A customised approach to exercise can help patients with diastolic heart failure, says Dr Lin Weiqin, cardiologist from the National University Heart Centre, Singapore.

About 22% of Singaporeans with heart failure suffer from diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF).

In patients with HFpEF, the heart muscle is unable to relax, causing the pressure inside its chambers to rise and preventing the heart from filling up properly. This results in heart failure, where the heart is unable to pump sufficient blood to supply nutrients and oxygen to important organs like the brain.

The incidence of HFpEF is rising in developed and developing countries, with a third of patients with heart failure found to suffer from HFpEF. The highest rate of HFpEF is among elderly women, and 40% of all causes is attributed to younger patients below 65 years old.

According to Dr Lin Weiqin, cardiologist from the National University Heart Centre , HFpEF can be further complicated when patients also suffer from other co-morbidities such as obesity, high blood pressure, and diabetes.

“The presence of other medical issues further complicates the treatment and recovery for patients with HFpEF. These patients experience specific symptoms such as shortness of breath or non-specific symptoms, such as lethargy or poor appetite, all of which tremendously affect their daily activities,” says Dr Lin.

Newer medications for HFpEF

Compared with just a few years ago, there are far more medications and treatment options for patients with HFpEF today.

“New treatments like empagliflozin, which was previously used to treat diabetes, has been proven to reduce the risk of hospitalisation by as much as 35% in patients with heart failure,” explains Dr Lin.

“Cardiologists will tailor the treatment plan based on each patient. For example, a patient who has been able to control his hypertension and diabetes, or have not had recent episodes of congestion or excessive fluid retention, or oedema, can reduce or stop some medications. Of course, this must only be done upon the recommendation of your cardiologist,” cautions Dr Lin.

Dr Lin Weiqin, a cardiologist from the National University Heart Centre

Dr Lin Weiqin, a cardiologist from the National University Heart Centre

Treating HFpEF holistically

Just as a low-sodium or low-fat diet might be prescribed for a patient with hypertension or high cholesterol, customised exercise plans can go a long way in improving the quality of life for those with HFpEF.

Unfortunately, many patients with cardiovascular disease often experience “exercise sensitivity”, where they become fearful of physical exertion, and may avoid physical activity.

“Many patients with heart failure incorrectly assume that their body can no longer cope with any form of exercise. They feel that this can put undue pressure on their heart or cardiovascular system,” says Dr Lin.

This could not be further from the truth. Exercise has been proven to provide a multitude of benefits for patients with heart failure. Evidence indicates that regular and repeated exercise drives cell growth that ultimately strengthens the heart and improves its function.

“Exercising helps heart failure patients gain and improve muscle strength, mobility, balance, and reduces the risk of muscles wasting away. It not only improves a patient’s cardiovascular function but also their mental well-being. Exercising outdoors also boosts vitamin D production, which in turn can elevate the mood and promote better mental health. This is why regular exercise can benefit patients who are living with chronic diseases like HFpEF,” explains Dr Lin.

Conversely, sedentary behaviour and unwillingness to exercise have been shown to cause a decline in physiological functions and increase the development of disabilities and frailty.

“Cardiologists generally recommend moderate-intensity aerobic exercises three to five times a week. Patients who are older and less mobile can partake in any form of physical movement or exercise that can be tolerated, as this is far better than a sedentary lifestyle,” says Dr Lin.

Examples of moderate-intensity exercises include brisk walking, jogging, cycling, swimming, carrying light weights, and using resistance bands.

When combined with more targeted treatment plans and dietary or lifestyle modifications, a personalised exercise regime can help patients with HFpEF enjoy a more fulfilling life in the long run.