An estimated four million people in Germany suffer from heart failure. How do endurance and strength training influence the course of this often life-threatening disease? The world's most comprehensive study to date, led by DHZC scientist Prof Frank Edelmann, has now provided meaningful findings in Nature Medicine.
In heart failure (also known as cardiac insufficiency or cardiac insufficiency), the heart is no longer able to supply the body with sufficient blood and therefore oxygen. Regardless of the cause, physicians differentiate between two forms of heart failure: if the heart muscle is no longer pumping hard enough, this is referred to as ‘heart failure with reduced ejection fraction’, or HFrEF for short.
In contrast, around half of all those affected suffer from ‘heart failure with preserved ejection fraction’, or HFpEF for short. In this case, the heart's pumping power is still within the normal range, but the heart cannot relax properly and therefore cannot take in the blood well. HFpEF leads to similar symptoms and risks as HFrEF, but there are far fewer treatment options available for this form of heart failure.
Influence of exercise on the disease and quality of life
What influence does targeted physical training have on the progression of the disease and the quality of life of patients with HFpEF? A research team from the German Heart Centre at Charité, Leipzig University Hospital and TUM University Hospital in Munich investigated this question.
The principal investigator (PI) of the study is Prof Frank Edelmann, senior physician at the Clinic for Cardiology, Angiology and Intensive Care Medicine on the Virchow-Klinikum campus of the German Heart Centre at Charité (DHZC) and Professor of Cardiovascular Prevention.
Most comprehensive study on the topic to date
The Ex-DHF study, funded by the German Research Foundation (DFG) and the German Centre for Cardiovascular Research (DZHK), was conducted at eleven locations in Germany and Austria and included 322 patients who were randomly assigned to either a one-year structured training programme or standard medical care. In terms of the number of study participants and the observation period, this is the world's largest study on this topic to date.
Structure of the training programme
The training programme consisted of a combination of endurance and strength training, in which the participants trained three times a week under supervision. At the beginning, the training consisted of 30 minutes of moderate cycling, which was gradually increased to 60 minutes over three months. After four weeks, strength training for the major muscle groups was additionally incorporated.
Performance measurement and results of the study
The success of the training was primarily measured using the so-called ‘modified Packer score’, which combines various parameters such as symptoms, resilience, hospitalisation and general well-being. The NYHA class and peak oxygen uptake (VO₂) were also recorded: The NYHA class categorises patients according to the severity of their heart failure (class I ‘no limitations’ to class IV ‘severe limitations in any physical activity’). The peak oxygen uptake (VO₂) indicates how much oxygen the body can absorb during physical exertion.
The scientists have now published the results of the study in Nature Medicine, one of the world's most important journals for medical research: In summary, no significant improvement in the ‘modified Packer score’ was found in most patients after one year of training. However, exercise training did lead to an improvement in the HFpEF patients' peak oxygen uptake (VO₂), which is difficult to measure. In addition, the patients in the ‘training group’ were assigned to a higher NYHA class on average, which indicates increased resilience and a higher quality of life.
Exercise as a valuable addition to HFpEF treatment
‘Our results show that a targeted exercise programme has the potential to improve the resilience and quality of life of HFpEF patients. As HFpEF is a systemic disease that affects the whole organism, these results are encouraging. They show that exercise can be a valuable addition to the treatment of HFpEF,' says study director Frank Edelmann.
Collaborative research centre on HFpEF
The cardiologist is also one of the project leaders of the HFpEF Collaborative Research Center (CRC) 1470, an interdisciplinary, long-term research consortium led by Charité – Universitätsmedizin Berlin. Funded by the German Research Foundation with €12 million, the CRC investigates the mechanisms and causes of HFpEF with the goal of developing new, targeted therapeutic approaches.
‘As part of the CRC 1470, we want to comprehensively characterise the clinical picture and develop targeted treatment options. The results of the ex-DHF study will also contribute to the success of this project,’ says Edelmann.
Original publication:
Combined endurance and resistance exercise training in heart failure with preserved ejection fraction: a randomized controlled trial. Edelmann, F., Wachter, R., Duvinage, A. et al. Nat Med (2025), https://doi.org/10.1038/s41591-024-03342-7
Scientific contact:
Prof. Frank Edelmann, German Heart Centre of the Charité (DHZC), make contact
Source: Press release German Heart Centre of the Charité (DHZC)
