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Al Hennawi H, Bedi A, Khan MK, Zohaib M, Khan IA, Mazzoni JA. Impact of exercise training on clinical outcomes and quality of life in chronic congestive heart failure: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102756. [PMID: 39074671 DOI: 10.1016/j.cpcardiol.2024.102756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Exercise training is a well-established intervention for patients with heart failure with reduced and preserved ejection fraction. Still, the evidence of its effects on mortality, hospitalization, and quality of life needs to be more conclusive. We aim to evaluate exercise training clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). METHODS We searched five databases and three clinical trial registries for RCTs that compared exercise training plus usual care versus usual care alone in congestive heart failure (CHF) patients. We extracted data on all-cause mortality, hospital admission, heart failure hospitalization, and health-related quality of life measured by the Minnesota Living with HF questionnaire (MLHFW) and other scales. We pooled the data using random-effects or fixed-effects models, depending on the heterogeneity of the outcomes. We performed subgroup analyses for patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). RESULTS We included 61 RCTs with 9062 participants. There was no mortality benefit, but exercise training improved health-related quality of life, reduced hospital admission at 12 months and longer follow-up, and reduced heart failure hospitalization. We observed substantial enhancement in health-related quality of life and a greater decrease in hospital admissions in the HFpEF group compared to the HFrEF group. CONCLUSIONS Despite the lack of mortality benefit, exercise training is a beneficial intervention for CHF patients, improving health-related quality of life and reducing hospitalization.
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Affiliation(s)
| | - Angad Bedi
- Jefferson Abington Hospital, Abington, PA
| | | | | | | | - Jennifer A Mazzoni
- Jefferson Abington Hospital, Abington, PA; Thomas Jefferson University Hospital, Philadelphia, PA
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Molloy C, Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, Coats AJ, Dalal H, Rees K, Singh SJ, Taylor RS. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev 2024; 3:CD003331. [PMID: 38451843 PMCID: PMC10919451 DOI: 10.1002/14651858.cd003331.pub6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND People with heart failure experience substantial disease burden that includes low exercise tolerance, poor health-related quality of life (HRQoL), increased risk of mortality and hospital admission, and high healthcare costs. The previous 2018 Cochrane review reported that exercise-based cardiac rehabilitation (ExCR) compared to no exercise control shows improvement in HRQoL and hospital admission amongst people with heart failure, as well as possible reduction in mortality over the longer term, and that these reductions appear to be consistent across patient and programme characteristics. Limitations noted by the authors of this previous Cochrane review include the following: (1) most trials were undertaken in patients with heart failure with reduced (< 45%) ejection fraction (HFrEF), and women, older people, and those with heart failure with preserved (≥ 45%) ejection fraction (HFpEF) were under-represented; and (2) most trials were undertaken in a hospital or centre-based setting. OBJECTIVES To assess the effects of ExCR on mortality, hospital admission, and health-related quality of life of adults with heart failure. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and Web of Science without language restriction on 13 December 2021. We also checked the bibliographies of included studies, identified relevant systematic reviews, and two clinical trials registers. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared ExCR interventions (either exercise only or exercise as part of a comprehensive cardiac rehabilitation) with a follow-up of six months or longer versus a no-exercise control (e.g. usual medical care). The study population comprised adults (≥ 18 years) with heart failure - either HFrEF or HFpEF. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were all-cause mortality, mortality due to heart failure, all-cause hospital admissions, heart failure-related hospital admissions, and HRQoL. Secondary outcomes were costs and cost-effectiveness. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 60 trials (8728 participants) with a median of six months' follow-up. For this latest update, we identified 16 new trials (2945 new participants), in addition to the previously identified 44 trials (5783 existing participants). Although the existing evidence base predominantly includes patients with HFrEF, with New York Heart Association (NYHA) classes II and III receiving centre-based ExCR programmes, a growing body of trials includes patients with HFpEF with ExCR undertaken in a home-based setting. All included trials employed a usual care comparator with a formal no-exercise intervention as well as a wide range of active comparators, such as education, psychological intervention, or medical management. The overall risk of bias in the included trials was low or unclear, and we mostly downgraded the certainty of evidence of outcomes upon GRADE assessment. There was no evidence of a difference in the short term (up to 12 months' follow-up) in the pooled risk of all-cause mortality when comparing ExCR versus usual care (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.71 to 