ABC | Volume 114, Nº4, April 2020

Original Article Schmidt et al. Physical fitness and quality of life in HFpEF Arq Bras Cardiol. 2020; 114(4):701-707 8FUG was the single physical fitness component that remained an independent predictor ( β =0.570; p=0.04). Finally, for MLHFQ emotional, the 8FUG was the single physical fitness component that remained an independent predictor ( β =0.611; p=0.002). Discussion The data provided by our study indicates that physical fitness is positively correlated with QoL in HFpEF patients. In addition, dynamic balance and mobility was the only physical fitness component that was independently associated with QoL total score, and physical and emotional dimensions. These findings suggest that this specific component of physical fitness outperforms CRF in assessing HFpEF patients’ QoL. In addition, it highlights the need to study interventions specifically targeting these fitness components to enhance QoL gains. Despite the high prevalence and poor prognosis of HFpEF, evidence-based therapies aimed at effectively reducing morbidity or mortality remains to be developed. 4 These patients are often characterized by poor QoL 21 and current treatment guidelines highlight the importance of aiming to improve patients’ well-being. 5 Physical fitness is a multicomponent construct 8 and several studies show it is a major determinant of QoL in HFpEF. 6,7 Our results corroborate this finding, as we observed that QoL total score strongly correlated with physical fitness (e.g. dynamic balance and mobility, and CRF) in HFpEF patients. Because physical fitness might influence QoL, strategies targeting physical fitness might potentially improve QoL, independent of further health benefits. 22 A recent meta- analysis showed that the combination of endurance exercise training together with cardiovascular drugs provide a clinically relevant improvement in both exercise capacity and QoL in HFpEF patients. 23 However, physical fitness and QoL are multicomponent and multidimensional constructs, respectively, and it is crucial to ascertain which dimension/ component is better related to each other to maximize possible QoL improvements. Previous studies have shown that CRF is mainly associated with the physical dimension, but not necessarily with the total score or emotional dimension of QoL. 7,10 We observed that CRF (assessed by the 6MWT) and dynamic balance and mobility (assessed by 8FUG) were both associated with the physical dimensions of QoL. Moreover, dynamic balance and mobility were the only physical fitness components associated with the QoL emotional dimension, while upper body strength (assessed by handgrip) and body composition were not associated with any dimension. In addition, multivariate analysis revealed that the dynamic balance and mobility was the only physical fitness component independently associated with all QoL dimensions, explaining 42% of variance in the total score QoL, 32% of the physical dimension and 37% of the emotional dimension of QoL. Thus, of all physical fitness components, dynamic balance and mobility seems to be the one that better assess QoL in HFpEF patients. Collectively, our data suggest that improving the specific physical fitness component of dynamic balance and mobility Table 1 – General patients’ characteristics All (n=24) Sociodemographic characteristics Age (years) 76 ± 6.1 Female (n) (%) 17 (71%) Anthropometrics Weight (Kg) 71.8 ± 15.9 Waist circumference (cm) 100.9 ± 12.6 Body fat (%) 36.1±6.5 Free fat mass (kg) 45.4±9.7 Risk factors, n (%) Obesity (BMI ≥ 30 kg/m2) 14 (58%) Ex-smoker 4 (17%) Hypertension 22 (92%) Dyslipidemia 17 (71%) Type 2 diabetes 2 (8%) Pre-diabetic 9 (38%) Atrial fibrillation 12 (50%) Atrial fibrillation (paroxysmal) 4 (17%) COPD 2 (8%) Obstructive sleep apnea 6 (25%) Clinical signs Resting HR (bpm) 72 ± 16 SBP (mmHg) 136 ± 19 DBP (mmHg) 70 ± 14 BNP (pg/mL) 289 ± 192 NYHA class II 19 (79%) NYHA class III 4 (17%) Medication (%) ACE-i/ARB 17 (71%) ß-Blocker 20 (83%) Loop diuretics 18 (75%) Statin 16 (67%) Digoxin 4 (17%) MRAs 2 (8%) Cardiac Function LVEF (%) 60 ± 6.3 E/e´ 12.2 ± 3.1 E/A 1.0 ± 0.5 LVMI (gm/m 2 ) 231.3 ± 94.5 LAVI (mL/m 2 ) 44.2 ± 11.7 COPD: chronic obstructive pulmonary disease; HR: heart rate; SBP: systolic blood pressure; DBP: diastolic blood pressure; BNP: brain natriuretic peptide; NYHA: New York Heart Association; ACEi/ARB: angiotensin-converting enzyme inhibitor and angiotensin receptor blocker; MRAs: mineralocorticoid receptor antagonists; LVEF: left ventricle ejection fraction; E/e´: ratio of early mitral inflow velocity and mitral annular early diastolic velocity; E/A: mitral ratio of peak early to late diastolic filing velocity; LVMI: left ventricle mass index; LAVI: left atrium volume index. 704