Chronic lack of exercise, termed “exercise deficiency,” is associated with cardiac atrophy, reduced cardiac output and chamber size, and decreased cardiorespiratory fitness (CRF) in a subgroup of patients with heart failure with preserved ejection fraction (HFpEF), the researchers say.
Increasing the physical activity levels of these sedentary individuals could be an effective preventive strategy, particularly for the very young and middle-aged, they suggest.
Thinking of HFpEF as an exercise deficiency syndrome leading to a small heart “runs counter to decades of cardiovascular teaching, because we have traditionally thought of heart failure as the big floppy heart,” Andre La Gerche, MBBS, PhD, of the Baker Heart and Diabetes Institute in Melbourne, Australia, said elcorazon.org | Medscape Cardiology.
“While it’s true that some people with HFpEF have thick, stiff hearts, we propose that another subgroup has a normal heart, except it’s small because it wasn’t exercised enough,” he said.
Article, Posted online September 5 as part of a series of seminars focusing on the Journal of the American College of Cardiologyit has “gone viral on social media,” said Jason C. Kovacic, MBBS, PhD, of the Victor Chang Heart Research Institute, Darlinghurst, Australia. elcorazon.org | Medscape Cardiology.
Kovacic is a J.A.C. editor of the section and coordinator and main author of the series, which addresses other issues related to physical activity, both in athletes and in the general public.
“Coin Toss Moment”
To support their hypothesis that HFpEF is an exercise deficiency in certain patients, La Gerche and colleagues conducted a literature review that highlights the following points:
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There is a strong association between physical activity and CRF and cardiac function.
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Exercise deficiency is an important risk factor for HFpEF in a subgroup of patients.
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Increased physical activity is associated with increased heart mass, race volumes, cardiac output, and maximal oxygen consumption.
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Physical inactivity leads to loss of cardiac muscle, decreased output and chamber size, and decreased ability to improve cardiac output with exercise.
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Aging results in a smaller, stiffer heart; however, this effect is mitigated by regular exercise.
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People who are sedentary throughout their lives are unable to attenuate age-related reductions in heart size and have increasing chamber stiffness.
“When we explain it, it’s like a coin drop moment, because it’s actually a very simple concept,” La Gerche said. “A small heart has a small stroke volume. A patient with a small heart with a maximum stroke volume of 60 mL can generate a cardiac output of 9 L/min at a heart rate of 150 beats/min during exercise, an output that alone is not enough. It’s like trying to drive a truck with a 50cc motorcycle engine.”
“In addition,” added La Gerche, “exercise deficiency also sets the stage for comorbidities such as obesitydiabetes and high blood pressure, all of which can ultimately lead to HFpEF.”
Considering HFpEF an exercise deficiency syndrome has two clinical implications, La Gerche said. “First, it helps us understand the condition and diagnose more cases. For example, I think professionals will start to recognize that dyspnea in some of their patients is associated with a small heart.”
“Second,” he said, “if it’s an exercise deficiency syndrome, the treatment is exercise. For most people, that means exercising regularly before the age of 60 to prevent congestive heart failure, because Studies have found that after age 60, the heart is a bit fixed and harder to remodel. That doesn’t mean you shouldn’t try it after age 60 or you won’t get any benefit. But the real sweet spot is middle age or before”.
the biggest photograph
the J.A.C. Focus Seminar Series start with an article underlining the benefits of regular physical activity. “The key is to get our patients to meet the guidelines: 150 to 300 minutes of moderate-intensity exercise per week, or 75 to 250 minutes of vigorous activity per week,” Kovacic said.
“Yes, we can give a statin to lower cholesterol. Yes, we can give a blood pressure medication to lower blood pressure. But when you prescribe exercise, it affects patients’ weight, their blood pressure, their cholesterol, their weight, your sense of well-being,” she said. “It cuts across so many different aspects of people’s lives that it’s important to underscore the value of exercise for everyone.”
That includes doctors, he said. “It behooves all doctors to lead by example. I would encourage those who are overweight or not exercising as much as they should to take the time to be healthy and exercise. If they don’t, poor health will suffer.” “. they force you to take the time to deal with health issues.
Other articles in the series deal with the athlete’s heart. Christopher Semsarian, MBBS, PhD, MPH, University of Sydney, Australia, and colleagues discuss emerging data in Hypertrophic cardiomyopathy and other genetic cardiovascular diseases, with the conclusion that it is probably okay for more athletes with these conditions to participate in recreational and competitive sports than previously thought, another paradigm shift, according to Kovacic.
the end article addresses some of the challenges and controversies related to the athlete’s heart, even if extreme exercise is associated with vulnerability to atrial fibrillation and other arrhythmias, and the impact of gender on cardiac response to exercise, which cannot be determined at this time due to a paucity of data on women in sports.
Overall, Kovacic said, the series is a “compelling” read that should encourage readers to embark on their own studies to add data and support. exercise prescription in all fields.
No commercial funding or relevant conflicts of interest were reported.
J Am Coll Cardiol. Published online on September 5, 2022.
tucker and others. LaGerche et al.. Semsarian et al.. LaGerche et al..
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