Effect of Physical Exercise Training in Patients With Chagas Heart Disease (from the PEACH STUDY)

Chagas heart disease (HD) is a chronic fibrosing myocarditis with high mortality. The PEACH study aimed to evaluate if exercise training can improve the functional capacity of Chagas HD patients with left ventricular dysfunction and/or heart failure. The PEACH study was a single center, parallel-group, clinical trial that randomized 30 clinical stable Chagas HD patients with left ventricular ejection fraction <45% or heart failure symptoms to either supervised exercise training 3 times/week for 6 months or a control group. Both groups had the same monthly pharmaceutical and nutritional counseling and usual care. Primary end point was functional capacity assessed by peak exercise oxygen consumption (peak VO₂) obtained by cardiopulmonary exercise test. Secondary end points included other cardiopulmonary exercise test variables, cardiac function by echocardiography, body composition, muscle respiratory strength, and metabolic biomarkers. Peak VO₂ increased among patients in exercise group from 17.60 ± 4.65 mlO₂ kg^-1 min^-1 to 19.40 ± 5.51 mlO₂ kg^-1 min^-1 while decreased in controls from 15.40 ± 6.30 mlO₂ kg^-1 min^-1 to 12.96 ± 4.50 mlO₂ kg^-1 min^-1, resulting in significant difference in change in peak VO₂ between groups after 6 months (β = +4.6, p = 0.004). There were significant differences between groups in changes in anaerobic threshold (β = 3.7, p = 0.05), peak oxygen pulse (β = +2.7, p = 0.032) and maximum minute ventilation (β = +13.9, p < 0.0001) after 6 months of intervention. In conclusion, exercise training improved functional capacity of chronic Chagas HD patients with left ventricular dysfunction and/or heart failure.