Pilates in Heart Failure Patients: A Randomized Controlled Pilot Trial

The impact of various mind-body exercises on cardiorespiratory function and quality of life in heart failure patients: A network meta-analysis

OBJECTIVE

This study aims to compare the relative effects of different mind-body exercises on cardiorespiratory function and quality of life in Heart failure (HF) patients, providing valuable insights for their rehabilitation.

METHODS

We conducted a search across seven Chinese and English databases, including China National Knowledge Infrastructure (CNKI) and Web of Science. A network meta-analysis was performed using STATA 14.0 within a frequentist framework.

RESULTS

A total of 38 studies were included, encompassing eight types of mind-body exercises. Ten studies reported peak VO2, indicating that dancing outperformed Tai Chi (MD:3.52, 95 % CI:6.74, -0.30) and Baduanjin (MD:2.34, 95 % CI:4.32, -0.36). Additionally, Pilates demonstrated greater effectiveness than Yijinjing, aside from Tai Chi (MD:5.10, 95 % CI:8.71, -1.49) and Baduanjin (MD:3.92, 95 % CI:6.50, -1.34). Twenty-one studies reported the six-minute walk test (6MTW), with only Tai Chi significantly improving 6MTW scores compared to the control group (MD: 50.77, 95 % CI: 8.12, 93.42). Twenty-three studies assessed left ventricular ejection fraction (LVEF), finding that Tai Chi (MD: 3.83, 95 % CI: 2.07, 5.59), Baduanjin (MD: 2.90, 95 % CI: 1.04, 4.76), and yoga (MD: 3.32, 95 % CI: 0.37, 6.27) significantly increased LVEF in HF patients. Nineteen studies evaluated quality of life, with the Liuzijue possibly being the most effective intervention (SUCRA: 98.9).

CONCLUSION

Different mind-body exercises have their own advantages in improving the heart function and quality of life of HF patients. In the future, higher-quality studies with larger samples are needed to further verify the validity of the results.

The Effect of Computerized Wobble Board and Core Stabilization Exercises on Balance Performance and Exercise Capacity in Patients With Heart Failure: A Randomized Controlled Trial

OBJECTIVE

To investigate the effects of computerized wobble board exercise training (CWBET) and core stabilization exercise training (CSET) on balance performance, and exercise capacity in patients with heart failure (HF).

DESING

Single-blind randomized controlled prospective study.

SETTING

Cardiology department of a local university hospital.

PARTICIPANTS

Fifty-one patients with HF with reduced ejection fraction, whose clinical status and medication had been stable for the previous 3 months, were included (N=51). Nine patients could not complete the follow-up period due to personal reasons. No patient experienced any adverse events during exercise training.

INTERVENTIONS

Patients were randomized to CWBET, CSET, and control group. CWBET and CSET groups participated in their own exercise programs, 3 days a week for 8 weeks. The control group received no exercise program.

MAIN OUTCOME MEASURES

All patients were evaluated at baseline and after 8 weeks. Postural stability, static and functional balance, and exercise capacity were evaluated with the Sensamove Balance Test Pro with Miniboard, the one-leg stance test (OLS), the Berg Balance Scale (BBS), and the six-minute walk distance (6MWD), respectively. Core stabilization and health-related quality of life (HRQOL) were assessed with OCTOcore app, and Minnesota Living with Heart Failure Questionnaire, respectively.

RESULTS

A mixed model repeated-measures ANOVA revealed significant group × time interaction effect for static postural stability performance (P<.001, ηp2=0.472), vertical (P<.001, ηp2=0.513), horizontal performance (P<.001, ηp2=0.467), OLS (P<.001, ηp2=0.474), BBS (P<.001, ηp2=0.440) scores, 6MWD (P<.001, ηp2=0.706), and HRQOL. Post hoc analysis revealed CWBET and CSET groups had similar improvements balance performance, exercise capacity, and HRQOL and both groups significantly improved compared with control group (P<.001). Core stabilization was significantly improved only in CSET group after 8 weeks.

