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01-03-2022 | Heart Failure

Physical activity and exercise training in heart failure with preserved ejection fraction: gathering evidence from clinical and pre-clinical studies

Authors: Cristine Schmidt, Daniel Moreira-Gonçalves, Mário Santos, Adelino Leite-Moreira, José Oliveira

Published in: Heart Failure Reviews | Issue 2/2022

Abstract

Conventional treatments for heart failure have failed to improve survival in heart failure with preserved ejection fraction (HFpEF). The current therapy recommendations highlight the importance of symptom management and improvement of patient’s well-being or other health-related outcomes. Physical activity/exercise training might be an adjuvant treatment option, since several studies in HFpEF patients reported beneficial effects on exercise intolerance, which is the main symptom associated with this disease. In addition, exercise training was shown to improve quality of life and, in some studies, to improve cardiac function. However, the mechanisms behind these effects are not completely known. The objective of this narrative review is to summarize the main clinical findings regarding the role of physical activity/exercise training in several outcomes, such as hospitalization and mortality, exercise capacity, quality of life, and cardiac function and remodeling. In addition, we will briefly discuss the findings provided by pre-clinical studies. In conclusion, while the impact of physical activity/exercise training on exercise intolerance and quality of life is already well known, its effect on mortality and hospitalization is not well documented, and whether it benefits diastolic function needs further investigation. Some clinical studies showed that exercise training can improve diastolic function, and evidences from pre-clinical studies suggest that this effect is mediated through reduced myocardial stiffness.

Oktay AA, Rich JD, Shah SJ (2013) The emerging epidemic of heart failure with preserved ejection fraction. Curr Heart Fail Rep 10(4):401–410. https://doi.org/10.1007/s11897-013-0155-7CrossRefPubMed

Glezeva N, Baugh JA (2014) Role of inflammation in the pathogenesis of heart failure with preserved ejection fraction and its potential as a therapeutic target. Heart Fail Rev 19(5):681–694. https://doi.org/10.1007/s10741-013-9405-8CrossRefPubMed

Ather S, Chan W, Bozkurt B, Aguilar D, Ramasubbu K, Zachariah AA, Wehrens XH, Deswal A (2012) Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol 59(11):998–1005. https://doi.org/10.1016/j.jacc.2011.11.040CrossRefPubMedPubMedCentral

Rodriguez-Artalejo F, Guallar-Castillon P, Pascual CR, Otero CM, Montes AO, Garcia AN, Conthe P, Chiva MO, Banegas JR, Herrera MC (2005) Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. Arch Intern Med 165(11):1274–1279CrossRefPubMed

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Group ESCSD (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200. https://doi.org/10.1093/eurheartj/ehw128CrossRefPubMed

Fukuta H, Goto T, Wakami K, Kamiya T, Ohte N (2019) Effects of exercise training on cardiac function, exercise capacity, and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Heart Fail Rev 24(4):535–547. https://doi.org/10.1007/s10741-019-09774-5CrossRefPubMed

Djousse L, Driver JA, Gaziano JM (2009) Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA 302(4):394–400. https://doi.org/10.1001/jama.2009.1062CrossRefPubMedPubMedCentral

Kenchaiah S, Sesso HD, Gaziano JM (2009) Body mass index and vigorous physical activity and the risk of heart failure among men. Circulation 119(1):44–52. https://doi.org/10.1161/CIRCULATIONAHA.108.807289CrossRefPubMed

Booth FW, Roberts CK, Laye MJ (2012) Lack of exercise is a major cause of chronic diseases. Compr Physiol 2(2):1143–1211. https://doi.org/10.1002/cphy.c110025CrossRefPubMedPubMedCentral

10.

Pandey A, LaMonte M, Klein L, Ayers C, Psaty BM, Eaton CB, Allen NB, de Lemos JA, Carnethon M, Greenland P, Berry JD (2017) Relationship between physical activity, body mass index, and risk of heart failure. J Am Coll Cardiol 69(9):1129–1142. https://doi.org/10.1016/j.jacc.2016.11.081CrossRefPubMedPubMedCentral

11.

