Written by Mary Marschner
Spoon Feed
For patients with class I or II diastolic heart failure, combination endurance and resistance exercise training over 12 months did not change the progressive nature of the disease.
HFpEF resists resistance…training
Diastolic heart failure is frustrating, because we have limited options to clinically improve outcomes yet it affects a large number of heart failure patients. SGLT-2 inhibitors are one of the few medications we have to decrease hospitalizations for patients with heart failure with preserved ejection fraction (HFpEF). Other medications to consider are GLP-1s and mineralocorticoid receptor antagonists, but the data are limited. Previous studies of cardiac rehab for these patients noted similar outcomes: improved VO₂ but not overall outcomes.
This randomized controlled trial evaluated combined endurance and resistance exercise in HFpEF patients over 12 months. The primary composite outcome (mortality, hospitalizations, VO₂, diastolic function, New York Heart Association (NYHA) class, and self-assessment) showed no significant difference; however, exercise improved peak VO₂ (+1.3 mL/kg/min; 95%CI 0.4–2.1) and NYHA class (OR 7.77; 95%CI 3.73–16.21). While not altering major outcomes, structured exercise enhanced functional capacity and symptoms in HFpEF, supporting its role in management. The study was quite small, with short follow-up. It reported issues with non-adherence in the exercise group and lacked information on patients’ perspectives. Committing to endurance and resistance training three times a week while having a chronic illness is a tough ask, and they didn’t report on quality of life or patient satisfaction. Additionally, changes in peak VO₂ and NYHA class have been shown to demonstrate mortality benefit over years.
How does this change my practice?
The study itself doesn’t support endurance and resistance training for HFpEF, but it is plagued with nonadherence and short follow-up. The benefits of strength, mobility, and confidence that endurance and resistance training bring to all ages means I will always recommend it, even though outcomes may be minimal.
Source
Combined endurance and resistance exercise training in heart failure with preserved ejection fraction: a randomized controlled trial. Nat Med. 2025 Jan;31(1):306-314. doi: 10.1038/s41591-024-03342-7. Epub 2025 Jan 2. PMID: 39747684