CONCLUSION

CWBET and CSET programs were equally effective and safe for improving balance performance and exercise capacity in patients with HF.

Cardiorespiratory responses: Pilates compared to different walking speeds in healthy adults

BACKGROUND

The impact of a single-session Pilates exercise on cardiorespiratory fitness and metabolic parameters is still uncertain.

AIMS

The aim of this study was to examine the cardiorespiratory changes during a single-session Pilates exercise and compare cardiorespiratory fitness-related parameters with walking at different speeds on a treadmill, at low (3.2 kph) and moderate intensities (4.8 kph).

METHODS

Cardiorespiratory responses were measured with a cardiopulmonary exercise test device in 31 healthy young adults at rest, during a single Pilates session, walking at 3.2 kph and walking at 4.8 kph. The study design employed a cross-over design. Participants were randomly assigned to two experimental groups: a Pilates training session following treadmill walking or treadmill walking following a Pilates training session.

RESULTS

Mean MET, oxygen and energy consumption during Pilates were similar to walking at 3.2 kph (p > 0.05), but significantly lower than walking at 4.8 kph (p < 0.05). The mean heart rate during Pilates was higher than walking at 3.2 kph (p < 0.05), but similar to walking at 4.8 kph (p > 0.05). Significantly higher carbohydrate metabolism was used during Pilates compared to walking (p < 0.05).

CONCLUSION

The cardiopulmonary responses to a single Pilates session are similar to walking at a speed of 3.2 kph but lower than walking at 4.8 kph. These results indicate that while Pilates may not generate sufficient cardiopulmonary changes to enhance cardiorespiratory fitness as a moderate-intensity exercise in healthy young adults, it may still offer other benefits such as improvements in flexibility, core strength, and posture.

improvement of cardiorespiratory fitness in healthy women after a 12-week Classical Pilates training

Aims: to evaluate the effects of 12 weeks of Pilates training (Classical Method) on cardiorespiratory fitness and heart rate responses of healthy sedentary women. Method: fifteen women (average age 29±4) performed 12 weeks of Pilates training for 60 minutes, three times per week (Pilates Group). Thirteen women (average age 29±5) as controls maintained their routine activities (Control Group). The exercises’ introduction was by the degree of difficulty with changes in the plane of movements; smaller base of support; spinal rotations and extensions; use of abdominal muscles in prone position. Heart rate was monitored and recorded during all sessions using a heart frequency meter. Results: ANOVA analysis results revealed significant difference in Pilates Group (p < 0.05) between pre and post measures of VO2peak (+13%), fat percentage (- 3.3%), free fat mass (+ 2.8 kg), and muscular endurance in the abdominal area (+61%), lower limbs (+75%) and upper limbs (+68%). The percent of Maximum Heart Rate achieved in the 6th (79.25%) and 12th (79.86%) weeks of training increased from the first week (73.4%). Physical fitness in Control Group remained unchanged. Conclusion: twelve weeks of Pilates training positively affected overall physical fitness in previously sedentary healthy women. Furthermore, the increase in VO2peak and achieved Maximum Heart Rate was significant even with no specific aerobic training.

Effects of individualized low-intensity mat Pilates on aerobic capacity and recovery ability in adults

PURPOSE

Although Pilates is one of the most widely performed physical activities in Korea, no physiological evidence is available regarding its energy recovery ability. Therefore, the purpose of this study was to investigate the effects of individualized low-intensity mat Pilates on aerobic capacity and recovery ability in adults.

METHODS

Ten physically active women participated in this study. Pre- and post-lactate threshold (LT) tests were performed to compare jogging/running speeds (S; km·h-1) and heart rates (HR; beats·min-1) at 1.5, 2.0, 3.0, 4.0 mmol·L-1 lactate concentrations (La-). Subjects performed 1 h of low-intensity mat Pilates twice a week for four weeks. During these sessions, exercise intensity was determined based on the heart rate corresponding to individualized low-inten- sity recovery zone 1, which was estimated using a mathematical model of log-log LT1 (from pre-test; &lt; 2 mmol·L-1). All physiological variables were measured before and after exercise intervention.