Kraigher-Krainer E, Lyass A, Massaro JM, Lee DS, Ho JE, Levy D, Kannel WB, Vasan RS (2013) Association of physical activity and heart failure with preserved vs. reduced ejection fraction in the elderly: the Framingham Heart Study. Eur J Heart Fail 15(7):742–746. https://doi.org/10.1093/eurjhf/hft025CrossRefPubMedPubMedCentral

12.

Bhella PS, Hastings JL, Fujimoto N, Shibata S, Carrick-Ranson G, Palmer MD, Boyd KN, Adams-Huet B, Levine BD (2014) Impact of lifelong exercise “dose” on left ventricular compliance and distensibility. J Am Coll Cardiol 64(12):1257–1266. https://doi.org/10.1016/j.jacc.2014.03.062CrossRefPubMedPubMedCentral

13.

Irimia JM, Guerrero M, Rodriguez-Miguelez P, Cadefau JA, Tesch PA, Cusso R, Fernandez-Gonzalo R (2017) Metabolic adaptations in skeletal muscle after 84 days of bed rest with and without concurrent flywheel resistance exercise. J Appl Physiol 122(1):96–103. https://doi.org/10.1152/japplphysiol.00521.2016CrossRefPubMed

14.

Dorfman TA, Rosen BD, Perhonen MA, Tillery T, McColl R, Peshock RM, Levine BD (2008) Diastolic suction is impaired by bed rest: MRI tagging studies of diastolic untwisting. J Appl Physiol (1985) 104 (4):1037–1044. doi:https://doi.org/10.1152/japplphysiol.00858.2006

15.

Kitzman DW, Brubaker P, Morgan T, Haykowsky M, Hundley G, Kraus WE, Eggebeen J, Nicklas BJ (2016) 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. JAMA 315(1):36–46. https://doi.org/10.1001/jama.2015.17346CrossRefPubMedPubMedCentral

16.

Fu TC, Yang NI, Wang CH, Cherng WJ, Chou SL, Pan TL, Wang JS (2016) Aerobic interval training elicits different hemodynamic adaptations between heart failure patients with preserved and reduced ejection fraction. Am J Phys Med Rehabil 95(1):15–27. https://doi.org/10.1097/PHM.0000000000000312CrossRefPubMed

17.

Pandey A, Kitzman DW, Brubaker P, Haykowsky MJ, Morgan T, Becton JT, Berry JD (2017) Response to endurance exercise training in older adults with heart failure with preserved or reduced ejection fraction. J Am Geriatr Soc 65(8):1698–1704. https://doi.org/10.1111/jgs.14867CrossRefPubMedPubMedCentral

18.

Angadi SS, Mookadam F, Lee CD, Tucker WJ, Haykowsky MJ, Gaesser GA (2015) High-intensity interval training vs. moderate-intensity continuous exercise training in heart failure with preserved ejection fraction: a pilot study. J Appl Physiol (1985) 119(6):753–758. https://doi.org/10.1152/japplphysiol.00518.2014CrossRef

19.

Nolte K, Schwarz S, Gelbrich G, Mensching S, Siegmund F, Wachter R, Hasenfuss G, Dungen HD, Herrmann-Lingen C, Halle M, Pieske B, Edelmann F (2014) Effects of long-term endurance and resistance training on diastolic function, exercise capacity, and quality of life in asymptomatic diastolic dysfunction vs. heart failure with preserved ejection fraction. ESC Heart Fail 1(1):59–74. https://doi.org/10.1002/ehf2.12007CrossRefPubMed

20.

Palau P, Dominguez E, Nunez E, Schmid JP, Vergara P, Ramon JM, Mascarell B, Sanchis J, Chorro FJ, Nunez J (2014) Effects of inspiratory muscle training in patients with heart failure with preserved ejection fraction. Eur J Prev Cardiol 21(12):1465–1473. https://doi.org/10.1177/2047487313498832CrossRefPubMed

21.

Kitzman DW, Brubaker PH, Herrington DM, Morgan TM, Stewart KP, Hundley WG, Abdelhamed A, Haykowsky MJ (2013) Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. J Am Coll Cardiol 62(7):584–592. https://doi.org/10.1016/j.jacc.2013.04.033CrossRefPubMedPubMedCentral

22.