1.21; absolute effects 5.0% versus 5.8%; 34 trials, 36 comparisons, 3941 participants; low-certainty evidence). Only a few trials reported information on whether participants died due to heart failure. Participation in ExCR versus usual care likely reduced the risk of all-cause hospital admissions (RR 0.69, 95% CI 0.56 to 0.86; absolute effects 15.9% versus 23.8%; 23 trials, 24 comparisons, 2283 participants; moderate-certainty evidence) and heart failure-related hospital admissions (RR 0.82, 95% CI 0.49 to 1.35; absolute effects 5.6% versus 6.4%; 10 trials; 10 comparisons, 911 participants; moderate-certainty evidence) in the short term. Participation in ExCR likely improved short-term HRQoL as measured by the Minnesota Living with Heart Failure (MLWHF) questionnaire (lower scores indicate better HRQoL and a difference of 5 points or more indicates clinical importance; mean difference (MD) -7.39 points, 95% CI -10.30 to -4.77; 21 trials, 22 comparisons, 2699 participants; moderate-certainty evidence). When pooling HRQoL data measured by any questionnaire/scale, we found that ExCR may improve HRQoL in the short term, but the evidence is very uncertain (33 trials, 37 comparisons, 4769 participants; standardised mean difference (SMD) -0.52, 95% CI -0.70 to -0.34; very-low certainty evidence). ExCR effects appeared to be consistent across different models of ExCR delivery: centre- versus home-based, exercise dose, exercise only versus comprehensive programmes, and aerobic training alone versus aerobic plus resistance programmes. AUTHORS' CONCLUSIONS This updated Cochrane review provides additional randomised evidence (16 trials) to support the conclusions of the previous 2018 version of the review. Compared to no exercise control, whilst there was no evidence of a difference in all-cause mortality in people with heart failure, ExCR participation likely reduces the risk of all-cause hospital admissions and heart failure-related hospital admissions, and may result in important improvements in HRQoL. Importantly, this updated review provides additional evidence supporting the use of alternative modes of ExCR delivery, including home-based and digitally-supported programmes. Future ExCR trials need to focus on the recruitment of traditionally less represented heart failure patient groups including older patients, women, and those with HFpEF.
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Affiliation(s)
- Cal Molloy
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Linda Long
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ify R Mordi
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Charlene Bridges
- Institute of Health Informatics Research, University College London, London, UK
| | | | - Edward J Davies
- Department of Cardiology, Royal Devon & Exeter Healthcare Foundation Trust, Exeter, UK
| | | | - Hasnain Dalal
- Department of Primary Care, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospitals Trust, Truro, UK
- Primary Care Research Group, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Karen Rees
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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3
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Molloy CD, Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, Coats AJS, Dalal H, Rees K, Singh SJ, Taylor RS. Exercise-based cardiac rehabilitation for adults with heart failure - 2023 Cochrane systematic review and meta-analysis. Eur J Heart Fail 2023; 25:2263-2273. [PMID: 37850321 DOI: 10.1002/ejhf.3046] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
AIMS Despite strong evidence, access to exercise-based cardiac rehabilitation (ExCR) remains low across global healthcare systems. We provide a contemporary update of the Cochrane review randomized trial evidence for ExCR for adults with heart failure (HF) and compare different delivery modes: centre-based, home-based (including digital support), and both (hybrid). METHODS AND RESULTS Databases, bibliographies of previous systematic reviews and included trials, and trials registers were searched with no language restrictions. Randomized controlled trials, recruiting adults with HF, assigned to either ExCR or a no-exercise control group, with follow-up of ≥6 months were included. Two review authors independently screened titles for inclusion, extracted trial and patient characteristics, outcome data, and assessed risk of bias. Outcomes of mortality, hospitalization, and health-related quality of life (HRQoL) were pooled across trials using meta-analysis at short-term (≤12 months) and long-term follow-up (>12 months) and stratified by delivery mode. Sixty trials (8728 participants) were included. In the short term, compared to control, ExCR did not impact all-cause mortality (relative risk [RR] 0.93; 95% confidence interval [CI] 0.71-1.21), reduced all-cause hospitalization (RR 0.69; 95% CI 0.56-0.86, number needed to treat: 13, 95% CI 9-22), and was associated with a clinically important improvement in HRQoL measured by the Minnesota Living with Heart Failure Questionnaire (MLWHF) overall score (mean difference: -7.39; 95% CI -10.30 to -4.47). Improvements in outcomes with ExCR was seen across centre, home (including digitally supported), and hybrid settings. A similar pattern of results was seen in the long term (mortality: RR 0.87, 95% CI 0.72-1.04; all-cause hospitalization: RR 0.84, 95% CI 0.70-1.01, MLWHF: -9.59, 95% CI -17.48 to -1.50). CONCLUSIONS To improve global suboptimal levels of uptake for HF patients, global healthcare systems need to routinely recommend ExCR and offer a choice of mode of delivery, dependent on an individual patient's level of risk and complexity.
