Older obese adults who have a common type of heart failure can improve their ability to exercise without experiencing shortness of breath, a new study suggests. The secret: cutting back on calories and adding physical activity.
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The study looked at older adults who have heart failure with preserved ejection fraction (HFPEF). These people have heart failure, but their hearts still pump out a normal volume of blood with each beat.
HFPEF is the most rapidly increasing form of heart failure. It occurs primarily in older women, and is associated with high rates of illness, death and health care costs.
More than 80 percent of patients with HFPEF are overweight or obese. Inability to exercise is the primary symptom of chronic HFPEF.
Diet and exercise
In the study, researchers from Wake Forest School of Medicine in North Carolina randomly assigned 100 obese older adults with chronic, stable HFPEF for 20 weeks to one of four groups – one that dieted only, one that exercised only, one that exercised and dieted or one that did nothing.
The researchers measured the participants’ exercise capacity and used a questionnaire to measure their quality of life.
The authors found that peak exercise capacity increased significantly when the participants either dieted or exercised. Those who dieted and exercised saw even greater increase in their ability to exercise without becoming short of breath.
The participants who dieted and exercised also saw a change in the percentage of their lean body mass. Members of the diet group saw their weight decrease by 7 percent; members of the exercise group saw a 3 percent weight loss; and members of the exercise and diet group saw a 10 percent decrease in their weight. The group whose members did nothing saw a 1 percent decrease in body weight.
There was no change among the participants’ quality of life as measured by the questionnaire.
The researchers say further studies are needed to determine whether the positive changes such as weight loss and improved ability to breathe translate into long-term benefit – particularly in the context of the heart failure obesity paradox. This is the scientific observation that heart patients who are overweight or obese have lower death rates.
The study appeared online Tuesday in the Journal of the American Medical Association.
Small and short-term
The study is important because it looks at a sub-population of patients with heart failure — those who have preserved ejection fraction, which is a very difficult group of patients to treat, says cardiologist Michael Rocco, MD.
In addition, the study focuses on individuals with heart failure and preserved ejection fraction who are obese, an “even more difficult population to treat,” Dr. Rocco says.
“The study is small and short-term but does demonstrate that a diet and exercise program in these individuals can improve exercise performance, at least as measured by peak oxygen consumption,” he says.
Dr. Rocco noted that the quality-of-life measurements did not show significant change, but added that could be due to the short-term nature of the study.
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Part of the equation
He also notes, as did the researchers, that the short-term nature of the study cannot say whether people’s health would benefit long-term from the diet and exercise regimen.
“However, mortality benefit is only part of the equation,” Dr. Rocco says. “Improvements in performance — and if this ultimately is shown to be linked to improvement in quality of life — would be beneficial.”
As for the weight loss, Dr. Rocco says the strict controls of the clinical trial may be tough for people to duplicate on their own in real-life.
“A 7 percent to 10 percent weight decrease over 20 weeks in the two diet treatment groups may be very difficult to achieve in the real world without a very focused, structured program and committed participants,” he says. “However, this is a starting point for further longer-term trials.”
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