One year of engaged exercise in middle age reversed disturbing heart stiffness

A year of physical training helped preserve or increase the youthful elasticity of heart muscle in people with early signs of heart failure, according to a small study.

The new research, published Monday in the journal American Heart Association Circulation, reinforces the idea that “exercise is medicine,” a significant shift in approach, the researchers wrote.

The study focused on a condition called heart failure with preserved ejection fraction, which affects about half of the 6 million people with heart failure in the United States. Characterized by increasing stiffness of the heart muscle and high pressures inside the heart during exercise, the disease is largely incurable once established and causes fatigue, excess fluid in the lungs and legs, and shortness of breath.

“It is considered by some to be one of the most important virtually incurable diseases in cardiovascular medicine,” said Dr. Benjamin Levine, lead author of the study. He is professor of internal medicine at UT Southwestern and director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Dallas. “So of course if there are no therapies the most important thing to do is figure out how to stop it from happening in the first place.”

Previous studies show that prolonged exercise training could improve heart elasticity in young people, but that it had no effect on heart stiffness in people 65 and older. The researchers therefore wondered whether physical exercise could improve heart stiffness in healthy, sedentary men and women aged 45 to 64.

The study, funded in part by the AHA, included 31 people who had thickened heart muscle and increased blood biomarkers associated with heart failure, even though they had no symptoms such as shortness of breath.

Eleven were randomly assigned to a control group and prescribed a yoga, balance and strength training program three times per week. The remainder were assigned a personalized walking, cycling, or swimming exercise program that gradually developed until participants did intensive aerobic interval training for at least 30 minutes at least twice a day. week, plus two to three moderate intensity workouts and one to two strength training sessions per week. Everyone had a personal trainer or exercise physiologist to oversee their training.

After one year, people performing vigorous physical training showed physiologically and statistically significant improvement in measures of cardiac stiffness and cardiorespiratory fitness, compared to no change in the control group.

The results suggest that your late 50s may be a “great place” to use exercise to prevent heart failure with preserved ejection fraction, before the heart gets too stiff, Levine said. He compared the heart muscle to a rubber band. A new one stretches easily and snaps back into place.

“It’s a young cardiovascular system,” he said. “Now put it in a drawer and come back 30 years later – it doesn’t stretch and shrink. And that’s one of the things that happens to circulation, both to the heart and to the blood vessels as we age, especially with sedentary aging. “

Researchers cannot determine from the new study whether these people will develop heart failure; larger studies will be needed for this. In addition, it is not easy for people to stick to an exercise program, and the intensive intervention studied can be difficult and expensive to replicate on a large scale.

“It can be a challenge, but I think this study is a good first step,” said Dr Shannon M. Dunlay, a cardiologist specializing in heart failure and transplantation who was not involved in the study. She is professor of medicine at the Mayo Clinic in Rochester, Minnesota. “Heart failure is a tough thing to live with, and if we can prevent it with exercise, if more studies show that as well, that’s really helpful information.”

Since this type of heart failure can be so difficult to treat, the new findings could help clinicians counsel their patients, she said. “This gives us more information to tell a patient, you already have these early results that you are at risk for heart failure, and exercise could help your heart become less stiff.”

Levine said physical activity, along with its health benefits, should be built into our daily lives.

“I tell my patients, you brush your teeth every day, take a shower, change your underwear, have dinner,” he said. “These are things you do for your health and personal hygiene. Exercise has to be part of that process. And this is how we can stay as healthy as possible throughout life.”