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 will eventually result in the greatest QoL improvement. The 8FUG reflects the specific demands of activities, such as standing up from a sitting position, walking short distances, turning, stopping and sitting down. 24 This might be explained by the wide range of physical abilities, including lower body strength, dynamic balance, walking ability, agility and gait speed 8 involved in the 8FUG. These abilities are also required during the normal daily tasks of an independent and autonomous life, especially among the elderly. 25 Future studies (e.g. longitudinal training programs) should assess if an exercise training program focused on enhancing motor abilities (e.g. dynamic balance and mobility) can improve the physical and emotional components of QoL in HFpEF in comparison to current standard ones. Study limitations The small sample size, cross-sectional and convenience sampling design of our study limits the generalization of our results. Despite that, our sample assembles the usual clinical features of HFpEF population reported in large studies 5 with a higher prevalence of elderly women and a higher prevalence of comorbidities. Further prospective cohort studies with a larger sample size are needed to strengthen or refute our conclusions that dynamic balance and mobility are more efficient in assessing HFpEF patients’ QoL. Conclusion Overall, our findings indicate that both CRF and dynamic balance and mobility are directly associated with the QoL total score and physical dimensions in patients with HFpEF, but only dynamic balance and mobility were concomitantly associated with the emotional dimension. Multivariate analyses revealed that dynamic balance and mobility outperforms CRF in assessing HFpEF patients’ QoL. In addition, our data suggests that specifically targeting motor agility and balance may be an important strategy to enhance QoL gains in all dimensions. Author contributions Conception and design of the research and obtaining financing: Schmidt C, Santos M, Moreira-Gonçalves D, Leite- Moreira A, Oliveira J; Acquisition of data: Schmidt C, Santos M, Bohn L, Delgado BM, Moreira-Gonçalves D; Analysis and interpretation of the data, writing of the manuscript and critical revision of the manuscript for intellectual content: Schmidt C, Santos M, Bohn L, Delgado BM, Moreira-Gonçalves D, Leite- Moreira A, Oliveira J; Statistical analysis: Schmidt C, Santos M, Bohn L, Delgado BM, Moreira-Gonçalves D, Oliveira J. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding CIAFEL is supported by FCT under Grant [UID/ DTP/00617/2019]. UnIC is supported by FCT under Grant [UID/IC/00051/2019] and [UID/DTP/00617/2019]. This work was supported by the project [PTDC/MEC-CAR/30011/2017] [POCI-01-0145-FEDER-030011]. Cristine Schmidt was supported by individual grant from CAPES [BEX 0554/14-6]. Study Association This article is part of the thesis of Doctoral submitted by Cristine Schmidt, from Faculdade de Desporto da Universidade do Porto. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Centro Hospitalar do Porto/HSA under the protocol number 2015-125. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. Table 2 – Bivariate correlation between physical fitness parameters Dynamic balance and mobility Upper body strength Cardiorespiratory fitness Body composition 8FUG Handgrip 6MWT BMI % FM FFM 8FUG -0.478 (0.018) -0.816 (<0.00) -0.030 (0.888) 0.184 (0.389) -0.221 (0.299) Handgrip -0.478 (0.018) 0.390 (0.060) 0.017 (0.939) -0.362 (0.082) 0.284 (0.179) 6MWT -0.816 (<0.00) 0.390 (0.060) -0.074 (0.733) -0.161 (0.453) 0.010 (0.964) BMI -0.030 (0.888) 0.017 (0.939) -0.074 (0.733) 0.566 (0.004) 0.533 (0.007) Fat Mass 0.184 (0.389) -0.362 (0.082) -0.161 (0.453) 0.566 (0.004) -0.258 (0.224) FFM -0.221 (0.299) 0.284 (0.179) 0.010 (0.964) 0.533 (0.007) -0.258 (0.224) 8FUG: 8-foot up and go test; 6MWT: six-minute walk test; BMI: body mass index; FM: fat mass; FFM: free fat mass. Data are r (p). 705