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

被引:647
作者
Kitzman, Dalane W. [1 ]
Brubaker, Peter [2 ]
Morgan, Timothy [3 ]
Haykowsky, Mark [4 ]
Hundley, Gregory [1 ]
Kraus, William E. [5 ]
Eggebeen, Joel [6 ]
Nicklas, Barbara J. [7 ]
机构
[1] Wake Forest Sch Med, Dept Internal Med, Cardiol Sect, Winston Salem, NC 27157 USA
[2] Wake Forest Univ, Dept Hlth & Exercise Sci, Winston Salem, NC 27109 USA
[3] Wake Forest Sch Med, Dept Publ Hlth Sci, Winston Salem, NC 27157 USA
[4] Univ Texas Arlington, Coll Nursing & Hlth Innovat, Arlington, TX USA
[5] Duke Univ, Sch Med, Durham, NC USA
[6] Emory Univ, Sch Med, Atlanta, GA USA
[7] Wake Forest Sch Med, Geriatr & Gerontol Sect, Dept Internal Med, Winston Salem, NC 27157 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2016年 / 315卷 / 01期
基金
美国国家卫生研究院;
关键词
NATRIURETIC PEPTIDE LEVELS; SINGLE-BLIND TRIAL; SKELETAL-MUSCLE; BARIATRIC SURGERY; PHYSICAL FUNCTION; WEIGHT-LOSS; ELDERLY-PATIENTS; INTOLERANCE; CAPACITY; ADULTS;
D O I
10.1001/jama.2015.17346
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IMPORTANCE More than 80% of patients with heart failure with preserved ejection fraction (HFPEF), the most common form of heart failure among older persons, are overweight or obese. Exercise intolerance is the primary symptom of chronic HFPEF and a major determinant of reduced quality of life (QOL). OBJECTIVE To determine whether caloric restriction (diet) or aerobic exercise training (exercise) improves exercise capacity and QOL in obese older patients with HFPEF. DESIGN, SETTING, AND PARTICIPANTS Randomized, attention-controlled, 2 x 2 factorial trial conducted from February 2009 through November 2014 in an urban academic medical center. Of 577 initially screened participants, 100 older obese participants (mean [SD]: age, 67 years [5]; body mass index, 39.3 [5.6]) with chronic, stable HFPEF were enrolled (366 excluded by inclusion and exclusion criteria, 31 for other reasons, and 80 declined participation). INTERVENTIONS Twenty weeks of diet, exercise, or both; attention control consisted of telephone calls every 2 weeks. MAIN OUTCOMES AND MEASURES Exercise capacity measured as peak oxygen consumption ((V)over dotO(2), mL/kg/min; co-primary outcome) and QOL measured by the Minnesota Living with Heart Failure (MLHF) Questionnaire (score range: 0-105, higher scores indicate worse heart failure-related QOL; co-primary outcome). RESULTS Of the 100 enrolled participants, 26 participants were randomized to exercise; 24 to diet; 25 to exercise + diet; 25 to control. Of these, 92 participants completed the trial. Exercise attendance was 84%(SD, 14%) and diet adherence was 99%(SD, 1%). By main effects analysis, peak (V)over dotO(2) was increased significantly by both interventions: exercise, 1.2 mL/kg body mass/min (95% CI, 0.7 to 1.7), P < .001; diet, 1.3 mL/kg body mass/min (95% CI, 0.8 to 1.8), P < .001. The combination of exercise + diet was additive (complementary) for peak (V)over dotO(2) (joint effect, 2.5 mL/kg/min). There was no statistically significant change in MLHF total score with exercise and with diet (main effect: exercise, -1 unit [95% CI, -8 to 5], P = .70; diet, -6 units [95% CI, -12 to 1], P = .08). The change in peak (V)over dotO(2) was positively correlated with the change in percent lean body mass (r = 0.32; P = .003) and the change in thigh muscle: intermuscular fat ratio (r = 0.27; P = .02). There were no study-related serious adverse events. Body weight decreased by 7%(7 kg [SD, 1]) in the diet group, 3%(4 kg [SD, 1]) in the exercise group, 10% (11 kg [SD, 1] in the exercise + diet group, and 1% (1 kg [SD, 1]) in the control group. CONCLUSIONS AND RELEVANCE Among obese older patients with clinically stable HFPEF, caloric restriction or aerobic exercise training increased peak (V)over dotO(2), and the effects may be additive. Neither intervention had a significant effect on quality of life as measured by the MLHF Questionnaire.
引用
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页码:36 / 46
页数:11
相关论文
共 41 条
[1]   Prevalence, Clinical Phenotype, and Outcomes Associated With Normal B-Type Natriuretic Peptide Levels in Heart Failure With Preserved Ejection Fraction [J].
