JAMA: Among obese older patients with a common type of heart failure,
calorie restriction or aerobic exercise training improved their ability
to exercise without experiencing shortness of breath, although neither
intervention had a significant effect on a measure of quality of life,
according to a study in the January 5 issue of JAMA.
Heart failure with preserved ejection fraction (a measure of how well the left ventricle of the heart
pumps with each contraction) is the most rapidly increasing form of
heart failure, occurs primarily in older women, and is associated with
high rates of illness, death, and health care expenditures. More than 80
percent of patients with heart failure with preserved ejection fraction
(HFPEF) are overweight or obese. Exercise intolerance is the primary
symptom of chronic HFPEF and a major determinant of reduced quality of
life (QOL).
Dalane W. Kitzman, M.D., of the Wake Forest School of Medicine,
Winston-Salem, N.C., and colleagues randomly assigned 100 older obese
participants (average age, 67 years) with chronic, stable HFPEF to 20
weeks of diet, exercise, or both, or a control group. The researchers
measured exercise capacity (peak oxygen consumption [Vo2]) and QOL (with the Minnesota Living with Heart Failure Questionnaire; MLHF).
Of the study participants, 26 were assigned to exercise; 24 to diet;
25 to exercise + diet; 25 to control. Of these, 92 completed the trial.
The authors found that peak Vo2 was increased significantly
by both exercise and diet, and the combination of diet with exercise
produced an even greater increase in exercise capacity. The change in
peak Vo2 was positively correlated with the change in percent
lean body mass. Body weight decreased by 7 percent in the diet group, 3
percent in the exercise group, 10 percent in the exercise + diet group,
and 1 percent in the control group.
There was no significant change in the MLHF score with exercise or diet.
The researchers note that because of the reported “heart failure
obesity paradox” (lower mortality observed in overweight or obese
individuals), before diet can be recommended for obese patients with
HFPEF, further studies likely are needed to determine whether these
favorable changes are associated with reduced clinical events.
(doi:10.1001/jama.2015.17346; Available pre-embargo to the media at http:/media.jamanetwork.com)