Reversing the Cardiac Effects of Sedentary Aging in Middle Age-A Randomized Controlled Trial

Implications for Heart Failure Prevention

Erin J. Howden, Satyam Sarma, Justin S. Lawley, Mildred Opondo, William Cornwell, Douglas A Stoller, Marcus A. Urey, Beverley Adams-Huet, Benjamin D. Levine

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Poor fitness in middle age is a risk factor for heart failure, particularly heart failure with a preserved ejection fraction. The development of heart failure with a preserved ejection fraction is likely mediated through increased left ventricular (LV) stiffness, a consequence of sedentary aging. In a prospective, parallel group, randomized controlled trial, we examined the effect of 2 years of supervised high-intensity exercise training on LV stiffness. Methods: Sixty-one (48% male) healthy, sedentary, middle-aged participants (53±5 years) were randomly assigned to either 2 years of exercise training (n=34) or attention control (control; n=27). Right heart catheterization and 3-dimensional echocardiography were performed with preload manipulations to define LV end-diastolic pressure-volume relationships and Frank-Starling curves. LV stiffness was calculated by curve fit of the diastolic pressure-volume curve. Maximal oxygen uptake (Vo 2 max) was measured to quantify changes in fitness. Results: Fifty-three participants completed the study. Adherence to prescribed exercise sessions was 88±11%. Vo 2 max increased by 18% (exercise training: pre 29.0±4.8 to post 34.4±6.4; control: pre 29.5±5.3 to post 28.7±5.4, group×time P<0.001) and LV stiffness was reduced (right/downward shift in the end-diastolic pressure-volume relationships; preexercise training stiffness constant 0.072±0.037 to postexercise training 0.051±0.0268, P=0.0018), whereas there was no change in controls (group×time P<0.001; pre stiffness constant 0.0635±0.026 to post 0.062±0.031, P=0.83). Exercise increased LV end-diastolic volume (group×time P<0.001), whereas pulmonary capillary wedge pressure was unchanged, providing greater stroke volume for any given filling pressure (loading×group×time P=0.007). Conclusions: In previously sedentary healthy middle-aged adults, 2 years of exercise training improved maximal oxygen uptake and decreased cardiac stiffness. Regular exercise training may provide protection against the future risk of heart failure with a preserved ejection fraction by preventing the increase in cardiac stiffness attributable to sedentary aging. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02039154.

Original languageEnglish (US)
Pages (from-to)1549-1560
Number of pages12
JournalCirculation
Volume137
Issue number15
DOIs
StatePublished - Apr 10 2018
Externally publishedYes

Fingerprint

Randomized Controlled Trials
Heart Failure
Exercise
Stroke Volume
Blood Pressure
Oxygen
Starlings
Pulmonary Wedge Pressure
Cardiac Catheterization
Echocardiography
Clinical Trials
Pressure

Keywords

  • catheterization
  • diastole
  • exercise
  • humans
  • monitoring, physiological
  • prevention & control
  • ventricular function
  • ventricular remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Reversing the Cardiac Effects of Sedentary Aging in Middle Age-A Randomized Controlled Trial : Implications for Heart Failure Prevention. / Howden, Erin J.; Sarma, Satyam; Lawley, Justin S.; Opondo, Mildred; Cornwell, William; Stoller, Douglas A; Urey, Marcus A.; Adams-Huet, Beverley; Levine, Benjamin D.

In: Circulation, Vol. 137, No. 15, 10.04.2018, p. 1549-1560.

