Heart Health Heart Disease Living With How Aerobic Exercise Fights Stiff Heart By Richard N. Fogoros, MD Updated on May 07, 2022 Medically reviewed by Richard N. Fogoros, MD Print Recent evidence strongly suggests that regular aerobic exercise can help reverse the “stiffening” of the heart muscle caused by diastolic dysfunction. Diastolic dysfunction often produces a significant reduction in exercise capacity and can lead to a type of heart failure known as diastolic heart failure. A program of aerobic exercise can improve the symptoms of diastolic dysfunction and enhance the quality of life. Gpointstudio / Getty Images Overview The beating of the heart is divided into two phases—the beating phase (when the heart muscle contracts and ejects blood into the arteries), and the relaxation phase (when the heart fills with blood to prepare for the next heartbeat). The beating phase is called systole, and the relaxation phase is called diastole. In diastolic dysfunction, a stiffening of the heart muscle affects the diastolic phase of the heartbeat, making it more difficult for the relaxing heart muscle to completely fill with blood. Exercise and Diastolic Dysfunction During exercise, the heart is normally able to substantially increase the amount of blood it pumps with each beat. Part of this increase, of course, is a stronger contraction during systole, in order to eject blood faster. But equally important is an ability to rapidly fill the heart with blood during diastole. Diastolic dysfunction—a stiff heart muscle—prevents this rapid filling. As a result, the amount of blood the heart can pump with each heartbeat is limited. Patients with diastolic dysfunction typically have a limited exercise capacity, and they often complain of dyspnea on relatively minimal exertion. How Aerobic Exercise Training Helps It has been known for a long time that regular aerobic training can substantially improve exercise capacity and quality of life in patients with typical heart failure—that is, heart failure associated with a weakened, dilated heart muscle (also known as dilated cardiomyopathy). More recently, it has been demonstrated that the same kinds of results can be achieved with aerobic training in patients with diastolic dysfunction. In particular, regular aerobic exercise can actually reduce the stiffening of the heart muscle and improve the filling of the heart during diastole. Randomized trials in patients with diastolic heart failure have demonstrated that regular aerobic training for three to four months can significantly improve exercise capacity, symptoms of shortness of breath with exertion, and quality of life measures. It is important to stress that with diastolic dysfunction it is aerobic exercise and not weight lifting or strength training that improves cardiac stiffness. In fact, there is evidence that in these individuals strength training may worsen the problem by causing the heart muscle to hypertrophy (thicken). Aerobic exercise—typically, walking, cycling, or jogging—is a more sustained, lower-intensity form of exercise in which the energy demands of the muscles are met by consuming oxygen. If You Have Diastolic Dysfunction If you have diastolic dysfunction, odds are high that you will benefit from a program of aerobic exercise. Not only are you likely to feel better after a few months, but also you may begin to reverse the stiffness of your heart muscle, and (more importantly) prevent the onset of diastolic heart failure. You should talk to your healthcare provider about beginning the aerobic exercise, or even about participating in a formal cardiac rehabilitation program, to get you started in the right direction. 11 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Leite-Moreira AF. Current perspectives in diastolic dysfunction and diastolic heart failure. Heart. 2006;92(5):712–718. doi:10.1136/hrt.2005.062950 Amundsen BH, Rognmo Ø, Hatlen-Rebhan G, Slørdahl SA. High-intensity aerobic exercise improves diastolic function in coronary artery disease. Scand Cardiovasc J. 2008;42(2):110–117. doi:10.1080/14017430701744477 Oberman R, Bhardwaj A. Physiology, Cardiac. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526089/ van der Velden J. Diastolic myofilament dysfunction in the failing human heart. Pflugers Arch. 2011;462(1):155–163. doi:10.1007/s00424-011-0960-3 Ichinose M, Ichinose-Kuwahara T, Kondo N, Nishiyasu T. Increasing blood flow to exercising muscle attenuates systemic cardiovascular responses during dynamic exercise in humans. Am J Physiol Regul Integr Comp Physiol. 2015;309(10):R1234–R1242. doi:10.1152/ajpregu.00063.2015 Nasim S, Nadeem N, Zahidie A, Sharif T. Relationship between exercise induced dyspnea and functional capacity with doppler-derived diastolic function'. BMC Res Notes. 2013;6:150. doi:10.1186/1756-0500-6-150 Mahmaljy H, Singhal M. Dilated cardiomyopathy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441911/ Nystoriak MA, Bhatnagar A. Cardiovascular effects and benefits of exercise. Front Cardiovasc Med. 2018;5:135. doi:10.3389/fcvm.2018.00135 Agarwal SK. Cardiovascular benefits of exercise. Int J Gen Med. 2012;5:541–545. doi:10.2147/IJGM.S30113 Patel H, Alkhawam H, Madanieh R, Shah N, Kosmas CE, Vittorio TJ. Aerobic vs anaerobic exercise training effects on the cardiovascular system. World J Cardiol. 2017;9(2):134–138. doi:10.4330/wjc.v9.i2.134 Trankle C, Canada JM, Buckley L, et al. Impaired myocardial relaxation with exercise determines peak aerobic exercise capacity in heart failure with preserved ejection fraction. ESC Heart Fail. 2017;4(3):351–355. doi:10.1002/ehf2.12147 Additional Reading Edelmann F, Gelbrich G, Düngen HD, et al. Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the Ex-DHF (Exercise training in Diastolic Heart Failure) pilot study. J Am Coll Cardiol. 2011;58:1780. doi:10.1016/j.jacc.2011.06.054 Kitzman DW, Brubaker PH, Morgan TM, et al. Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. Circ Heart Fail. 2010;3:659. doi:10.1056/NEJMoa032566 Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure—abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med. 2004;350:1953. doi:10.1056/NEJMoa032566 By Richard N. Fogoros, MD Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit