循環器ジャーナル71巻3号

2023年07月発行

特集 心臓リハビリテーションのエビデンスを極める Ⅱ.新しい分野の心臓リハビリテーションを知る

HFpEFに対する心臓リハビリテーション

著者： 合田あゆみ¹

所属機関： ¹杏林大学医学部循環器内科

ページ範囲：P.393 - P.400

POINT
・HFpEFにおいてもHFrEFと同様，運動療法ならびに心臓リハビリテーションの効果が示されており，運動可能なすべての患者に提供されるべきである．
・HFpEFの運動療法の効果の主たるものは，末梢での動静脈酸素較差に代表される末梢機能の改善，骨格筋機能の改善，それに伴う，運動耐容能改善と生活の質（QOL）改善である．
・HFpEFに伴うフレイルに対しては，筋力，バランス能力，移動能力，持久力それぞれに介入していくことが身体機能改善に有用であることが示されている．栄養に対する介入や高齢者に対する社会的視点をもった包括的な介入もますます重要となってくる．

参考文献

1）Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction. Nat Rev Cardiol 2020 ; 17 : 559-73.

2）Del Buono MG, Arena R, Borlaug BA, et al. Exercise Intolerance in Patients With Heart Failure : JACC State-of-the-Art Review. J Am Coll Cardiol 2019 ; 73 : 2209-25.

Pathway Analysis. Circulation 2018 ; 137 : 148-61.

4）Pandey A, Shah SJ, Butler J, et al. Exercise Intolerance in Older Adults With Heart Failure With Preserved Ejection Fraction : JACC State-of-the-Art Review. J Am Coll Cardiol 2021 ; 78 : 1166-87.

5）Wolsk E, Kaye DM, Komtebedde J, et al. Determinants and consequences of heart rate and stroke volume response to exercise in patients with heart failure and preserved ejection fraction. Eur J Heart Fail 2021 ; 23 : 754-64.

6）Palau P, Seller J, Dominguez E, et al. Effect of beta-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction. J Am Coll Cardiol 2021 ; 78 : 2042-56.

7）McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021 ; 42 : 3599-726.

8）Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure : A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022 ; 79 : e263-421.

9）Kitzman DW, Brubaker PH, Morgan TM, et al. Exercise training in older patients with heart failure and preserved ejection fraction : a randomized, controlled, single-blind trial. Circ Heart Fail 2010 ; 3 : 659-67.

10）Edelmann F, Gelbrich G, Dungen HD, et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction : results of the Ex-DHF（Exercise training in Diastolic Heart Failure）pilot study. J Am Coll Cardiol 2011 ; 58 : 1780-91.

11）Murad K, Brubaker PH, Fitzgerald DM, et al. Exercise training improves heart rate variability in older patients with heart failure : a randomized, controlled, single-blinded trial. Congest Heart Fail 2012 ; 18 : 192-7.

12）Smart NA, Haluska B, Jeffriess L, et al. Exercise training in heart failure with preserved systolic function : a randomized controlled trial of the effects on cardiac function and functional capacity. Congest Heart Fail 2012 ; 18 : 295-301.

13）Kitzman DW, Brubaker PH, Herrington DM, et al. Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction : a randomized, controlled, single-blind trial. J Am Coll Cardiol 2013 ; 62 : 584-92.

14）Nolte K, Herrmann-Lingen C, Wachter R, et al. Effects of exercise training on different quality of life dimensions in heart failure with preserved ejection fraction : the Ex-DHF-P trial. Eur J Prev Cardiol 2015 ; 22 : 582-93.

15）Angadi SS, Mookadam F, Lee CD, et al. High-intensity interval training vs. moderate-intensity continuous exercise training in heart failure with preserved ejection fraction : a pilot study. J Appl Physiol（1985）2015 ; 119 : 753-8.

16）Kitzman DW, Brubaker P, Morgan T, et al. Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved Ejection Fraction : A Randomized Clinical Trial. JAMA 2016 ; 315 : 36-46.

17）Maldonado-Martin S, Brubaker PH, Eggebeen J, et al. Association Between 6-Minute Walk Test Distance and Objective Variables of Functional Capacity After Exercise Training in Elderly Heart Failure Patients With Preserved Ejection Fraction : A Randomized Exercise Trial. Arch Phys Med Rehabil 2017 ; 98 : 600-3.

18）Mueller S, Winzer EB, Duvinage A, et al. Effect of High-Intensity Interval Training, Moderate Continuous Training, or Guideline-Based Physical Activity Advice on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction : A Randomized Clinical Trial. JAMA 2021 ; 325 : 542-51.

19）Fukuta H, Goto T, Wakami K, et al. Effects of drug and exercise intervention on functional capacity and quality of life in heart failure with preserved ejection fraction : A meta-analysis of randomized controlled trials. Eur J Prev Cardiol 2016 ; 23 : 78-85.

20）Pandey A, Parashar A, Kumbhani D, et al. Exercise training in patients with heart failure and preserved ejection fraction : meta-analysis of randomized control trials. Circ Heart Fail 2015 ; 8 : 33-40.

21）Fukuta H, Goto T, Wakami K, et al. Effects of exercise training on cardiac function, exercise capacity, and quality of life in heart failure with preserved ejection fraction : a meta-analysis of randomized controlled trials. Heart Fail Rev 2019 ; 24 : 535-47.

22）Gevaert AB, Bohm B, Hartmann H, et al. Effect of Training on Vascular Function and Repair in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail 2023 ; 11 : 454-64.

23）Haykowsky MJ, Brubaker PH, Stewart KP, et al. Effect of endurance training on the determinants of peak exercise oxygen consumption in elderly patients with stable compensated heart failure and preserved ejection fraction. J Am Coll Cardiol 2012 ; 60 : 120-8.

24）Winzer EB, Augstein A, Schauer A, et al. Impact of Different Training Modalities on Molecular Alterations in Skeletal Muscle of Patients With Heart Failure With Preserved Ejection Fraction : A Substudy of the OptimEx Trial. Circ Heart Fail 2022 ; 15 : e009124.

25）Kamiya K, Sato Y, Takahashi T, et al. Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure. Circ Heart Fail 2020 ; 13 : e006798.

26）Kitzman DW, Whellan DJ, Duncan P, et al. Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. N Engl J Med 2021 ; 385 : 203-16.

27）Mentz RJ, Whellan DJ, Reeves GR, et al. Rehabilitation Intervention in Older Patients With Acute Heart Failure With Preserved Versus Reduced Ejection Fraction. JACC Heart Fail 2021 ; 9 : 747-57.

28）Andersen K, Mariosa D, Adami HO, et al. Dose-response relationship of total and leisure time physical activity to risk of heart failure : a prospective cohort study. Circ Heart Fail 2014 ; 7 : 701-8.