Haykowsky MJ, Brubaker PH, Stewart KP, Morgan TM, Eggebeen J, Kitzman DW (2012) Effect of endurance training on the determinants of peak exercise oxygen consumption in elderly patients with stable compensated heart failure and preserved ejection fraction. J Am Coll Cardiol 60(2):120–128. https://doi.org/10.1016/j.jacc.2012.02.055CrossRefPubMedPubMedCentral

23.

Smart NA, Haluska B, Jeffriess L, Leung D (2012) Exercise training in heart failure with preserved systolic function: a randomized controlled trial of the effects on cardiac function and functional capacity. Congest Heart Fail 18(6):295–301. https://doi.org/10.1111/j.1751-7133.2012.00295.xCrossRefPubMed

24.

Alves AJ, Ribeiro F, Goldhammer E, Rivlin Y, Rosenschein U, Viana JL, Duarte JA, Sagiv M, Oliveira J (2012) Exercise training improves diastolic function in heart failure patients. Med Sci Sports Exerc 44(5):776–785. https://doi.org/10.1249/MSS.0b013e31823cd16aCrossRefPubMed

25.

Fujimoto N, Prasad A, Hastings JL, Bhella PS, Shibata S, Palmer D, Levine BD (2012) Cardiovascular effects of 1 year of progressive endurance exercise training in patients with heart failure with preserved ejection fraction. Am Heart J 164(6):869–877. https://doi.org/10.1016/j.ahj.2012.06.028CrossRefPubMed

26.

Edelmann F, Gelbrich G, Dungen HD, Frohling S, Wachter R, Stahrenberg R, Binder L, Topper A, Lashki DJ, Schwarz S, Herrmann-Lingen C, Loffler M, Hasenfuss G, Halle M, Pieske B (2011) Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol 58(17):1780–1791. https://doi.org/10.1016/j.jacc.2011.06.054CrossRefPubMed

27.

Kitzman DW, Brubaker PH, Morgan TM, Stewart KP, Little WC (2010) Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. Circ Heart Fail 3(6):659–667CrossRefPubMedPubMedCentral

28.

Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal HM, Lough F, Rees K, Singh S, Taylor RS (2015) Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart 2(1):e000163. https://doi.org/10.1136/openhrt-2014-000163CrossRefPubMedPubMedCentral

29.

Hegde SM, Claggett B, Shah AM, Lewis EF, Anand I, Shah SJ, Sweitzer NK, Fang JC, Pitt B, Pfeffer MA, Solomon SD (2017) Physical activity and prognosis in the TOPCAT trial (treatment of preserved cardiac function heart failure with an aldosterone antagonist). Circulation 136(11):982–992. https://doi.org/10.1161/CIRCULATIONAHA.117.028002CrossRefPubMedPubMedCentral

30.

Brinker SK, Pandey A, Ayers CR, Barlow CE, DeFina LF, Willis BL, Radford NB, Farzaneh-Far R, de Lemos JA, Drazner MH, Berry JD (2014) Association of cardiorespiratory fitness with left ventricular remodeling and diastolic function: the Cooper Center Longitudinal Study. JACC Heart Fail 2(3):238–246. https://doi.org/10.1016/j.jchf.2014.01.004CrossRefPubMedPubMedCentral

31.

Chan E, Giallauria F, Vigorito C, Smart NA (2016) Exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis. Monaldi Arch Chest Dis 86(1–2):759. https://doi.org/10.4081/monaldi.2016.759CrossRefPubMed

32.

Fontes-Carvalho R, Azevedo AI, Sampaio F, Teixeira M, Bettencourt N, Campos L, Goncalves FR, Ribeiro VG, Azevedo A, Leite-Moreira A (2015) The effect of exercise training on diastolic and systolic function after acute myocardial infarction: a randomized study. Medicine (Baltimore) 94(36):e1450. https://doi.org/10.1097/MD.0000000000001450CrossRef

33.