Research output: Contribution to journalArticle

Howden, EJ, Sarma, S, Lawley, JS, Opondo, M, Cornwell, W, Stoller, DA, Urey, MA, Adams-Huet, B & Levine, BD 2018, 'Reversing the Cardiac Effects of Sedentary Aging in Middle Age-A Randomized Controlled Trial: Implications for Heart Failure Prevention', Circulation, vol. 137, no. 15, pp. 1549-1560. https://doi.org/10.1161/CIRCULATIONAHA.117.030617
Howden, Erin J. ; Sarma, Satyam ; Lawley, Justin S. ; Opondo, Mildred ; Cornwell, William ; Stoller, Douglas A ; Urey, Marcus A. ; Adams-Huet, Beverley ; Levine, Benjamin D. / Reversing the Cardiac Effects of Sedentary Aging in Middle Age-A Randomized Controlled Trial : Implications for Heart Failure Prevention. In: Circulation. 2018 ; Vol. 137, No. 15. pp. 1549-1560.
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abstract = "Background: Poor fitness in middle age is a risk factor for heart failure, particularly heart failure with a preserved ejection fraction. The development of heart failure with a preserved ejection fraction is likely mediated through increased left ventricular (LV) stiffness, a consequence of sedentary aging. In a prospective, parallel group, randomized controlled trial, we examined the effect of 2 years of supervised high-intensity exercise training on LV stiffness. Methods: Sixty-one (48{\%} male) healthy, sedentary, middle-aged participants (53±5 years) were randomly assigned to either 2 years of exercise training (n=34) or attention control (control; n=27). Right heart catheterization and 3-dimensional echocardiography were performed with preload manipulations to define LV end-diastolic pressure-volume relationships and Frank-Starling curves. LV stiffness was calculated by curve fit of the diastolic pressure-volume curve. Maximal oxygen uptake (Vo 2 max) was measured to quantify changes in fitness. Results: Fifty-three participants completed the study. Adherence to prescribed exercise sessions was 88±11{\%}. Vo 2 max increased by 18{\%} (exercise training: pre 29.0±4.8 to post 34.4±6.4; control: pre 29.5±5.3 to post 28.7±5.4, group×time P<0.001) and LV stiffness was reduced (right/downward shift in the end-diastolic pressure-volume relationships; preexercise training stiffness constant 0.072±0.037 to postexercise training 0.051±0.0268, P=0.0018), whereas there was no change in controls (group×time P<0.001; pre stiffness constant 0.0635±0.026 to post 0.062±0.031, P=0.83). Exercise increased LV end-diastolic volume (group×time P<0.001), whereas pulmonary capillary wedge pressure was unchanged, providing greater stroke volume for any given filling pressure (loading×group×time P=0.007). Conclusions: In previously sedentary healthy middle-aged adults, 2 years of exercise training improved maximal oxygen uptake and decreased cardiac stiffness. Regular exercise training may provide protection against the future risk of heart failure with a preserved ejection fraction by preventing the increase in cardiac stiffness attributable to sedentary aging. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02039154.",
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T2 - Implications for Heart Failure Prevention

AU - Howden, Erin J.

AU - Sarma, Satyam

AU - Lawley, Justin S.

AU - Opondo, Mildred

AU - Cornwell, William

AU - Stoller, Douglas A

AU - Urey, Marcus A.

AU - Adams-Huet, Beverley

AU - Levine, Benjamin D.

PY - 2018/4/10

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N2 - Background: Poor fitness in middle age is a risk factor for heart failure, particularly heart failure with a preserved ejection fraction. The development of heart failure with a preserved ejection fraction is likely mediated through increased left ventricular (LV) stiffness, a consequence of sedentary aging. In a prospective, parallel group, randomized controlled trial, we examined the effect of 2 years of supervised high-intensity exercise training on LV stiffness. Methods: Sixty-one (48% male) healthy, sedentary, middle-aged participants (53±5 years) were randomly assigned to either 2 years of exercise training (n=34) or attention control (control; n=27). Right heart catheterization and 3-dimensional echocardiography were performed with preload manipulations to define LV end-diastolic pressure-volume relationships and Frank-Starling curves. LV stiffness was calculated by curve fit of the diastolic pressure-volume curve. Maximal oxygen uptake (Vo 2 max) was measured to quantify changes in fitness. Results: Fifty-three participants completed the study. Adherence to prescribed exercise sessions was 88±11%. Vo 2 max increased by 18% (exercise training: pre 29.0±4.8 to post 34.4±6.4; control: pre 29.5±5.3 to post 28.7±5.4, group×time P<0.001) and LV stiffness was reduced (right/downward shift in the end-diastolic pressure-volume relationships; preexercise training stiffness constant 0.072±0.037 to postexercise training 0.051±0.0268, P=0.0018), whereas there was no change in controls (group×time P<0.001; pre stiffness constant 0.0635±0.026 to post 0.062±0.031, P=0.83). Exercise increased LV end-diastolic volume (group×time P<0.001), whereas pulmonary capillary wedge pressure was unchanged, providing greater stroke volume for any given filling pressure (loading×group×time P=0.007). Conclusions: In previously sedentary healthy middle-aged adults, 2 years of exercise training improved maximal oxygen uptake and decreased cardiac stiffness. Regular exercise training may provide protection against the future risk of heart failure with a preserved ejection fraction by preventing the increase in cardiac stiffness attributable to sedentary aging. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02039154.

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