Physical Activity in Heart Failure With Preserved Ejection Fraction
Moving Toward a Newer Treatment Paradigm
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Article, see p 982
Physical inactivity and low fitness are important, modifiable risk factors for the development of heart failure (HF).1–4 Recent studies have demonstrated strong, dose-dependent inverse associations among physical activity, fitness, and risk of incident HF.5 Physical activity has been shown to have a stronger and more graded association with risk of HF with preserved ejection fraction (HFpEF) than HF with reduced ejection fraction.6 However, the prognostic role of physical activity among patients with established HFpEF is less well established. This finding is particularly relevant given the near-universal presence of exercise intolerance among patients with HFpEF.
In this issue of Circulation, Hegde et al7 have addressed this knowledge gap by evaluating the association between physical activity levels and risk of adverse clinical outcomes among 1751 patients with HFpEF in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist). The authors observed several important findings. First, only 11% of the study participants engaged in guideline-recommended physical activity levels at baseline. Second, compared with individuals with ideal physical activity, those with poor and intermediate self-reported physical activity had a higher risk of HF hospitalization and mortality within …