ABC | Volume 114, Nº4, April 2020

Original Article Dynamic Balance and Mobility Explain Quality of Life in HFpEF, Outperforming All the Other Physical Fitness Components Cristine Schmidt, 1, 5 M ário Santos, 2,3 Lucimere Bohn, 1 Bruno Miguel Delgado, 4 D aniel Moreira-Gonçalves, 1 Adelino Leite-Moreira, 5 José Oliveira 1 Faculdade de Desporto da Universidade do Porto (FADEUP), Centro de Investigação em Actividade Física, Saúde e Lazer (CIAFEL), 1 Porto – Portugal Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Unidade de Pesquisa Multidisciplinar em Biomedicina, 2 Porto – Portugal Centro Hospitalar do Porto, Departamento de Cardiologia, 3 Porto – Portugal Centro Hospitalar do Porto, 4 Porto – Portugal Faculdade de Medicina da Universidade do Porto (FMUP), Unidade de Investigação Cardiovascular (UniC), 5 Porto – Portugal Mailing Address: Cristine Schmidt • CIAFEL – Faculdade de Desporto da Universidade do Porto. Rua Dr. Plácido da Costa, 91. Postal Code 4200-450, Porto – Portugal E-mail: schmidtcristine@gmail.com Manuscript received February 06, 2019, revised manuscript June 10, 2019, accepted June 23, 2019 DOI: https://doi.org/10.36660/abc.20190080 Abstract Background: Physical fitness is an important determinant of quality of life (QoL) in heart failure with preserved ejection fraction (HFpEF) patients. However, how the different physical fitness components correlate with the specific dimensions of QoL in HFpEF patients remains unknown. Objective: To evaluate the association between different physical fitness components and QoL dimensions in HFpEF patients, and, assess which physical fitness components were independently associated to QoL. Methods: Patients with HFpEF were assessed for physical fitness [dynamic balance and mobility (8-foot-up-and go test), upper body strength (handgrip), cardiorespiratory fitness (CRF) (6-minute-walking test) and body composition (body mass index)] and for QoL (Minnesota Living With Heart Failure Questionnaire). Partial correlation was used to verify the association between physical fitness components and QoL dimensions. The determination of independent predictors in QoL dimensions was assessed through stepwise multivariate linear regression analysis. Statistical significance was set at p<0.05. Results: Both CRF and dynamic balance and mobility are significantly associated with the total score and physical dimensions of QoL (p<0.05), but only dynamic balance and mobility were concomitantly associated with the emotional dimension (r=0.597; p=0.004). Dynamic balance and mobility were independently associated with total score ( β =0.651; r 2 =0.424; p=0.001), physical ( β =0.570; r 2 =0.324; p=0.04) and emotional ( β =0.611; r2=0.373 p=0.002) dimensions of QoL. Conclusion: Our data suggests that dynamic balance and mobility better assess QoL than CRF, which is commonly measured in clinical practice. Whether interventions specifically targeting dynamic balance and mobility have different impacts on QoL remains unknown. (Arq Bras Cardiol. 2020; 114(4):701-707) Keywords: Heart Failure/physiopathology; Work-Life Balance/methods; Physical Fitness; Quality of Life; Breathing Exercises; Body Composition. Introduction Heart failure with preserved ejection fraction (HFpEF) accounts for half of all HF cases in the developed world’s population. 1 The most common manifestation of the disease is exercise intolerance, which impacts on patients’ ability to cope with activities of daily life and reduces their quality of life (QoL). 2 Furthermore, QoL is related with poor outcomes, such as higher frequency of hospital readmission and higher mortality rates. 3 Despite its high prevalence and poor prognosis, HFpEF remains a disease with no approved therapy that improves survival. 4 Therefore, current recommendations for the treatment of these patients highlight the importance to focus on effective therapies capable of alleviating symptoms and meaningfully improve QoL. 5 Reduced levels of physical fitness are associated with poor QoL in patients with HFpEF. 6,7 Importantly, exercise training has shown to improve physical fitness, together with symptom and QoL improvement. 6,7 Because physical fitness and QoL are mutually related, targeting physical fitness with exercise training programs may be an effective strategy to accomplish the management recommendations of patients with HFpEF. 5 However, physical fitness is a multicomponent (e.g. dynamic 701