Exercise Training Across the Spectrum of HFpEF: Time for Tailoring or One Size Fits All?
Exercise Training Across the Spectrum of HFpEF: Time for Tailoring or One Size Fits All?
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跨 HFpEF 范围的运动训练：是时候量身定制还是一刀切了？
DOI：
10.1016/j.jchf.2022.02.003
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Robbins,JeremyM
中科院分区：
文献类型：
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作者：
Ho,JenniferE;Robbins,JeremyM
心力衰竭(HF)的分期分类是为了突出高危受试者(A期)到临床显性心衰(C期)的疾病进展，并强调在其早期阶段预防心衰的可能性。尽管目前对A期心力衰竭患者的建议侧重于调整危险因素，包括治疗高血压和心脏代谢性疾病，但运动训练的作用仍不清楚。肥胖、心脏代谢性疾病和缺乏体力活动都与心力衰竭的风险有关，尤其是射血分数保留的心力衰竭(HFpEF)。以前的研究表明，休闲时间的体力活动与HFpEF之间存在分级的负相关关系--但与降低EF风险的HF无关。1此外，较低的体重指数和较高的心肺健康水平与发生心力衰竭呈负相关，但只有心肺健康状况的间歇性改善--而不是身体质量指数--与心力衰竭风险有关。2由于HFpEF缺乏有效的药物治疗，这些研究和其他研究强调了可改变的生活方式努力，包括增加体力活动、减肥和定期锻炼，在预防和治疗HFpEF方面可能发挥的潜在作用。在此背景下，赫伦等人在本期《美国医学会杂志：心力衰竭是一个及时而重要的贡献》中的研究。研究人员检查了强化生活方式干预对高危肥胖成人的影响。在80名随机接受1年高强度间歇训练(HITT)的受试者中，56人完成了干预。参与者还接受了omega-3脂肪酸补充剂与安慰剂的比较，这对研究结果没有影响。HIIT组受试者1年后心肺功能明显改善，相对峰值氧耗量(VO2)平均增加4.46mL/kg/min，绝对峰值VO2平均增加0.43mLVO2。>；1Met(假设1代谢当量=3.5mL/kg/min)的增加是显著的，具有临床意义；从观察数据推断，在转至临床运动试验的男性中，运动量增加1MET与死亡率降低12%相关。4尽管峰值VO2的变化幅度反映了同一研究小组之前在B期心衰患者中所做的工作，5但它比以前在运动训练研究中看到的对C期HFpEF患者的改善要大得多，但需要注意的是，后一种干预措施的持续时间很短，不同类型的运动训练不同，而且纳入了基线峰值VO2较低的老年患者。6-8除了显示HIIT治疗后VO2峰值有所改善外，研究人员还对心血管结构、功能和身体成分进行了详细的表型分析。为什么这很重要？我们知道，在HFpEF患者中，心脏和心外器官储备的多重缺陷可能导致其显著症状-运动不耐受。量化特定器官对运动的贡献
The staging classification of heart failure (HF) was developed to highlight progression of disease among high-risk subjects (Stage A) to clinically overt HF (Stage C) and to emphasize the potential for HF prevention in its early stages. Although current recommendations among patients with Stage A HF focus on risk factor modification, including treatment of hypertension and cardiometabolic disease, the role of exercise training remains unclear. Obesity, cardiometabolic disease, and physical inactivity have all been linked to risk of HF, with specific predilection for HF with preserved ejection fraction (HFpEF). Previous studies demonstrate a graded, inverse relationship between leisure-time physical activity and HFpEF―but not HF with reduced EF―risk. 1 Furthermore, lower body mass index and higher levels of cardiorespiratory fitness are inversely associated with incident HF, yet only interval improvements in cardiorespiratory fitness―but not body mass index―are related to HF risk. 2 Because of the dearth of effective pharmacotherapies for HFpEF, these and other studies highlight the potential role that modifiable lifestyle efforts, including increased physical activity, weight loss, and regular exercise, may play in its prevention and treatment. In this context, the study by Hearon et al 3 in this issue of JACC: Heart Failure is a timely and important contribution. The investigators examined the effects of intensive lifestyle interventions among obese adults at high risk for HFpEF. Of 80 subjects randomized to 1 year of high-intensity interval training (HITT) versus an attention control group, 56 completed the intervention. Participants also received omega-3 fatty acid supplementation versus placebo, which had no effect on study outcomes. Subjects in the HIIT group had markedly improved cardiorespiratory fitness after 1 year, with an average increase of 4.46 mL/kg/min in relative peak oxygen consumption (VO2) and an increase of 0.43 L/min in absolute peak VO2 This increase of> 1 MET (assuming 1 metabolic equivalent= 3.5 mL/kg/min) is notable and clinically meaningful; extrapolated from observational data, we know that among men referred for clinical exercise testing, a 1 MET higher exercise capacity was associated with 12% lower mortality. 4Although this magnitude of change in peak VO2 mirrors previous work by the same investigative group among patients with Stage B HF, 5 it represents a much larger improvement than previously seen in exercise training studies in patients with Stage C HFpEF, with the caveat that these latter interventions were largely shorter in duration, differed across types of exercise training, and enrolled older patients with lower baseline peak VO2. 6-8 Beyond showing improvements in peak VO2 with HIIT, the investigators conducted detailed phenotyping of cardiovascular structure, function, and body composition. Why is this important? We know that among patients with HFpEF, multiple deficits in both cardiac and extracardiac organ reserve can lead to its hallmark symptom―exercise intolerance. Quantifying specific organ contributions to exercise