RESULTS

Significant differences were found in body mass increase and body mass index increase between the pre- and post-tests (p = 0.016 and p = 0.014, respectively, effect size (ES) = 0.13; ES = -0.11). Levels of La- between 1.0 and 1.4 m·s-1 in the post-LT test tended to decrease, although such decrease was not significantly different. Moderate to high positive correlations between differences (Δ) of S and ΔHR at 1.5, 3.0, and 4.0 mmol·L-1La- were observed.

CONCLUSION

Positive correlations between ΔS and ΔHR at certain La- levels indicate that low-intensity mat Pilates based on heart rate corresponding to individualized recovery zone 1 might be recommended for physically active adults.

Is the Combination of Aerobic Exercise with Mat Pilates Better than Mat Pilates Training Alone on Autonomic Modulation Related to Functional Outcomes in Hypertensive Women? Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Although mat Pilates (MP) has become popular, the effects of MP in hypertensive women (HW) are not entirely clear. Here, we investigated the effects of 16 weeks of MP training contrasted with MP supplemented with aerobic exercise (MP+AE) and compared with a non-intervention group on autonomic modulation, cardiorespiratory fitness, strength, flexibility, performance of functional tasks, QOL, anthropometric variables, clinical BP, and heart rate.

METHODS

This is a three-arm, secondary analysis of an RCT. Sixty HW, aged 30 to 59 years, were allocated into: MP only (MP), MP+AE on a treadmill (MP+AE), and Control Group, without exercises. Assessments were performed before and after 16 weeks of training.

RESULTS

The ANOVA shows differences in between-group comparisons in the SDNN, rMSSD, and SD1 in the heart rate variability analysis, with increases in rMSSD, SDNN, and SD1 only in the MP, and this result was not found in the MP+AE group (p < 0.05). Differences were observed in the between-group comparisons in time in the cardiorespiratory exercise test (CPX), flexibility, and the waist-to-hip ratio, with changes in the MP+AE, differences in QOL, and increments in the MP and MP+AE (p < 0.05).

CONCLUSIONS

MP increased the indices that reflect vagal and global cardiac autonomic modulation. MP+AE improved the CPX performance, flexibility, QOL, and anthropometric variables. These results suggest that MP supplemented or not with AE has promising effects in HW.

Effects of β-blocker therapy on exercise oscillatory ventilation in reduced ejection fraction heart failure patients: A case series study

BACKGROUND

Exercise oscillatory ventilation (EOV) is an abnormal breathing pattern that occurs in ~20% of patients with heart failure (HF) and is associated with poor prognosis and exercise intolerance. β-blockers (βb) are prescribed for most HF patients; however, their effect on EOV remains unclear. We evaluated the effect of βb on EOV in HF patients with reduced ejection fraction (HFrEF).

METHODS

Fifteen patients diagnosed with HF, ejection fraction < 45%, aged from 18 to 65 years, were included before starting βb therapy. Patients underwent clinical evaluation, cardiopulmonary exercise testing, echocardiography, laboratory exams (norepinephrine levels, B type natriuretic peptide) at baseline and after βb therapy optimized for six months. Presence of exercise oscillatory breathing was determined by two experienced observers who were blinded to the moment of the test (pre or post).

RESULTS

Fifteen patients (1 female), aged 49.5 ± 2.5 years, with HFrEF, NYHA I-III enrolled in the study. The etiologies of the HFrEF were idiopathic (n = 8) and hypertensive (n = 7). LVEF increased after βb therapy from 25.9 ± 2.5% to 33 ± 2.6%, P = 0.02; peak VO₂ did not significantly change (21.8 ± 1.7 vs 24.7 ± 1.9, P = 0.4); VE/VCO₂ slope changed from 32.1 ± 10.6-27.5 ± 9.1, P = 0.03. Before βb initiation, nine patients (60%) had EOV, but only two (13%) did after optimized therapy. McNemar test was used to evaluate the significance of the association between the two moments (P = 0.02).

CONCLUSION

In patients with HF, medical therapy with βb can reverse EOV. This may explain why these patients experience symptom improvement after βb therapy.

