Chronic ‘Exercise Deficiency’ Linked to heart failure

For those chronic pain pts who have had their pain meds reduced or eliminated all together… and have become bed, chair, house confined…  those pts may end up suffering from one more potential health issues that could contribute to a premature failure.  At the bottom of this post, I have included a chart of all the possible complication of a pt’s comorbidity issues by under/untreated pain and premature deaths

Chronic ‘Exercise Deficiency’ Linked to HFpEF

Chronic lack of exercise — dubbed “exercise deficiency” — is associated with cardiac atrophy, reduced cardiac output and chamber size, and diminished cardiorespiratory fitness (CRF) in a subgroup of patients with heart failure with preserved ejection fraction (HFpEF), researchers say.

Increasing the physical activity levels of these sedentary individuals could be an effective preventive strategy, particularly for those who are younger and middle-aged, they suggest.

Thinking of HFpEF as an exercise deficiency syndrome leading to a small heart “flies in the face of decades of cardiovascular teaching, because traditionally, we’ve thought of heart failure as the big floppy heart,” Andre La Gerche, MBBS, PhD, of the Baker Heart and Diabetes Institute in Melbourne, Australia, told | Medscape Cardiology.

“While it is true that some people with HFpEF have thick, stiff hearts, we propose that another subset has a normal heart, except it’s small because it’s been underexercised,” he said.

The article, published online September 5 as part of a Focus Seminar series in the Journal of the American College of Cardiology, has “gone viral on social media,” Jason C. Kovacic, MBBS, PhD, of the Victor Chang Cardiac Research Institute, Darlinghurst, Australia, told | Medscape Cardiology.

Kovacic is a JACC section editor and the coordinating and senior author of the series, which covers other issues surrounding physical activity, both in athletes and the general public.

“Coin-Dropping 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:

  • There is a strong association between physical activity and both CRF and heart function.
  • Exercise deficiency is a major risk factor for HFpEF in a subset of patients.
  • Increasing physical activity is associated with greater cardiac mass, stroke volumes, cardiac output, and peak oxygen consumption.
  • Physical inactivity leads to loss of heart muscle, reduced output and chamber size, and less ability to improve cardiac performance with exercise.
  • Aging results in a smaller, stiffer heart; however, this effect is mitigated by regular exercise.
  • Individuals who are sedentary throughout life cannot attenuate age-related reductions in heart size and have increasing chamber stiffness.

“When we explain it, it’s like a coin-dropping moment, because it’s actually a really simple concept,” La Gerche said. “A small heart has a small stroke volume. A patient with a small heart with a maximal 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 just isn’t enough. It’s like trying to drive a truck with a 50cc motorbike engine.”

“Plus,” La Gerche added, “exercise deficiency also sets the stage for comorbidities such as obesity, diabetes, and high blood pressure, all of which can ultimately lead to HFpEF.”

Considering HFpEF as 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 practitioners will start to recognize that breathlessness 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 HFpEF, because studies have found that after the age of 60, the heart is a bit fixed and harder to remodel. That doesn’t mean you shouldn’t try after 60 or that you won’t get benefit. But the real sweet spot is in middle age and younger.”

The Bigger Picture

The JACC Focus Seminar series starts with an article that underscores the benefits of regular physical activity. “The key is getting 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 emphasized.

“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, you impact patients’ weight, their blood pressure, their cholesterol, their weight, their sense of well-being,” he said. “It cuts across so many different aspects of people’s lives that it’s important to underscore the value of exercise to everybody.”

That includes physicians, he affirmed. “It behooves all physicians to be leading by example. I would encourage those who are overweight or aren’t exercising as much as they should be to make the time to be healthy and to exercise. If you don’t, then bad health will force you to make the time to deal with bad 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 on 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 was previously thought — another paradigm shift, according to Kovacic.

The final article addresses some of the challenges and controversies related to the athlete’s heart, including whether extreme exercise is associated with vulnerability to atrial fibrillation and other arrhythmias, and the impact of gender on the cardiac response to exercise, which can’t be determined now because of a paucity of data on women in sports.

Overall, Kovacic said, the series makes for “compelling” reading that should encourage readers to embark on their own studies to add to the data and support exercise prescription across the board.



2 Responses

  1. exercise is one of the subjects that are just perfect for the pain patients’ “Catch-22” list: If you exercise, your doctor tells you that you can’t be in much pain if you’re exercising, so cuts down/off pain meds. If you’re not exercising, your doctor tells you your pain is only due to lack of exercise. Suck it up & exercise! And btw, since your pain is strictly due to lack of exercise, the doc cuts down/off pain meds.

    I have a whole list of Pain Patient Catch-22s, most of which I’ve experienced personally. It’s simultaneously funny & enraging.

  2. This is exactly what i am going thru right now,,,and doctors are looking for every excuse in the world….other then,,,,the FORCED reduction,,i just keep putting it in writting on my chart,,,Heart tested just before forced reduce,,heart was fine,,,,Forced reduced,,enlarged left ventricle,,av node freaking out,,,,can’t even take magnetic feild/deep breathing for mri’s w/out going into svt,st segment changes,,inverted t-waves etc,,,,,,All from forced reduced,,thus not moving/functioning,,,,,I also take pictures of ,”my chart,” communicatuons,,soo if they delete it,,i got it,,This will kill me,,literally,,,,,Again,,government honoring KOLODNYS WORDS,,,,’LET EM DIE OFF,,”tell me again,,why cutting the head of the snake off isn’t important????maryw

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