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The impact of exercise training on post-exercise oxygen uptake recovery in heart failure – a post-hoc analysis of the EXIT-HF randomized clinical trial
Session:
Sessão de Comunicações Orais 08 – Reabilitação Cardíaca como terapia: recuperação funcional na doença cardiovascular avançada
Speaker:
Tiago Miguel Peixoto
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
10. Chronic Heart Failure
Subtheme:
10.3 Chronic Heart Failure – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Tiago Miguel Oliveira Peixoto; Pedro Monteiro; Cristine Schmidt; Sandra Magalhães; Maria Isilda Oliveira; João Pedro Ferreira; Fernando Ribeiro; Mário Santos
Abstract
<p><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Introduction</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">: Exercise physiology research shows that post-exercise VO2 recovery kinetics offers valuable and cardio-specific insights into cardiovascular health. In advanced heart failure, prolonged VO2 recovery kinetics, defined as the time for VO2 to returns toward baseline, reflect delayed restoration of stroke volume and cardiac output, independently predicting hospitalization and mortality. However, the effects of exercise training on VO2 recovery and its prognostic significance remain unknown. </span></span></p> <p><span style="font-size:12.0pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Methods: </span></strong><span style="font-family:"Times New Roman",serif">Early post-exercise </span><span style="font-family:"Times New Roman",serif">VO2 </span><span style="font-family:"Times New Roman",serif">recovery (VO2T12.5%: time in seconds for VO2 to decrease by 12.5% from peak VO<sub>2</sub></span><span style="font-family:"Times New Roman",serif"> during recovery) was analyzed from the cardiopulmonary exercise testing (CPET) done at baseline and after a 12-week cardiac rehabilitation (CR) program in HF patients enrolled in the EXIF-HF trial. Participants were divided into tertiles based on baseline VO2T12.5%. The impact of the CR program was assessed by computing delta VO2T12.5% (baseline minus 12-week; analyzed via paired t-tests); we studied correlations (Pearson's r) with prognostically validated CPET parameters. Tertile differences were evaluated using one-away ANOVA.</span></span></span></p> <p><span style="font-size:12.0pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Result</span></strong><span style="font-family:"Times New Roman",serif">s: We analyzed data from 93 HF patients (mean age 63 ± 11.1 years; 33% female; 87% with reduced LVEF). At baseline, those with prolonged VO2T12.5% (> 85 s) were significantly older (68.1 ± 10.2 vs. 61.3 ± 11.0 years; <em>p</em> = 0.014). Across baseline tertiles, both oxygen pulse (<em>p</em> = 0.005) and 1-min heart rate recovery (<em>p</em> < 0.001) differed significantly. After 12 weeks of CR, VO2T12.5% improved by an average of –10 ± 22 s (<em>p </em>< 0.001). The upper quartile of responders (shortening > 20 s) did not differ from the rest of the cohort in any baseline demographic, clinical, or CPET variable. Changes in VO2T12.5% showed no meaningful associations with changes in VO2peak (r = –0.03; <em>p</em> = 0.81) or VE/VCO2 slope (r = 0.16; <em>p</em> = 0.13).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Conclusion: </span></strong></span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">The 12-week CR program significantly improved early post-exercise VO2 recovery in HF patients. VO2T12.5% was physiologically linked with oxygen pulse and heart rate recovery, while training-induced improvements occurred independently of changes in traditional prognostic markers like VO<sub>2</sub>peak. Our data support VO2T12.5% as a physiologically meaningful and modifiable metric that may enhance CPET-guided risk stratification and therapeutic monitoring in HF.</span></span></span></p>
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