Exercise Training in Heart Failure With Reduced Ejection Fraction and Permanent Atrial Fibrillation: A Randomized Clinical Trial

BACKGROUND

Heart failure (HF) associated with atrial fibrillation (AF) increases patients' physical inactivity, worsening their clinical condition and mortality. Exercise training is safe and has clear benefits in HF. However, little is known about the effects of exercise training on heart failure patients with reduced ejection fraction and permanent atrial fibrillation (HFAF).

OBJECTIVE

To test the hypothesis that exercise training improves functional capacity, cardiac function, and quality of life in patients with HFAF.

METHODS

This randomized clinical trial was conducted at the Heart Institute. Patients with HFAF, LVEF ≤40% and resting HR ≤80 bpm were included in the study. Cardiopulmonary testing, echocardiography, autonomic, and quality of life assessment were performed before and after the 12-week protocol period.

RESULTS

Twenty-six patients, 58±1 years, were randomized to exercise training (HFAF-trained, n=13) or no training (HFAF-untrained, n=13). At baseline, no differences between groups were found. Exercise improved VO₂ peak, slope VE/VCO₂, and quality of life. HFAF-trained significantly decreased resting HR (from 73±2 to 69±2 bpm, P=.02) and recovery HR (from 148±11 to 128±9 bpm, P=.001). Concomitantly, LVEF increased (from 31±1 to 36±0.9 %, P=.01), LA decreased (from 52±1.2 to 47±1mm, P=.03), and LV-ESV and LV-EDV deceased (from 69±2 to 64±1.8 mL/m², and 99±2.1 to 91±2, P<.05, respectively). No changes were observed in the untrained group.

CONCLUSION

Exercise training can improve exercise capacity, quality of life, and cardiac function in patients with heart failure with reduced ejection fraction and permanent atrial fibrillation.

The Effect of Mat Pilates Training Combined With Aerobic Exercise Versus Mat Pilates Training Alone on Blood Pressure in Women With Hypertension: A Randomized Controlled Trial

OBJECTIVE

The purpose of this study was to determine the effects of mat Pilates (MP) versus MP plus aerobic exercise (AE) compared with the effects of no intervention on ambulatory blood pressure (BP) in women with hypertension.

METHODS

This 3-arm, parallel-group randomized clinical trial assessed 60 women who had hypertension and were 30 to 59 years old. The intervention lasted 16 weeks, and the participants were allocated into 3 groups: MP only (MP group), MP with alternating bouts of AE on a treadmill (MP + AE group), and control group (CG) with no exercises. Primary outcomes were the effects of the interventions on ambulatory BP assessed in the 24-hour, awake, and asleep periods of analysis.

RESULTS

A 2-way analysis of variance did not reveal statistically significant differences in between-group comparisons in the 24-hour period of analysis for systolic BP (CG vs MP = 3.3 [95% CI = -7.1 to 13.8]; MP vs MP + AE = 0.7 [95% CI = -4 to 5.4]; CG vs MP + AE = 4.0 [95% CI = -5.2 to 13.4]), diastolic BP (CG vs MP = 2.2 [95% CI = -5.6 to 10.0]; MP vs MP + AE = 1.1 [95% CI = -4.3 to 6.5]; CG vs MP + AE = 3.3 [95% CI = -3.8 to 10.4]), and heart rate (CG vs MP = 3.4 [95% CI = -2 to 8.8]; MP vs MP + AE = 2.0 [95% CI = -3.4 to 7.5]; CG vs MP + AE = 5.4 [95% CI = -0.8 to 11.8]). The awake and asleep periods of analyses also showed similar behavior and did not reveal statistically significant between-group differences. Furthermore, in the responsiveness analysis based on the minimal clinically important difference, no differences were observed between groups.

CONCLUSION

The magnitudes of the decrease in systolic BP during the 24-hour period of analysis were -3 and -5.48 mm Hg for the MP and MP + AE groups, without differences for responsiveness between groups. The results suggest that MP supplemented with AE or not may be an alternative adjuvant treatment for women who have hypertension and are using antihypertension medication.

