Invited editorial commentary for American Heart Journal mechanisms of exercise training in heart failure with preserved ejection fraction: Central disappointment and peripheral promise

Cardiology and Geriatrics Sections, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC. Electronic address: .
American heart journal (Impact Factor: 4.46). 12/2012; 164(6):807-9. DOI: 10.1016/j.ahj.2012.09.002
Source: PubMed
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Available from: Mark J.F. Haykowsky, May 14, 2014
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    • "A single bout of strenuous exercise in a previously sedentary subject unleashes a broad array of cellular and molecular processes, which serve to quickly prepare for the next episode of physical exertion. The opposite can also occur quickly, as evidenced by the marked muscle atrophy and decline in exercise performance following forced bed rest in older individuals, which likely mimics the condition resulting from the frequent hospitalizations experienced by older HF patients (Kitzman and Haykowsky, 2012). "
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    ABSTRACT: Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) in older adults. The primary chronic symptom in patients with HFpEF, even when well compensated, is severe exercise intolerance. Cardiac and peripheral functions contribute equally to exercise intolerance in HFpEF, though the latter has been the focus of fewer studies. Of note, multiple studies with exercise training have shown that exercise intolerance can improve significantly in the absence of improvements in exercise cardiac output, indicating a role of peripheral, noncardiac adaptations. In addition, clinical drug trials performed to date in HFpEF, all of which have focused on influencing cardiovascular function, have not been positive on primary clinical outcomes and most have not improved exercise capacity. Mounting evidence indicates that sarcopenic obesity, characterized by the coexistence of excess fat mass and decreased muscle mass, could contribute to the pathophysiology of exercise intolerance in older HFpEF patients and may provide avenues for novel treatments.
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