Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial.
Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial.
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DOI：
10.1001/jama.2015.17346
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发表时间：
2016-01-05
期刊：
影响因子：
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通讯作者：
Nicklas BJ
中科院分区：
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作者：
Kitzman DW;Brubaker P;Morgan T;Haykowsky M;Hundley G;Kraus WE;Eggebeen J;Nicklas BJ
超过80%的心力衰竭患者的射血分数(HFPEF)保留，这是老年人最常见的心衰形式，他们超重/肥胖。运动不耐受是慢性HFPEF的主要症状，也是生活质量(QOL)降低的主要决定因素。目的：确定限制热量摄入(饮食)或有氧运动训练(锻炼)是否能改善肥胖老年HFPEF患者的运动能力和生活质量。从2009年2月至2014年11月进行的随机、注意力控制、2x2析因试验。城市学术医疗中心。100名老年(67±5岁)肥胖(BMI=39.3±5.6 kg/m2)，女性(n=81)和男性(n=19)慢性稳定的HFPEF患者从577名初步筛查的患者中登记(366名被纳入/排除标准排除，31名因其他原因，80名拒绝参加)。26名参与者被随机分为单独运动组、24名单纯节食组、25名节食+运动组和25名对照组；92名参与者完成了试验。20周的饮食和/或锻炼；注意力控制包括每两周打一次电话。运动能力以最大耗氧量(VO2，ml/kg/min；主要结果)衡量，生活质量由明尼苏达心力衰竭生活问卷(MLHF)总分(共同主要结果；分数范围：0-105，分数越高表明心力衰竭相关生活质量越差)衡量。经主效应分析，运动主效1.2ml/kg/min(95%CI：0.7，1.7；p<；0.001)；饮食主效1.3ml/kg/min(95%CI：0.8，1.8；p<；0.001)。运动+饮食组合对峰值VO2(联合作用2.5ml/kg/min)具有相加(互补)作用。运动(主效−1单位；95%CI：−8，5；p=0.7)和饮食(主效−6单位；95%CI：−12，1；p=0.078)对MLHF总分无显著影响。VO2峰值的变化与瘦体重百分比的变化(r=0.32；p=0.003)和大腿肌肉/肌间脂肪比的变化(r=0.27；p=0.02)呈正相关。没有发生与研究相关的严重不良事件。运动参与率为84±14%，饮食依从性为99±1%。饮食组体重下降7±1 kg(7%)，运动组体重下降4±1 kg(3%)，运动+饮食组体重下降11±1 kg(10%)，对照组体重下降1±1 kg(1%)。在临床稳定的心力衰竭和射血分数保持不变的肥胖老年患者中，限制卡路里饮食或有氧运动训练增加了峰值耗氧量，而且这种影响可能是相加的。根据明尼苏达州心力衰竭生活问卷(ClinicalTrials.gov，NCT00959660；https://clinicaltrials.gov/ct2/show/NCT00959660)的测量，这两种干预措施都没有对生活质量产生显著影响
More than 80% of patients with heart failure with preserved ejection fraction (HFPEF), the most common form of HF among older persons, are overweight/obese. Exercise intolerance is the primary symptom of chronic HFPEF and a major determinant of reduced quality-of-life (QOL). To determine whether caloric restriction (Diet), or aerobic exercise training (Exercise), improves exercise capacity and QOL in obese older HFPEF patients. Randomized, attention-controlled, 2x2 factorial trial conducted from February 2009 November 2014. Urban academic medical center. 100 older (67±5 years) obese (BMI=39.3±5.6kg/m2) women (n=81) and men (n=19) with chronic, stable HFPEF enrolled from 577 patients initially screened (366 excluded by inclusion / exclusion criteria, 31 for other reasons, 80 declined participation). Twenty-six participants were randomized to Exercise alone, 24 to Diet alone, 25 to Diet+Exercise, and 25 to Control; 92 completed the trial. 20 weeks of Diet and/or Exercise; Attention Control consisted of telephone calls every 2 weeks. Exercise capacity measured as peak oxygen consumption (VO2, ml/kg/min; primary outcome) and QOL measured by the Minnesota Living with HF Questionnaire (MLHF) total score (co-primary outcome; score range: 0–105, higher scores indicate worse HF-related QOL). By main effects analysis, peak VO2 was increased significantly by both interventions: Exercise main effect 1.2 ml/kg/min (95%CI: 0.7,1.7; p<0.001); Diet main effect 1.3 ml/kg/min (95%CI: 0.8,1.8; p<0.001). The combination of Exercise+Diet was additive (complementary) for peak VO2 (joint effect 2.5 ml/kg/min). The change in MLHF total score was non-significant with Exercise (main effect −1 unit; 95%CI: −8,5; p=0.70) and with Diet (main effect −6 units; 95%CI: −12,1; p=0.078). The change in peak VO2 was positively correlated with the change in percent lean body mass (r=0.32; p=0.003) and the change in thigh muscle/intermuscular fat ratio (r=0.27; p=0.02). There were no study-related serious adverse events. Exercise attendance was 84±14%; Diet compliance was 99±1%. Body weight decreased by 7±1 kg (7%) in Diet, 4±1 kg (3%) in Exercise, 11±1 kg (10%) in Exercise+Diet, and 1±1 kg (1%) in Control. Among obese older patients with clinically stable heart failure and preserved ejection fraction, caloric restriction diet or aerobic exercise training increased peak oxygen consumption, and the effects may be additive. Neither intervention had a significant effect on quality of life as measured by the Minnesota Living with Heart Failure Questionnaire, Clinicaltrials.gov, NCT00959660; https://clinicaltrials.gov/ct2/show/NCT00959660