IMPACT

Sixteen weeks of MP training reduced ambulatory BP in women who had hypertension. The MP + AE group displayed a BP reduction similar to that of the MP group. A reduction in ambulatory BP can decrease the risk of cardiovascular disease.

Effects of the exercise training on skeletal muscle oxygen consumption in heart failure patients with reduced ejection fraction

AIMS

Skeletal muscle dysfunction is a systemic consequence of heart failure (HF) that correlates with functional capacity. However, the impairment within the skeletal muscle is not well established. We investigated the effect of exercise training on peripheral muscular performance and oxygenation in HF patients.

METHODS AND RESULTS

HF patients with ejection fraction ≤40% were randomized 2:1 to exercise training or control for 12 weeks. Muscle tissue oxygen was measured noninvasively by near-infrared spectroscopy (NIRS) during rest and a symptom-limited cardiopulmonary exercise test (CPET) before and after intervention. Measurements included skeletal muscle oxygenated hemoglobin concentration, deoxygenated hemoglobin concentration, total hemoglobin concentration, VO₂ peak, VE/VCO₂ slope, and heart rate. Muscle sympathetic nerve activity by microneurography, and muscle blood flow by plethysmography were also assessed at rest pre and post 12 weeks. Twenty-four participants (47.5 ± 7.4 years, 58% men, 75% no ischemic) were allocated to exercise training (ET, n = 16) or control (CG, n = 8). At baseline, no differences between groups were found. Exercise improved VO₂ peak, slope VE/VCO₂, and heart rate. After the intervention, significant improvements at rest were seen in the ET group in muscle sympathetic nerve activity and muscle blood flow. Concomitantly, a significant decreased in Oxy-Hb (from 29.4 ± 20.4 to 15.7 ± 9.0 μmol, p = 0.01), Deoxi-Hb (from 16.3 ± 8.2 to 12.2 ± 6.0 μmol, p = 0.003) and HbT (from 45.7 ± 27.6 to 27.7 ± 13.4 μmol, p = 0.008) was detected at peak exercise after training. No changes were observed in the control group.

CONCLUSION

Exercise training improves skeletal muscle function and functional capacity in HF patients with reduced ejection fraction. This improvement was associated with increased oxygenation of the peripheral muscles, increased muscle blood flow, and decreased sympathetic nerve activity.

The Efficacy of Pilates on Urinary Incontinence in Korean Women: A Metabolomics Approach

Pilates has been known as exercise intervention that improves the function of pelvic floor muscle (PFM) associated with impacting urinary incontinence (UI). This study investigated the effect of Pilates on UI in Korean women by determining the change in functional movement of PFM (FMP) and metabolic profiles. UI group with Pilates (UIP, n = 13) participated in 8-weeks Oov Pilates program, and 8 subjects were assigned to Control and UI group with no Pilates (UINP), respectively. Before and after 8 weeks, plasma samples were collected from all participants, and ultrasonography was used to measure the functional change of PFM for calculating FMP ratio. Plasma samples were analyzed by mass spectrometry to identify the change of metabolic features. After 8-weeks intervention, FMP ratio was remarkably decreased in UIP (48.1% ↓, p < 0.001), but not in Control and UINP (p > 0.05). In metabolic features, L-Glutamine (m/z: 147.07 [M + H]⁺), L-Cystathionine (m/z: 240.09 [M + NH₄]⁺), L-Arginine (m/z: 197.1 [M + Na]⁺), and L-1-Pyrroline-3-hydroxy-5-carboxylate (m/z: 147.07 [M + NH₄]⁺) were significantly elevated solely in UIP (p < 0.001). Our study elucidated that Pilates can ameliorate the FMP and enhance the specific metabolic characteristics, which was potentially associated with invigorated PFM contractility to effectively control the bladder base and continence.

