Preventive Cardiology

Is HFpEF an Exercise Deficiency Syndrome?

HF and Exercise

The JACC published a four-part series last week in which experts spotlight exercise as a means of cardiovascular disease reduction, prevention, and treatment. The second paper in the series received a lot of attention, with one cardiologist speculating that it may be the best paper of the year.

The paper in question argues that a subgroup of patients with heart failure with preserved ejection fraction (HFpEF) have rarely exercised throughout their life. As a result, they have smaller hearts that do not adequately protect from heart failure during the aging process.  

It’s well established that consistent exercise results in increased cardiac mass, stroke volume, cardiac output, and peak oxygen consumption. But does physical inactivity lead to cardiac atrophy, reduced output, and reduced heart chamber size? The authors say yes. 

The paper cites nearly one hundred studies in support of its claim. Here are the highlights:

  • There is a strong association between physical activity, cardiorespiratory fitness, and heart function.
  • Aging results in a smaller, stiffer heart, but regular exercise mitigates these effects.
  • Physical inactivity leads to reduced output, smaller heart chamber size, and less ability to improve cardiac performance in the future with exercise.
  • A chronic lack of exercise is a major risk factor for HFpEF.

The Clinical Implications

Thinking of HFpEF as an exercise deficiency syndrome will help physicians better understand the condition, recognize risk earlier, and most importantly, provide a clear path to prevention. The authors recommend consistent exercise, especially before the age of 60, after which exercise intervention benefits are usually modest. 

The Takeaway

The fact that exercise is good for heart health may not be earth-shattering, but this literature review underscores the role of exercise as a major HFpEF risk factor. The authors propose that a subset of HFpEF patients have hearts that are smaller because they’ve been underexercised, making regular physical activity an effective prevention strategy.

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