More than 6.2 million Americans1 have a heart that cannot pump enough blood through their body to support the health and function of their heart and other organs. This heart condition, known as heart failure, can be fatal, and in fact, in 2018 it was listed among the multiple causes of death on 42 percent2 of death certificates in which cardiovascular disease was named as the underlying cause.
The good news is that recent research indicates that heart failure can be reversed, and it doesn’t require drugs. There’s also more good news: even if you start to take care of your heart in middle age, you can still improve heart health and help improve heart failure.
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Heart failure often occurs when conditions such as coronary artery disease (most common cause), myocarditis, congenital heart disease, diabetes, obesity, or high blood pressure damage or weaken the heart to a point where the heart muscle fails to pump blood adequately.
There are two types of heart failure that have been identified: diastolic heart failure and systolic heart failure (aka congestive heart failure).
An important term to remember when talking about heart failure is ejection fraction. This refers to how well the left ventricle (the heart’s main pumping chamber) pumps blood with each heartbeat. In some cases, the term also refers to the right ventricle.
Symptoms of heart failure typically include:
Numerous lifestyle factors can contribute to heart failure, and modifying them can alleviate symptoms, slow the progression of the disease, and improve daily life, particularly among those with mild to moderate heart failure. The one factor we will focus on here is exercise, but first there are other issues to consider as well. For example:
Lack of sufficient exercise is another contributing factor to heart failure. In a 2018 study appearing in Circulation3, the authors reported that poor physical fitness in middle age is a significant risk factor for heart failure, especially “heart failure with a preserved ejection fraction.”
They go on to explain that “The development of heart failure with a preserved ejection fraction is likely mediated through increased left ventricular (LV) stiffness,” which is a result of being sedentary as one ages.
The study involved 61 healthy, sedentary, middle-aged individuals (45 to 64; 48% male) who were randomly assigned to one of two groups:
In the exercise group, the training increased in frequency, duration, and intensity over time, and each participant had his or her own personalized trainer and training program.
Pre-study testing involved right heart catheterization, three-dimensional echocardiography, determination of left ventricular stiffness, and maximal oxygen uptake, which helps identify changes in fitness.
Fifty-three of the participants finished the study and demonstrated the following:
An integral part of the exercise program, according to Benjamin D. Levine, MD4, one of the study’s authors, was a high-intensity workout known as 4×4 intervals.
This involves participants exercising at 95 percent of maximal ability for four minutes, followed by three minutes of active recovery. This routine is repeated four times.
Overall, “We took these 50-year-old hearts and turned the clock back to 30- or 35-year-old hearts,” noted Levine. “And the reason they got so much stronger, and fitter was because their hearts could now fill a lot better and pump a lot more blood during exercise.”
The hearts of the participants in the control group, however, didn’t change.
This latest study went beyond what other research had shown: that people who exercise in their younger years and who continue with physical activity often have healthier, more youthful hearts.
One example appeared in the Journal of Physiology5, in which the authors evaluated older adults who had participated in more than 25 years of exercise.
They noted 4 to 5 days a week of exercise was “necessary to preserve youthful vascular compliance, especially of the large central arteries,” while more casual activity (2 to 3 times per week) “may be sufficient for middle-sized arteries…to minimize arterial stiffening with aging.”
We have evidence that healthy middle-aged adults who have been sedentary can improve their heart health and protect against the risk of heart failure by taking up high-intensity exercise at this stage of their lives.
More specifically, this activity improves the strength and reduces the stiffness of the left ventricle, and essentially leaves them with a more “youthful” heart.
1. Heart failure. Centers for Disease Control and Prevention.
2. Virani SS et al. Heart disease and stroke statistics—2021 update: A report from the American Heart Association. Published online 2021 Jan 27 Circulation
3. Howden EJ et al. Reversing the cardiac effects of sedentary aging in middle age—a randomized controlled trial. Circulation 2018; 137(15):1349-60
4. Shibata S et al. The effect of lifelong exercise frequency on arterial stiffness. Journal of Physiology 2018 Jul; 596(14):2783-2795.
5. Neighmond P. Hearts get “younger,” even at middle-age, with exercise. NPR 2018 Mar 12
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