Resistance Training as a Countermeasure for Key Non-communicable Diseases in Low-Resource Settings: A Review

Background: Non-communicable diseases (NCDs) are responsible for 60% of global deaths. Of these NCD-attributable deaths, about 80% are in low- to middle-income countries (LMICs). The role of exercise in major NCDs is evident; however, popular and cost-effective aerobic modes of exercise, such as walking, consistently do not meet minimum intensity guidelines for health improvement. Interestingly, low-cost resistance training (using callisthenics, Pilates, elastic tubing, etc.) has proven equally effective to conventional resistance training using weight machines in improving several health parameters related to NCDs, although their effectiveness in LMICs is not as well documented as in high-income countries (HICs). Objectives: This review aimed to examine low-cost approaches of resistance training to health promotion, NCD risk reduction, and NCD rehabilitation/management to mitigate the epidemic of NCDs in lower-resource settings. Methods: An electronic search was performed on the following databases from inception until December 2019: PubMed/Medline, Sport Discuss, Embase, Science Direct, Current Contents, CISTI Source, Google Scholar, Cochrane Library, Cochrane Database of Systematic Reviews, CINAHL EBM Reviews, and international e-catalogues. Results: Data on resistance training provision cost in low-resource settings indicates that it is not reasonable to use this mode of training in low-resource settings in the same way as it is used in high-resource ones. This review summarized some strategies which can be employed to ensure the delivery of all core resistance training components in low-resource settings. The data suggests that resistance training be adapted for delivery in non-clinical settings in LMICs. Conclusions: Program design variables of resistance training are similar in low- and well-resourced settings. However, only individuals with low-risk will be able to perform exercise without adverse consequences in home-based settings. Health care practitioners in LMICs should take an active role in promoting resistance training when promoting health, reducing NCD risk, and NCD rehabilitation.

Eight-week equipment-based Pilates exercises positively affects quality of life, and functional capacity in non-active adult women: a randomized controlled trial

BACKGROUND

The Pilates exercises are popular for muscle conditioning among women. However, the effects on conditioning of healthy non-active adult women due to Pilates practicing are not fully explained. The aim of this randomized controlled trial was to assess the effects of equipment-based Pilates exercises on the percentage of body fat, weight, body mass index (BMI), functional capacity, and quality of life of adult healthy women.

METHODS

Seventy-eight non-active women were randomly assigned to 2 groups (Pilates or Control). The Pilates group performed a total of 16 exercise sessions (60 minutes each, performed twice a week for 8 consecutive weeks). The control group was instructed to perform no exercise. Percentage of body fat (DXA scans), weight, BMI, distance covered in the incremental shuttle walk test, maximal oxygen uptake (VO<inf>2max</inf>), and quality of life (SF-36 scores) were analyzed.

RESULTS

There were no significant between-group differences at baseline, but significant group-by-time interaction was observed for Pilates group postintervention. Higher distance covered (P=0.01), VO<inf>2max</inf> (P=0.04), and quality of life (P=0.04) were observed after the intervention compared to the control group. No differences were observed for body composition.

CONCLUSIONS

Two months of equipment-based Pilates training improved functional capacity and quality of life in healthy adult women.

Pilates Method Improves Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis

Cardiorespiratory fitness has been postulated as an independent predictor of several chronic diseases. We aimed to estimate the effect of Pilates on improving cardiorespiratory fitness and to explore whether this effect could be modified by a participant's health condition or by baseline VO2 max levels. We searched databases from inception to September 2019. Data were pooled using a random effects model. The Cochrane risk of bias (RoB 2.0) tool and the Quality Assessment Tool for Quantitative Studies were performed. The primary outcome was cardiorespiratory fitness measured by VO2 max. The search identified 527 potential studies of which 10 studies were included in the systematic review and 9 in the meta-analysis. The meta-analysis showed that Pilates increased VO2 max, with an effect size (ES) = 0.57 (95% CI: 0.15-1; I2 = 63.5%, p = 0.018) for the Pilates group vs. the control and ES = 0.51 (95% CI: 0.26-0.76; I2 = 67%, p = 0.002) for Pilates pre-post effect. The estimates of the pooled ES were similar in both sensitivity and subgroup analyses; however, random-effects meta-regressions based on baseline VO2 max were significant. Pilates improves cardiorespiratory fitness regardless of the population's health status. Therefore, it may be an efficacious alternative for both the healthy population and patients suffering from specific disorders to achieve evidenced-based results from cardiorespiratory and neuromotor exercises.

