Schmidt Cristine, Moreira-Gonçalves Daniel, Santos Mário, Leite-Moreira Adelino, Oliveira José
UniC, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
CIAFEL, Faculdade de Desporto, Universidade do Porto, Porto, Portugal.
Heart Fail Rev. 2022 Mar;27(2):573-586. doi: 10.1007/s10741-020-09973-5.
Conventional treatments for heart failure have failed to improve survival in heart failure with preserved ejection fraction (HFpEF). The current therapy recommendations highlight the importance of symptom management and improvement of patient's well-being or other health-related outcomes. Physical activity/exercise training might be an adjuvant treatment option, since several studies in HFpEF patients reported beneficial effects on exercise intolerance, which is the main symptom associated with this disease. In addition, exercise training was shown to improve quality of life and, in some studies, to improve cardiac function. However, the mechanisms behind these effects are not completely known. The objective of this narrative review is to summarize the main clinical findings regarding the role of physical activity/exercise training in several outcomes, such as hospitalization and mortality, exercise capacity, quality of life, and cardiac function and remodeling. In addition, we will briefly discuss the findings provided by pre-clinical studies. In conclusion, while the impact of physical activity/exercise training on exercise intolerance and quality of life is already well known, its effect on mortality and hospitalization is not well documented, and whether it benefits diastolic function needs further investigation. Some clinical studies showed that exercise training can improve diastolic function, and evidences from pre-clinical studies suggest that this effect is mediated through reduced myocardial stiffness.
射血分数保留的心力衰竭（HFpEF）的传统治疗方法未能提高患者生存率。当前的治疗建议强调症状管理以及改善患者幸福感或其他与健康相关结局的重要性。体力活动/运动训练可能是一种辅助治疗选择，因为多项针对HFpEF患者的研究报告称其对运动不耐受（该病的主要症状）具有有益作用。此外，运动训练被证明可改善生活质量，并且在一些研究中还可改善心脏功能。然而，这些作用背后的机制尚不完全清楚。本叙述性综述的目的是总结有关体力活动/运动训练在多种结局（如住院率和死亡率、运动能力、生活质量以及心脏功能和重塑）中作用的主要临床研究结果。此外，我们将简要讨论临床前研究的结果。总之，虽然体力活动/运动训练对运动不耐受和生活质量的影响已广为人知，但其对死亡率和住院率的影响尚无充分记录，并且其是否有益于舒张功能仍需进一步研究。一些临床研究表明运动训练可改善舒张功能，临床前研究的证据表明这种作用是通过降低心肌僵硬度介导的。