Snipelisky D, Kelly J, Levine JA, Koepp GA, Anstrom KJ, McNulty SE, Zakeri R, Felker GM, Hernandez AF, Braunwald E, Redfield MM (2017) Accelerometer-measured daily activity in heart failure with preserved ejection fraction: clinical correlates and association with standard heart failure severity indices. Circ Heart Fail 10(6):e003878. https://doi.org/10.1161/CIRCHEARTFAILURE.117.003878CrossRefPubMedPubMedCentral

34.

Bobenko A, Bartels I, Munch M, Trippel T, Lindhorst R, Nolte K, Herrmann-Lingen C, Halle M, Duvinage A, Dungen HD, Gelbrich G, Tschope C, Hasenfuss G, Wachter R, Pieske B, Edelmann F (2018) Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction. ESC Heart Fail 5(1):53–62. https://doi.org/10.1002/ehf2.12227CrossRefPubMed

35.

Dhakal BP, Malhotra R, Murphy RM, Pappagianopoulos PP, Baggish AL, Weiner RB, Houstis NE, Eisman AS, Hough SS, Lewis GD (2015) Mechanisms of exercise intolerance in heart failure with preserved ejection fraction: the role of abnormal peripheral oxygen extraction. Circ Heart Fail 8(2):286–294. https://doi.org/10.1161/CIRCHEARTFAILURE.114.001825CrossRefPubMed

36.

Yavari M, Haykowsky MJF, Savu A, Kaul P, Dyck JRB, Haennel RG, Alberta HI (2017) Volume and patterns of physical activity across the health and heart failure continuum. Can J Cardiol 33(11):1465–1471. https://doi.org/10.1016/j.cjca.2017.07.005CrossRefPubMed

37.

Kitzman DW (2011) Exercise training in heart failure with preserved ejection fraction: beyond proof-of-concept. J Am Coll Cardiol 58(17):1792–1794. https://doi.org/10.1016/j.jacc.2011.07.024CrossRefPubMed

38.

Fukuta H, Goto T, Wakami K, Ohte N (2016) Effects of drug and exercise intervention on functional capacity and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Eur J Prev Cardiol 23(1):78–85CrossRefPubMed

39.

Houstis NE, Eisman AS, Pappagianopoulos PP, Wooster L, Bailey CS, Wagner PD, Lewis GD (2018) Exercise intolerance in heart failure with preserved ejection fraction: diagnosing and ranking its causes using personalized O2 pathway analysis. Circulation 137(2):148–161. https://doi.org/10.1161/CIRCULATIONAHA.117.029058CrossRefPubMed

40.

Bahls M, Friedrich N, Pietzner M, Wachter R, Budde K, Hasenfuss G, Nauck M, Pressler A, Felix SB, Edelmann F, Halle M, Dorr M (2019) Heterogeneous metabolic response to exercise training in heart failure with preserved ejection fraction. J Clin Med 8(5). https://doi.org/10.3390/jcm8050591

41.

Rector TS, Cohn JN (1992) Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. Pimobendan Multicenter Research Group. Am Heart J 124(4):1017–1025CrossRefPubMed

42.

43.

Smart N, Haluska B, Jeffriess L, Marwick TH (2007) Exercise training in systolic and diastolic dysfunction: effects on cardiac function, functional capacity, and quality of life. Am Heart J 153(4):530–536. https://doi.org/10.1016/j.ahj.2007.01.004CrossRefPubMed

44.

Sandesara PB, Lambert CT, Gordon NF, Fletcher GF, Franklin BA, Wenger NK, Sperling L (2015) Cardiac rehabilitation and risk reduction: time to “rebrand and reinvigorate”. J Am Coll Cardiol 65(4):389–395. https://doi.org/10.1016/j.jacc.2014.10.059CrossRefPubMed

45.

Fernandes T, Barauna VG, Negrao CE, Phillips MI, Oliveira EM (2015) Aerobic exercise training promotes physiological cardiac remodeling involving a set of microRNAs. Am J Physiol Heart Circ Physiol 309(4):H543–H552. https://doi.org/10.1152/ajpheart.00899.2014CrossRefPubMedPubMedCentral

46.

