Early Detection of Diastolic Dysfunction and the Role of Lifestyle Measures in Its Treatment
Condition: Diastolic Dysfunction
Study type: Interventional

Summary: 
      The project aims to investigate the effect of a regular exercise for 6 months on diastolic
      parameters in patients who present with shortness of breath and who have evidence of early
      diastolic dysfunction on echocardiography. Patients will be enrolled from the VA General
      Medicine and Cardiology Clinics, and will be screened for diastolic dysfunction. Once
      enrolled, they will be on an exercise regimen that involves aerobic exercise for 30-45
      minutes five times a week at home. The participants will have an initial supervised exercise
      session with the VA Cardiac Rehabilitation team, and will have either every other week or
      monthly supervised sessions at the VA Cardiac Rehabilitation Center to monitor their
      progress. Clinical, biometric, laboratory and echocardiographic parameters will be obtained
      before and after the 6 month period.
    

Detailed description: 
      Introduction:

      Diastolic dysfunction (DD) accounts for >50% of all heart failure (DHF) hospitalizations and
      this number is increasing with age, obesity and diabetes.

      There are no proven treatments for DHF apart from blood pressure control.

      Aim:

      If diagnosed early, is this reversible with lifestyle changes; namely, aerobic exercise and
      weight reduction?

      Methods:

      We will screen veterans presenting to the medicine, cardiology and pulmonary services with
      dyspnea. We will perform echocardiography with Doppler which non-invasively measures cardiac
      filling and diastolic dysfunction. Treadmill exercise echo will be performed to quantify DD.

      Bruce treadmill protocol description/ procedure: Exercise is performed on a treadmill. The
      test starts at 2.74 km/hr (1.7 mph) and at a gradient (or incline) of 10%. At three minute
      intervals the incline of the treadmill increases by 2%, and the speed increases as shown in
      the table below.

      Stage Speed (mph) Gradient:

        1. 1.7 10

        2. 2.5 12

        3. 3.4 14

        4. 4.2 16

        5. 5.0 18

        6. 5.5 20

        7. 6.0 22

        8. 6.5 24

        9. 7.0 26

       10. 7.5 28

      Subject exercise study:

      For physical exercise to have a beneficial effect on cardiac function, we suggest the
      following:

        -  Type of Exercise

        -  Walking - outdoors or treadmill

        -  Running or jogging

        -  Cycling - outdoors or stationary

      Duration of Exercise:

      Initial 2-3 minute gradual warm-up period. Roughly 30 minutes of continuous exercise 5 times
      a week.

      Finally a few minutes of gradual cool-down before terminating exercise.

      Intensity of Exercise:

      Target exercise at a "moderately significant exertion".

      We will demonstrate what is adequate in the beginning and periodically throughout the 6
      months of the study.

      "Maximum age predicted heart rate (MPHR)" is calculated as 220 minus subject's age. Then we
      would like to sustain roughly about 70 to 85% of MPHR for 25-30 minutes.

      "Successful" Exerciser: Subjects who are able to adhere to the required intensity and
      duration of exercise for the majority (about 75% or more) of the time; averaging 150 minutes/
      week on self reporting.
    

Intervention name(s): Exercise
Intervention type(s): Behavioral
Intervention description(s): Aerobic exercise for 30-45 minutes five times a week for six months
Other intervention name(s): Diastolic Dysfunction
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Early Cardiac Diastolic Dysfunction; Aerobic Exercise; Weight Reduction