Exercise in Specific Diseases: Heart Failure with Preserved Ejection Fraction

Heart failure (HF) with preserved ejection fraction (HFpEF) is the most rapidly increasing form of HF, occurs primarily in older women, and is associated with high rates of morbidity, mortality, and health care expenditures. However, its pathophysiology is poorly understood; thus, the therapeutic options for patients with HFpEF remain limited. A cardinal feature of HFpEF is exercise intolerance, measured objectively as peak exercise oxygen uptake (peak VO2), that results in decreased quality of life. Several recent studies have evaluated exercise training as a therapeutic management strategy in patients with HFpEF. Although these studies were not designed to address clinical end points, such as HF hospitalizations and mortality, they have shown that exercise training is a safe and effective intervention to improve peak VO2 and quality of life in clinically stable HF patients. Of note, studies with exercise training have shown that exercise intolerance can improve in patents with HFpEF through mechanism independent of LV systolic or diastolic function. In this chapter, we will discuss the systemic nature of HFpEF and its role in development and worsening of exercise intolerance, results from completed exercise training trials in HFpEF, mechanisms of benefit, and future directions.