Anand IS, Rector TS, Cleland JG, Kuskowski M, McKelvie RS, Persson H, McMurray JJ, Zile MR, Komajda M, Massie BM, Carson PE (2011) Prognostic value of baseline plasma amino-terminal pro-brain natriuretic peptide and its interactions with irbesartan treatment effects in patients with heart failure and preserved ejection fraction: findings from the I-PRESERVE trial. Circ Heart Fail 4(5):569–577. https://doi.org/10.1161/CIRCHEARTFAILURE.111.962654CrossRefPubMed

47.

Conraads VM, Beckers P, Vaes J, Martin M, Van Hoof V, De Maeyer C, Possemiers N, Wuyts FL, Vrints CJ (2004) Combined endurance/resistance training reduces NT-proBNP levels in patients with chronic heart failure. Eur Heart J 25(20):1797–1805. https://doi.org/10.1016/j.ehj.2004.07.022CrossRefPubMed

48.

Nakanishi M, Nakao K, Kumasaka L, Arakawa T, Fukui S, Ohara T, Yanase M, Noguchi T, Yasuda S, Goto Y (2017) Improvement in exercise capacity by exercise training associated with favorable clinical outcomes in advanced heart failure with high B-type natriuretic peptide level. Circ J 81(9):1307–1314. https://doi.org/10.1253/circj.CJ-16-1268CrossRefPubMed

49.

Howden EJ, Sarma S, Lawley JS, Opondo M, Cornwell W, Stoller D, Urey MA, Adams-Huet B, Levine BD (2018) Reversing the cardiac effects of sedentary aging in middle age-a randomized controlled trial: implications for heart failure prevention. Circulation 137(15):1549–1560. https://doi.org/10.1161/CIRCULATIONAHA.117.030617CrossRefPubMedPubMedCentral

50.

Slater RE, Strom JG, Granzier H (2017) Effect of exercise on passive myocardial stiffness in mice with diastolic dysfunction. J Mol Cell Cardiol 108:24–33. https://doi.org/10.1016/j.yjmcc.2017.04.006CrossRefPubMed

51.

Kotter S, Gout L, Von Frieling-Salewsky M, Muller AE, Helling S, Marcus K, Dos Remedios C, Linke WA, Kruger M (2013) Differential changes in titin domain phosphorylation increase myofilament stiffness in failing human hearts. Cardiovasc Res 99(4):648–656. https://doi.org/10.1093/cvr/cvt144CrossRefPubMed

52.

Hidalgo C, Saripalli C, Granzier HL (2014) Effect of exercise training on post-translational and post-transcriptional regulation of titin stiffness in striated muscle of wild type and IG KO mice. Arch Biochem Biophys 552-553:100–107. https://doi.org/10.1016/j.abb.2014.02.010CrossRefPubMed

53.

Marshall KD, Muller BN, Krenz M, Hanft LM, McDonald KS, Dellsperger KC, Emter CA (2013) Heart failure with preserved ejection fraction: chronic low-intensity interval exercise training preserves myocardial O2 balance and diastolic function. J Appl Physiol 114(1):131–147. https://doi.org/10.1152/japplphysiol.01059.2012CrossRefPubMed

54.

Westermann D, Lindner D, Kasner M, Zietsch C, Savvatis K, Escher F, von Schlippenbach J, Skurk C, Steendijk P, Riad A, Poller W, Schultheiss HP, Tschope C (2011) Cardiac inflammation contributes to changes in the extracellular matrix in patients with heart failure and normal ejection fraction. Circ Heart Fail 4(1):44–52. https://doi.org/10.1161/CIRCHEARTFAILURE.109.931451CrossRefPubMed

55.

Smart NA, Steele M (2011) The effect of physical training on systemic proinflammatory cytokine expression in heart failure patients: a systematic review. Congest Heart Fail 17(3):110–114. https://doi.org/10.1111/j.1751-7133.2011.00217.xCrossRefPubMed

56.

Sties SW, Andreato LV, de Carvalho T, Gonzales AI, Angarten VG, Ulbrich AZ, de Mara LS, Netto AS, da Silva EL, Andrade A (2018) Influence of exercise on oxidative stress in patients with heart failure. Heart Fail Rev 23(2):225–235. https://doi.org/10.1007/s10741-018-9686-zCrossRefPubMed

57.