Pilates in noncommunicable diseases: A systematic review of its effects

OBJECTIVES

Chronic cardiovascular diseases, cancer, chronic respiratory diseases and diabetes are the four major groups of non-communicable diseases (NCDs) and the main cause of mortality worldwide. Pilates has been described as an effective intervention to promote healthy behaviors and physical activity in people with chronic diseases. However, the evidence of its effects in NCDs have not been systematized. We investigated the effects of Pilates in the four major groups of NCDs.

DESIGN

A systematic review was performed. Searches were conducted on Cochrane Library, EBSCO, PubMed, Science Direct, Scopus and Web of Science databases. Studies were rated with the quality assessment tool for quantitative studies. As a meta-analysis was not possible to conduct, a best-evidence synthesis was used.

RESULTS

Twelve studies, mostly of moderate quality, were included with 491 participants (78.6% females; age range 13-70 years old) with breast cancer (n = 3), diabetes (n = 3), chronic stroke (2 years post stroke) (n = 2), chronic obstructive pulmonary disease (n = 1), cystic fibrosis (n = 1), heart failure (n = 1) and arterial hypertension (n = 1). The best-evidence synthesis revealed strong evidence for improving exercise tolerance; moderate evidence for improving symptoms, muscle strength and health-related quality of life and limited or conflicting evidence on vital signs, metabolic parameters, body composition, respiratory function, functional status, balance, flexibility and social support.

CONCLUSIONS

Pilates should be considered for patients with NCDs, as it improves exercise tolerance. Future studies with robust methodologies are still needed to clarify its effectiveness on outcomes with moderate, limited or conflicting evidence and to establish the most suitable intervention protocol.

Mind-Body Interventions for Individuals With Heart Failure: A Systematic Review of Randomized Trials

BACKGROUND

The effects of mind-body interventions (MBIs) (eg, Tai Chi, yoga, meditation) for individuals with heart failure (HF) have not been systematically evaluated.

METHODS AND RESULTS

We performed a systematic review of randomized controlled trials (RCTs) examining the effects of MBIs in HF. We extracted participant characteristics, MBI procedure, outcomes assessed, and main results of English-language RCTs before October 2016. We identified 24 RCTs (n = 1314 participants) of 9 MBI types: Tai Chi (n = 7), yoga (n = 4), relaxation (n = 4), meditation (n = 2), acupuncture (n = 2), biofeedback (n = 2), stress management (n = 1), Pilates (n = 1), and reflexology (n = 1). Most (n = 22, 95.8%) reported small-to-moderate improvements in quality of life (14/14 studies), exercise capacity (8/9 studies), depression (5/5 studies), anxiety and fatigue (4/4 studies), blood pressure (3/5 studies), heart rate (5/6 studies), heart rate variability (7/9 studies), and B-type natriuretic peptide (3/4 studies). Studies ranged from 4 minutes to 26 weeks and group sizes ranged from 8 to 65 patients per study arm.

CONCLUSIONS

Although wide variability exists in the types and delivery, RCTs of MBIs have demonstrated small-to-moderate positive effects on HF patients' objective and subjective outcomes. Future research should examine the mechanisms by which different MBIs exert their effects.

The effects of Pilates exercise on cardiopulmonary function in the chronic stroke patients: a randomized controlled trials

[Purpose] The purpose of this study was to examine the effect of modified Pilates exercise on cardiopulmonary function in chronic stroke patients. [Subjects and Methods] Twenty participants (age, 62.7 ± 7.3 years; height, 163.3 ± 8.5 cm; weight, 68.8 ± 10.3 kg) were recruited for this study, and randomly allocated to the modified Pilates exercise group (n=10) or the control group (n=10). Graded submaximal treadmill exercise test was used to examine the status of patients' cardiopulmonary function, based on maximal oxygen intake, at the end of a patient's exercise tolerance limit. [Results] The resting heart rates, maximal oxygen intake, and maximal oxygen intake per kilogram were significantly different after 8 weeks of modified Pilates exercise. In addition, these variables were also significantly different between the Pilates and control groups after 8 weeks. [Conclusion] This study has demonstrated that 8 weeks of modified Pilates exercise program can have a positive influence on patients with chronic stroke, potentially by enhancing the cardiopulmonary function, which may have positive implications for increasing their functional ability.

