Home-based physical activity intervention (Active-at-Home-HF) improves left atrial function, exercise duration and quality of life in heart failure with preserved ejection fraction

Abstract Background: There is limited evidence regarding the effect of physical activity interventions on exercise tolerance, left ventricular filling pressure, and quality of life in patients with heart failure with preserved ejection fraction (HFpEF). This study assessed the acceptability, feasibility, and physiological outcome of a novel, personalized, home-based physical activity intervention in HFpEF. Methods: This was a prospective, feasibility randomized study. Forty HFpEF patients who were clinically stable were randomized 2:1 ratio to an intervention group (60±6 years, n=25, 12 male) which involved increasing daily physical activity by 2,000 steps from baseline (Active-at-Home-HF) or to standard care control group (60±7 years, n=15, 4 male) for 12 weeks. Before and after the 12 weeks, patients underwent supervised exercise stress test on a treadmill, and assessment of exercise stress echocardiography, Quality of life (QoL) (Minnesota living with heart failure questionnaire) and N-terminal prohormone of brain natriuretic peptide (NTproBNP) were also assessed before and after intervention. All patients were monitored weekly via telephone and pedometers. Results: In the intervention group, patients achieved target step count after three weeks (from 4457±653 to 6592±546 steps per day, p<0.001), and maintained throughout the duration of the study. Exercise duration increased significantly in the intervention (350±122 vs 463±135 secs) but not in control group (399±126 vs 358±88 secs p=0.007 group*time interaction) at follow-up. Left ventricular (LV) filling pressure (E/E’) improved in the intervention group (12.43±3.6 vs 9.72±1.86) but was not significantly different compared to controls (12.86±3.17 vs 12.44±2.23) (group*time interaction p=0.08). The left atrial reservoir strain significantly improved in intervention group (25.5±4.4 vs 23.3±4.5%) and not in non-intervention group (21.8±4.4 vs 21.9±4.8%)(p=0.015). There was no change in NT proBNP, left ventricular ejection fraction, LV longitudinal strain, stroke volume, cardiac output, cardiac power output and right ventricular systolic function in the intervention or control group (p>0.05). There were no adverse events. Conclusions: In this study of HFpEF patients, a 12-week personalised home-based physical activity intervention is feasible, acceptable, safe, improves left atrial function, exercise duration and quality of life and may improve left ventricular filling pressures.