Pearson MJ, Smart NA (2017) Effect of exercise training on endothelial function in heart failure patients: a systematic review meta-analysis. Int J Cardiol 231:234–243. https://doi.org/10.1016/j.ijcard.2016.12.145CrossRefPubMed

58.

Paulus WJ, Tschope C (2013) A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol 62(4):263–271. https://doi.org/10.1016/j.jacc.2013.02.092CrossRefPubMed

59.

Bowen TS, Brauer D, Rolim NPL, Baekkerud FH, Kricke A, Ormbostad Berre AM, Fischer T, Linke A, da Silva GJ, Wisloff U, Adams V (2017) Exercise training reveals inflexibility of the diaphragm in an animal model of patients with obesity-driven heart failure with a preserved ejection fraction. J Am Heart Assoc 6(10). https://doi.org/10.1161/JAHA.117.006416

60.

Schmederer Z, Rolim N, Bowen TS, Linke A, Wisloff U, Adams V, OptimEx study g (2018) Endothelial function is disturbed in a hypertensive diabetic animal model of HFpEF: moderate continuous vs. high intensity interval training. Int J Cardiol 273:147–154. doi:https://doi.org/10.1016/j.ijcard.2018.08.087

61.

Bowen TS, Herz C, Rolim NPL, Berre AO, Halle M, Kricke A, Linke A, da Silva GJ, Wisloff U, Adams V (2018) Effects of endurance training on detrimental structural, cellular, and functional alterations in skeletal muscles of heart failure with preserved ejection fraction. J Card Fail 24(9):603–613. https://doi.org/10.1016/j.cardfail.2018.08.009CrossRefPubMed

62.

Hamdani N, Franssen C, Lourenco A, Falcao-Pires I, Fontoura D, Leite S, Plettig L, Lopez B, Ottenheijm CA, Becher PM, Gonzalez A, Tschope C, Diez J, Linke WA, Leite-Moreira AF, Paulus WJ (2013) Myocardial titin hypophosphorylation importantly contributes to heart failure with preserved ejection fraction in a rat metabolic risk model. Circ Heart Fail 6(6):1239–1249. https://doi.org/10.1161/CIRCHEARTFAILURE.113.000539CrossRefPubMed

63.

Leite S, Oliveira-Pinto J, Tavares-Silva M, Abdellatif M, Fontoura D, Falcao-Pires I, Leite-Moreira AF, Lourenco AP (2015) Echocardiography and invasive hemodynamics during stress testing for diagnosis of heart failure with preserved ejection fraction: an experimental study. Am J Physiol Heart Circ Physiol 308(12):H1556–H1563. https://doi.org/10.1152/ajpheart.00076.2015CrossRefPubMed

64.

Schmidt C, Goncalves N, Silva AF, Coelho J, Fontoura D, Leite S, Miranda-Silva D, Falcao-Pires I, Lourenco A, Oliveira J, Leite-Moreira AF, Moreira-Goncalves D (2017) Chronic exercise training modulates inflammation and reduces left ventricle stiffness in heart failure with preserved ejection fraction. Eur Heart J 38:64–64

65.

Physical Activity Guidelines Advisory Committee Scientific Report (2018) 2018 physical activity guidelines advisory committee. Washington, DC: U.S. Department of Health and Human Services, 2018

Title: Physical activity and exercise training in heart failure with preserved ejection fraction: gathering evidence from clinical and pre-clinical studies
Authors: Cristine Schmidt
Daniel Moreira-Gonçalves
Mário Santos
Adelino Leite-Moreira
José Oliveira
Publication date: 01-03-2022
Publisher: Springer US
Keyword: Heart Failure
Published in: Heart Failure Reviews / Issue 2/2022
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI: https://doi.org/10.1007/s10741-020-09973-5

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Physical activity and exercise training in heart failure with preserved ejection fraction: gathering evidence from clinical and pre-clinical studies

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Keynote webinar | Spotlight on medication adherence

Springer Medicine

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