Chronic physical inactivity, termed ‘physical inactivity’, is associated with cardiac atrophy, reduced cardiac output and ventricular size, and reduced cardiopulmonary fitness (CRF) in a subgroup of patients with heart failure with preserved ejection fraction (HFpEF). Researchers say it is related to
They suggest that increasing physical activity levels in these sedentary individuals could be an effective prevention strategy, especially for young and middle-aged people.
To think of HFpEF as an exercise-deficit syndrome that leads to a small heart “goes against decades of cardiovascular education because, traditionally, we think of heart failure as a big, floppy heart.” André La Guerche, MBBS, PhD Baker Heart and Diabetes Institute, Melbourne, Australia, said: theheart.org| Medscape Cardiology.
“While it is true that some people with HFpEF have thick and hard hearts, we propose another subset with normal hearts, aside from smaller hearts due to lack of exercise,” he said. rice field.
This article is part of a Focus Seminar series published online on September 5th. Journal of the American College of Cardiology“It went viral on social media,” said Jason C. Kovacic, MBBS, Ph.D., of the Victor Chan Heart Institute in Darlinghurst, Australia. theheart.org| Medscape Cardiology.
Kovacic is Jack Section Editor, coordinator and senior author of a series covering other issues surrounding physical activity for both athletes and the general public.
“Moment of coin drop”
To support their hypothesis that HFpEF is a lack of exercise in certain patients, La Gerche et al. conducted a literature review highlighting the following:
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There are strong associations between physical activity and both CRF and cardiac function.
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Physical inactivity is a major risk factor for HFpEF in a subset of patients.
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Increased physical activity is associated with increased heart mass, stroke volume, cardiac output, and maximal oxygen consumption.
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Insufficient exercise leads to loss of myocardium, reduced cardiac output and chamber size, and reduced ability to improve heart function with exercise.
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As we age, the heart becomes smaller and harder. However, this effect is mitigated by regular exercise.
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People who are sedentary throughout their lives are unable to mitigate the age-related decline in heart size, which increases ventricular stiffness.
“It’s like the moment you drop a coin, because it’s actually a very simple concept,” says La Gerche. “Small hearts have low stroke volume. It’s not enough, it’s like trying to drive a truck with a 50cc motorcycle engine.”
“Additionally, physical inactivity sets the stage for comorbidities such as obesity, diabetes and hypertension, all of which can ultimately lead to HFpEF.”
Viewing HFpEF as a motor deficit syndrome has two clinical implications, Dr. La Gerche said. “First, it will help us understand the condition and diagnose more cases. For example, I think doctors will start to realize that shortness of breath in some patients is associated with a small heart.”
“Second, in the case of exercise deprivation syndrome, the treatment is exercise. For most people, this means regular exercise before age 60 to prevent HFpEF. That doesn’t mean you can’t try or benefit from it after age 60. But the real sweet spot is middle age and younger.
Overall picture
of Jack The Focus Seminar series begins with articles highlighting the benefits of regular physical activity. “The key is to make sure the patient meets the guidelines: He gets 150 to 300 minutes of moderate-intensity exercise a week, or he gets 75 to 250 minutes of vigorous exercise a week,” Kovacic said. emphasized.
“Yes, statins can be given to lower cholesterol. Yes, antihypertensive drugs can be given to lower blood pressure. It affects your well-being,” he said. “Exercise affects many aspects of people’s lives, so it’s important to emphasize the value of exercise to everyone.”
That includes doctors, he asserted. “All doctors should set an example. I recommend that people who are overweight or not exercising as much as they should be healthy and making time to exercise. It makes my condition worse. It forces me to make time to deal with my bad health problems.”
Other articles in the series deal with the athlete’s mind. Christopher Semsarian, MBBS, PhD, MPH, University of Sydney, Australia, and colleagues discuss emerging data on hypertrophic cardiomyopathy and other hereditary cardiovascular diseases to encourage more athletes with these conditions to participate in recreational and We’ve come to the conclusion that it’s probably okay to participate in competitive sports. According to Kovacic, this is a bigger paradigm shift than previously thought.
A final article discusses several issues related to the heart of athletes, including whether extreme exercise is associated with vulnerability to atrial fibrillation and other arrhythmias, and the effects of gender on the heart’s response to exercise. and controversy. This is due to the lack of data on women in sports.
Overall, according to Kovacic, the series is a “compelling” read that should encourage readers to undertake their own research to add data and support holistic exercise prescriptions. .
No commercial funding or related conflicts of interest have been reported.
Jay Am Col Cardiol. Published online on September 5, 2022.
Tucker et al. La Guerche et al. Semsarian et al. La Guerche et al.
Follow Marilyn Larkin on Twitter. @ Marilyn
For more information, visit theheart.org. Medscape Cardiology, follow me twitter When Facebook.
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