Heart Failure With Preserved Ejection Fraction as an Exercise Deficiency Syndrome

Highlights

• Physical activity is associated with increases in cardiac mass, stroke volume, cardiac output, and peak oxygen consumption, and reduction of clinical events. As a corollary, inactivity results in cardiac atrophy, reduced cardiac output and chamber size, and impaired augmentation of cardiac performance during exercise.

• A chronic lack of exercise is a risk factor for HFpEF in certain individuals.

• Lifelong physical activity improves cardiorespiratory fitness in middle-life and can allow for normal age-related declines in cardiac function without disability.

Abstract

Across differing spectrums of cardiac function and cardiac pathologies, there are strong associations between measures of cardiorespiratory fitness and burden of symptoms, quality of life, and prognosis. In this part 2 of a 4-part series, we contend that there is a strong association among physical activity, cardiorespiratory fitness, and cardiac function. We argue that a chronic lack of exercise is a major risk factor for heart failure with preserved ejection fraction in some patients. In support of this hypothesis, increasing physical activity is associated with greater cardiac mass, greater stroke volumes, greater cardiac output and peak oxygen consumption, and fewer clinical events. Conversely, physical inactivity results in cardiac atrophy, reduced output, reduced chamber size, and decreased ability to augment cardiac performance with exercise. Moreover, physical inactivity is a strong predictor of heart failure risk and death. In sum, exercise deficiency should be considered part of the broad heart failure with preserved ejection fraction phenotype.