Neurohumoral and Endothelial Responses to Heated Water-Based Exercise in Resistant Hypertensive Patients

BACKGROUND

The neurohumoral and endothelial responses to the blood pressure (BP) lowering effects of heated water-based exercise (HEx) in resistant hypertension (HT) patients remain undefined.

METHODS AND RESULTS

We investigated these in 44 true resistant HT patients (age 53.3±0.9 years, mean±SEM). They were randomized and allocated to 2 groups, 28 to a HEx training protocol, which consisted of callisthenic exercises and walking in a heated pool for 1 h, three times weekly for 12 weeks and 16 patients to a control group maintaining their habitual activities. Measurements made before and after 12 weeks of HEx included clinic and 24-h BP, plasma levels of nitric oxide, endothelin-1, aldosterone, renin, norepinephrine and epinephrine, as well as peak V̇O2, and endothelial function (reactive hyperemia). After 12 weeks of HEx patients showed a significant decrease in clinic and 24-h systolic and diastolic BPs. Concomitantly, nitric oxide increased significantly (from 25±8 to 75±24 μmol/L, P<0.01), while endothelin-1 (from 41±5 to 26±3 pg/mL), renin (from 35±4 to 3.4±1 ng/mL/h), and norepinephrine (from 720±54 to 306±35 pg/mL) decreased significantly (P<0.01). Plasma aldosterone also tended to decrease, although not significantly (from 101±9 to 76±4 pg/mL, P=NS). Peak V̇O2increased significantly after HEx (P<0.01), while endothelial function was unchanged. No significant change was detected in the control group.

CONCLUSIONS

The BP-lowering effects of HEx in resistant HT patients were accompanied by a significant reduction in the marked neurohumoral activation characterizing this clinical condition.

Heated water-based exercise training reduces 24-hour ambulatory blood pressure levels in resistant hypertensive patients: a randomized controlled trial (HEx trial)

BACKGROUND

Regular exercise is an effective intervention to decrease blood pressure (BP) in hypertension, but no data are available concerning the effects of heated water-based exercise (HEx). This study examines the effects of HEx on BP in resistant hypertensive patients.

METHODS

This is a parallel, randomized controlled trial. 125 nonconsecutive sedentary patients with resistant hypertension from a hypertension outpatient clinic in a university hospital were screened; 32 patients fulfilled the study requirements. The training was performed for 60-minute sessions in a heated pool (32°C), three times a week for 12 weeks. The HEx protocol consisted of callisthenic exercises and walking inside the pool. The control group was asked to maintain habitual activities. The main outcome measure was change in mean 24-hour ambulatory BP (ABPM).

RESULTS

32 patients (HEx n=16; control n=16) were randomized; none were lost to follow-up. Office BPs decreased significantly after heated water exercise (36/12 mmHg). HEx decreased 24-hour systolic (from 137±23 to 120±12 mmHg, p=0.001) and diastolic BPs (from 81±13 to 72±10 mmHg, p=0.009); daytime systolic (from 141±24 to 120±13 mmHg, p<0.0001) and diastolic BPs (from 84±14 to 73±11 mmHg, p=0.003); and nighttime systolic (from 129±22 to 114±12 mmHg, p=0.006) and diastolic BPs (from 74±11 to 66±10 mmHg, p<0.0001). The control group after 12 weeks significantly increased in 24-hour systolic and diastolic BPs, and daytime and nighttime diastolic BPs.

CONCLUSION

HEx reduced office BPs and 24-hour ABPM levels in resistant hypertensive patients. These effects suggest that HEx may be a potential new therapeutic approach in these patients.