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Affiliation(s)
- Cal D Molloy
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Linda Long
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ify R Mordi
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Charlene Bridges
- Institute of Health Informatics Research, University College London, London, UK
| | | | - Edward J Davies
- Department of Cardiology, Royal Devon & Exeter Healthcare Foundation Trust, Exeter, UK
| | | | - Hasnain Dalal
- Primary Care Research Group, Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter Medical School, St Luke's Campus, Exeter, UK
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit, Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
- Department of Psychology, Faculty of Health Sciences, National Institute of Public Health, University of South Denmark, Odense, Denmark
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Cardiac rehabilitation in heart failure with severely reduced ejection fraction: effects on mortality. Heart Fail Rev 2023; 28:1-19. [PMID: 35596876 DOI: 10.1007/s10741-022-10242-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 02/07/2023]
Abstract
Thirty years ago, patients with low ejection fraction (EF) have often been excluded from rehabilitation programs due to concern about possibility of sudden death or other adverse cardiovascular events during exercise sessions. Recent studies have highlighted the fact that cardiac rehabilitation could improve exercise capacity, cardiac function, and health-related quality of life in congestive heart failure patients. This encouraged us to write a review article and update our latest knowledge about the outcome of rehabilitation program in patients with severely depressed cardiac function. We were particularly interested in effect of cardiac rehabilitation on exercise capacity, quality of life, vascular effects, neuro-hormonal changes, and mortality. We also conducted a mini-systematic review and meta-analysis on randomized controlled trials comparing exercise training with usual care in patients with severely reduced left ventricular ejection fraction, for the mortality subsection to obtain precise estimates of overall treatment benefit on mortality. It is our privilege to submit our manuscript for possible publication in your prestigious journal.
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Hafkamp FJ, Tio RA, Otterspoor LC, de Greef T, van Steenbergen GJ, van de Ven ART, Smits G, Post H, van Veghel D. Optimal effectiveness of heart failure management - an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure. Heart Fail Rev 2022; 27:1683-1748. [PMID: 35239106 PMCID: PMC8892116 DOI: 10.1007/s10741-021-10212-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a major health concern, which accounts for 1-2% of all hospital admissions. Nevertheless, there remains a knowledge gap concerning which interventions contribute to effective prevention of HF (re)hospitalization. Therefore, this umbrella review aims to systematically review meta-analyses that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in HFrEF patients. An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane Reviews, CINAHL, and Medline to identify eligible studies published in the English language in the past 10 years. Primarily, to synthesize the meta-analyzed data, a best-evidence synthesis was used in which meta-analyses were classified based on level of validity. Secondarily, all unique RCTS were extracted from the meta-analyses and examined. A total of 44 meta-analyses were included which encompassed 186 unique RCTs. Strong or moderate evidence suggested that catheter ablation, cardiac resynchronization therapy, cardiac rehabilitation, telemonitoring, and RAAS inhibitors could reduce (re)hospitalization. Additionally, limited evidence suggested that multidisciplinary clinic or self-management promotion programs, beta-blockers, statins, and mitral valve therapy could reduce HF hospitalization. No, or conflicting evidence was found for the effects of cell therapy or anticoagulation. This umbrella review highlights different levels of evidence regarding the effectiveness of several interventions in reducing HF-related (re)hospitalization in HFrEF patients. It could guide future guideline development in optimizing care pathways for heart failure patients.
