Exercise rehabilitation offers a promising treatment approach for people living with heart failure with preserved ejection fraction (HFpEF), including those with transthyretin amyloid cardiomyopathy (ATTR-CM), according to a review published recently in Frontiers in Cardiovascular Medicine.
HFpEF accounts for about half of all heart failure cases and tends to affect older adults, especially women. It is often linked with obesity, diabetes and high blood pressure.
HFpEF can be caused by ATTR-CM. “Notably, transthyretin amyloid cardiomyopathy (ATTR-CM) demonstrates high prevalence among elderly HFpEF cohorts, with cardiac amyloid deposition directly compromising diastolic mechanics through myocyte infiltration and restrictive physiology,” the study’s authors said.
ATTR-CM and HFpEF cause many of the same problems. Common symptoms include extreme fatigue, shortness of breath and intolerance to exercise. Research shows these issues can stem not only from heart dysfunction but also from poor muscle metabolism, inflammation and impaired blood vessel function throughout the body.
Medications have a limited effect in treating HFpEF, but structured physical activity has shown meaningful improvements in symptoms, walking ability and overall well-being.
“HFpEF, a multisystem disorder, demands personalized rehabilitation,” explained the review’s authors. “Exercise improves functional capacity (VO2peak), quality of life, and hemodynamics via cardiac-skeletal adaptations and anti-inflammatory effects, yet lacks robust mortality/hospitalization reduction.”
Read more about ATTR-CM prognosis and staging
Studies have found that exercise can improve symptoms through a variety of mechanisms. For example, combining resistance and aerobic training helps increase oxygen use, lowers blood pressure and reduces inflammation. Improvements have been noted in peak oxygen consumption, walking tests and physical performance scores. Even modest improvements in daily activity can translate into better independence and less need for hospitalization.
However, exercise is not a one-size-fits-all treatment. People with ATTR-CM-related HFpEF may have unique needs, especially if they are older, frail or have other health conditions. Personalized plans based on fitness testing, age and body composition are more effective. For some, lighter activities such as walking or breathing exercises may be safer starting points.
Despite its promise, exercise therapy for HFpEF still faces barriers. Long-term benefits such as survival or reduced hospital stays have not been clearly proven. Many programs are hospital-based and hard to access, and fewer than half of patients stick with exercise guidelines. Still, as evidence grows, experts see physical training as a vital part of managing HFpEF, especially for those with ATTR-CM, who may benefit from improved quality of life even if medications fall short.
Patients should speak with their doctors about supervised cardiac rehabilitation or safe at-home programs tailored to their individual health profile.
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