heart is a little repaired and difficult to remodel. That’s no It means you shouldn’t try after the age of 60 or you won’t get a benefit. But the real ideal place is in middle age and younger.”

bigger picture

The JACC Focus Seminar Series Starts with an article That emphasizes the benefits of regular physical activity. “The key is getting our patients to meet the guidelines: 150 to 300 minutes of moderate-intensity exercise per week, or 75 to 250 minutes of vigorous activity per week,” Kovacic emphasized.

“Yes, we can give statins to lower cholesterol. Yes, we can give blood pressure medication to lower blood pressure. But when you prescribe exercise, you affect patients’ weight, blood pressure, cholesterol, weight and sense of well-being.” “It transcends so many different aspects of people’s lives that it is important to emphasize the value of exercise for everyone.”

He confirmed that among them are doctors. “All doctors have to lead by example. I would encourage those who are overweight or not exercising as much as they should make time to be healthy and exercise. If you don’t, poor health will force you to take the time to deal with Bad health problems.

Other articles in the series deal with the athlete’s heart. Christopher Simsian, MBBS, PhD, MSc in Public Health, University of Sydney, Australia, and colleagues Discuss emerging data on me hypertrophic cardiomyopathy and other hereditary cardiovascular diseases, with the conclusion that it is likely that more athletes with these conditions will participate in recreational and competitive sports than previously thought — another paradigm shift, according to Kovacic.

The last article Addresses some of the challenges and controversies related to the athlete’s heart, including whether or not intense exercise is associated with weakness atrial fibrillation and cardiac arrhythmias, and the effect of gender on the heart’s response to exercise, which cannot now be determined due to the paucity of data on women in sports.

Overall, Kovacic said, the series makes for “compelling” reading that will encourage readers to embark on their own studies to add to the data and support. Prescription across the board.

No commercial financing or related conflicts of interest were reported.

J Am Cool Cardiol. Posted online September 5, 2022.
Tucker et al. La Gerche et al. Semsarian and others. La Gerche et al.

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