Ex-DHF

Exercise Training in Diastolic Heart Failure

Patient / Population Intervention / Exposure Comparison Outcome

In 322 patients with heart failure and preserved ejection fraction, 12 months of supervised endurance and resistance training did not significantly improve a hierarchical composite of death, hospitalisation, peak oxygen uptake, diastolic function and symptoms compared with usual care, although peak oxygen uptake and NYHA class improved.

N
322
Design
Randomised controlled trial with 12 months of supervised training
Endpoint
Hierarchical composite (modified Packer score) at 12 months
Relevance
3
ResultScore improved in 20.5 % vs 8.1 % and worsened in 42.9 % vs 44.1 % (p=0.17). Peak VO₂ +1.3 mL/kg/min (95 % CI 0.4–2.1); NYHA class OR 7.77 (95 % CI 3.73–16.21).
Edelmann F, Wachter R, Duvinage A, et al. Nat Med. 2025;31(1):306-314. 10.1038/s41591-024-03342-7
Discussion & critique

The hierarchical primary endpoint weights death and hospitalisation so heavily in an elderly comorbid cohort that it swamped the functional signal — an endpoint-selection failure as much as a therapeutic one. It is the largest and longest randomised training trial in HFpEF and its gains in peak oxygen uptake and NYHA class are the evidence behind offering structured exercise.