J Card Fail. 2024 Jul 04. pii: S1071-9164(24)00226-4. [Epub ahead of print]
BACKGROUND: Obesity with heart failure with preserved ejection fraction (HFpEF) is the dominant form of HF among older persons. In a randomized trial, we previously showed that a 5-month calorie restriction (CR) program, with or without aerobic exercise training (AT), resulted in significant weight and fat loss and improved exercise capacity. However, little is known regarding the long-term effects of these outcomes after a short-term (5-month) intervention of CR with or without AT in older patients with obesity and HFpEF.METHODS: Sixteen participants from either the CR or CR+AT who experienced significant weight loss ≥2 kg were reexamined after a long-term follow-up endpoint (28.0±10.8 months) without intervention. The follow-up assessment included body weight and composition via dual-energy X-ray absorptiometry and exhaustive cardiopulmonary treadmill exercise testing.
RESULTS: Compared to the 5-month time point intervention endpoint, at the long-term follow-up endpoint, mean body weight increased +5.2±4.0 kg (90.7±11.2kg versus 95.9±11.9, p<0.001) due to increased fat mass (38.9± 9.3 versus 43.8 ± 9.8, p<0.001) with no change in lean mass (49.6±7.1 versus 49.9±7.6, p=0.67), resulting in worse body composition (decreased lean-to-fat mass). Change in total mass was strongly and significantly correlated with change in fat mass (r=0.75, p<0.001), whereas there appeared to be a weaker correlation with change in lean mass (r=0.50, p=0.051). Additionally, from the end of the 5-month time point intervention endpoint to the long-term follow-up endpoint, there were large, significant decreases in VO2peak (-2.2± 2.1ml/kg/min, p=0.003) and exercise time (-2.4±2.6min, p=0.006). There appeared to be an inverse correlation between the change in VO2peak and the change in fat mass (r=-0.52, p=0.062).
CONCLUSION: Although CR and CR+AT in older patients with obesity and HFpEF can significantly improve body composition and exercise capacity, these positive changes diminish considerably during long-term follow-up endpoint, and regained weight is predominantly adipose, resulting in worsened overall body composition compared to baseline. This suggests a need for long-term adherence strategies to prevent weight regain and maintain improvements in body composition and exercise capacity following CR in older patients with obesity and HFpEF.
Keywords: Calorie restriction; Exercise training; HFpEF; Obesity; Sarcopenic obesity