Background: We've shown that combined caloric restriction (CR) and aerobic exercise training (AT) improve peak exercise O2 consumption (VO2peak); and quality-of-life (QOL) in older patients with obese heart failure with preserved ejection fraction (HFpEF). However, ~35% of weight lost during CR+AT was skeletal muscle (SM) mass. We examined whether addition of resistance training (RT) to CR+AT would reduce SM loss and further improve outcomes.

Methods: Randomized, controlled, single-blind, 20-week trial of RT+CR+AT vs. CR+AT in 88 patients with chronic HFpEF and body mass index (BMI) ≥28 kg/m2. Outcomes at 20 weeks included: the primary outcome (VO2peak); MRI and dual X-ray absorptiometry; leg muscle strength and quality (leg strength ÷ leg SM area); Kansas City Cardiomyopathy Questionnaire (KCCQ).

Results: 77 participants completed the trial. RT+CR+AT and CR+AT produced non-significant differences in weight loss: mean (95% CI): -8(-9,-7) versus -9(-11,-8) (p=0.21). RT+CR+AT and CR+AT had non-significantly differences in the reduction of body fat [-6.5(-7.2,-5.8) versus -7.4(-8.1,-6.7) kg] and SM [-2.1(-2.7,-1.5) versus -2.1(-2.7,-1.4) kg] (p=0.20 and 0.23, respectively). RT+CR+AT produced significantly greater increases in leg muscle strength [4.9(0.7,9.0) versus -1.1(-5.5,3.2) Nm, p=0.05] and leg muscle quality [0.07(0.03,0.11) versus 0.02(-0.02,0.06) Nm/cm2, p=0.04]. Both RT+CR+AT and CR+AT produced significant improvements in VO2peak [108(958,157) versus 80(30,130) ml/min; p=0.001 and 0.002, respectively], and KCCQ score [17(12,22) versus 23(17,28); p=0.001 for both], with no significant between-group differences. Both RT+CR+AT and CR+AT significantly reduced LV mass and arterial stiffness. There were no study-related serious adverse events.

Conclusions: In older obese HFpEF patients, CR+AT produces large improvements in VO2peak and QOL. Adding RT to CR+AT increased leg strength and muscle quality without attenuating SM loss or further increasing VO2peak or QOL.

Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT02636439