Exercise, Nutrition and GLP-1 Medicines to Improve Body Weight and Muscle Function in Heart Failure with Preserved Ejection Fraction

Abstract

This narrative review synthesizes current evidence on lifestyle, pharmacological, surgical, and multimodal interventions targeting muscle strength, body composition, and functional capacity in HFpEF with sarcopenia and/or obesity. Exercise, particularly concurrent endurance and resistance training protocols, improve aerobic capacity, functional performance, symptoms, and quality of life in HFpEF. Protein supplementation may preserve muscle mass, while caloric restriction may enhance aerobic capacity and function butdecreases muscle mass. SGLT2i and GLP-1 medicines may reduce hospitalizations and improve symptoms, with GLP-1 medicines producing greater weight loss and performance benefits. Bariatric surgery may also achieve substantial weight loss and functional improvements, although evidence in HFpEF with obesity is limited. Obesity-related HFpEF may benefit from a combination of resistance exercise and adequate protein intake to preserve muscle during weight loss, while pharmacotherapy can be used to support cardiac function. Future trials should evaluate multimodal interventions to mitigate frailty risk in HFpEF.