Anjan, Venkatesh Y. ;
Loftus, Timothy M. ;
Burke, Michael A. ;
Akhter, Nausheen ;
Fonarow, Gregg C. ;
Gheorghiade, Mihai ;
Shah, Sanjiv J. .
AMERICAN JOURNAL OF CARDIOLOGY, 2012, 110 (06) :870-876
[2]   Associations between body composition and gait-speed decline: results from the Health, Aging, and Body Composition study [J].
Beavers, Kristen M. ;
Beavers, Daniel P. ;
Houston, Denise K. ;
Harris, Tamara B. ;
Hue, Trisha F. ;
Koster, Annemarie ;
Newman, Anne B. ;
Simonsick, Eleanor M. ;
Studenski, Stephanie A. ;
Nicklas, Barbara J. ;
Kritchevsky, Stephen B. .
AMERICAN JOURNAL OF CLINICAL NUTRITION, 2013, 97 (03) :552-560
[3]   Fat Mass Loss Predicts Gain in Physical Function With Intentional Weight Loss in Older Adults [J].
Beavers, Kristen M. ;
Miller, Michael E. ;
Rejeski, W. Jack ;
Nicklas, Barbara J. ;
Krichevsky, Stephen B. .
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES, 2013, 68 (01) :80-86
[4]  
Bharadwaj M, 2013, GERONTOLOGIST, V53, P945
[5]   Heart failure with preserved ejection fraction induces molecular, mitochondrial, histological, and functional alterations in rat respiratory and limb skeletal muscle [J].
Bowen, T. Scott ;
Rolim, Natale P. L. ;
Fischer, Tina ;
Baekkerud, Fredrik H. ;
Medeiros, Alessandra ;
Werner, Sarah ;
Bronstad, Eivind ;
Rognmo, Oivind ;
Mangner, Norman ;
Linke, Axel ;
Schuler, Gerhard ;
Silva, Gustavo J. J. ;
Wisloff, Ulrik ;
Adams, Volker .
EUROPEAN JOURNAL OF HEART FAILURE, 2015, 17 (03) :263-272
[6]   Calorie restriction increases muscle mitochondrial biogenesis in healthy humans [J].
Civitarese, Anthony E. ;
Carling, Stacy ;
Heilbronn, Leonie K. ;
Hulver, Mathew H. ;
Ukropcova, Barbara ;
Deutsch, Walter A. ;
Smith, Steven R. ;
Ravussin, Eric .
PLOS MEDICINE, 2007, 4 (03) :485-494
[7]   Mechanisms of Exercise Intolerance in Heart Failure With Preserved Ejection Fraction The Role of Abnormal Peripheral Oxygen Extraction [J].
Dhakal, Bishnu P. ;
Malhotra, Rajeev ;
Murphy, Ryan M. ;
Pappagianopoulos, Paul P. ;
Baggish, Aaron L. ;
Weiner, Rory B. ;
Houstis, Nicholas E. ;
Eisman, Aaron S. ;
Hough, Stacyann S. ;
Lewis, Gregory D. .
CIRCULATION-HEART FAILURE, 2015, 8 (02) :286-+
[8]   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].
Edelmann, Frank ;
Gelbrich, Goetz ;
Duengen, Hans-Dirk ;
Froehling, Stefan ;
Wachter, Rolf ;
Stahrenberg, Raoul ;
Binder, Lutz ;
Toepper, Agnieszka ;
Lashki, Diana Jahandar ;
Schwarz, Silja ;
Herrmann-Lingen, Christoph ;
Loeffler, Markus ;
Hasenfuss, Gerd ;
Halle, Martin ;
Pieske, Burkert .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2011, 58 (17) :1780-1791
[9]   Effects of Exercise Training on Health Status in Patients With Chronic Heart Failure HF-ACTION Randomized Controlled Trial [J].
Flynn, Kathryn E. ;
Pina, Ileana L. ;
Whellan, David J. ;
Lin, Li ;
Blumenthal, James A. ;
Ellis, Stephen J. ;
Fine, Lawrence J. ;
Howlett, Jonathan G. ;
Keteyian, Steven J. ;
Kitzman, Dalane W. ;
Kraus, William E. ;
Miller, Nancy Houston ;
Schulman, Kevin A. ;
Spertus, John A. ;
O'Connor, Christopher M. ;
Weinfurt, Kevin P. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2009, 301 (14) :1451-1459
[10]   Body Mass Index and Adverse Cardiovascular Outcomes in Heart Failure Patients With Preserved Ejection Fraction Results From the Irbesartan in Heart Failure With Preserved Ejection Fraction (I-PRESERVE) Trial [J].
Haass, Markus ;
Kitzman, Dalane W. ;
Anand, Inder S. ;
Miller, Alan ;
Zile, Michael R. ;
Massie, Barry M. ;
Carson, Peter E. .
CIRCULATION-HEART FAILURE, 2011, 4 (03) :324-331