Effect of exercise training in patients with chronotropic incompetence and heart failure with preserved ejection fraction: the TRAINING-HR randomized clinical trial

Autores de INCLIVA

• 

  Patricia Palau Sampio

  Autor

• 

  Gonzalo Núñez Marín

  Autor

• 

  Cristina Flor Rufino

  Autor

• 

  Rafael De La Espriella Juan

  Autor

• Eloy Dominguez Mafé

  Autor

• 

  Juan Sanchis Fores

  Autor

• 

  Julio Núñez Villota

  Autor

• 

  Laura Lopez Bueno

  Autor

Participantes ajenos a INCLIVA

• de Amo, I
• García-Conejo, C
• Berlanga-Tovar, SE
• Casaña-Granell, J
• Calatayud, J
• Sanchis-Gomar, F
• Meyer, M

Grupos y Plataformas de I+D+i

• Grupo de Investigación en Cardiología Clínica

  

  Leading Researcher

  Juan Sanchis Fores

• Grupo de Investigación en Insuficiencia Cardiaca

  

  Established Researcher

  Julio Núñez Villota

Abstract

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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Keywords

• HFpEF; Chronotropic incompetence; Exercise training; Chronotropic response to exercise; PeakVO(2); Per cent predicted peakVO(2)