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Affiliation(s)
| | - Rene A. Tio
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Luuk C. Otterspoor
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Tineke de Greef
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | | | - Arjen R. T. van de Ven
- Netherlands Heart Network, Veldhoven, The Netherlands
- St. Anna Hospital, Geldrop, The Netherlands
| | - Geert Smits
- Netherlands Heart Network, Veldhoven, The Netherlands
- Primary care group Pozob, Veldhoven, The Netherlands
| | - Hans Post
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Dennis van Veghel
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
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6
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Tegegne TK, Rawstorn JC, Nourse RA, Kibret KT, Ahmed KY, Maddison R. Effects of exercise-based cardiac rehabilitation delivery modes on exercise capacity and health-related quality of life in heart failure: a systematic review and network meta-analysis. Open Heart 2022; 9:openhrt-2021-001949. [PMID: 35680170 PMCID: PMC9185675 DOI: 10.1136/openhrt-2021-001949] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/02/2022] [Indexed: 12/26/2022] Open
Abstract
Background This review aimed to compare the relative effectiveness of different exercise-based cardiac rehabilitation (ExCR) delivery modes (centre-based, home-based, hybrid and technology-enabled ExCR) on key heart failure (HF) outcomes: exercise capacity, health-related quality of life (HRQoL), HF-related hospitalisation and HF-related mortality. Methods and results Randomised controlled trials (RCTs) published through 20 June 2021 were identified from six databases, and reference lists of included studies. Risk of bias and certainty of evidence were evaluated using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation, respectively. Bayesian network meta-analysis was performed using R. Continuous and binary outcomes are reported as mean differences (MD) and ORs, respectively, with 95% credible intervals (95% CrI). One-hundred and thirty-nine RCTs (n=18 670) were included in the analysis. Network meta-analysis demonstrated improvements in VO2peak following centre-based (MD (95% CrI)=3.10 (2.56 to 3.65) mL/kg/min), home-based (MD=2.69 (1.67 to 3.70) mL/kg/min) and technology-enabled ExCR (MD=1.76 (0.27 to 3.26) mL/kg/min). Similarly, 6 min walk distance was improved following hybrid (MD=84.78 (31.64 to 138.32) m), centre-based (MD=50.35 (30.15 to 70.56) m) and home-based ExCR (MD=36.77 (12.47 to 61.29) m). Incremental shuttle walk distance did not improve following any ExCR delivery modes. Minnesota living with HF questionnaire improved after centre-based (MD=−10.38 (−14.15 to –6.46)) and home-based ExCR (MD=−8.80 (−13.62 to –4.07)). Kansas City Cardiomyopathy Questionnaire was improved following home-based ExCR (MD=20.61 (4.61 to 36.47)), and Short Form Survey 36 mental component after centre-based ExCR (MD=3.64 (0.30 to 6.14)). HF-related hospitalisation and mortality risks reduced only after centre-based ExCR (OR=0.41 (0.17 to 0.76) and OR=0.42 (0.16 to 0.90), respectively). Mean age of study participants was only associated with changes in VO2peak. Conclusion ExCR programmes have broader benefits for people with HF and since different delivery modes were comparably effective for improving exercise capacity and HRQoL, the selection of delivery modes should be tailored to individuals’ preferences.
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Affiliation(s)
- Teketo Kassaw Tegegne
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia .,Department of Public Health, Debre Markos University, Debre Markos, Amhara, Ethiopia
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Rebecca Amy Nourse
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | | | - Kedir Yimam Ahmed
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
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Cao Z, Li Y, Wang L, Liu Y, Zhang L, Ma L, An Y, Wang Y, Li H. Effect of Perceptual Stress Reduction Control Intervention on the Level of Symptoms in Breast Cancer at Different Time Points. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1232-1241. [PMID: 33083289 PMCID: PMC7548480 DOI: 10.18502/ijph.v49i7.3576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background To investigate the effect of perceptual stress reduction control intervention on the level of symptomatic groups at different time points in breast cancer. Methods A total of 124 breast cancer patients were divided into intervention group and control group, 62 cases in each group. Perioperative nursing and chemotherapy nursing were given to the control group, and the intervention group was given the interventional stress reduction control intervention. The level of symptom clusters of different time points were compared between the two groups. Results The incidence and severity of myelosuppression in the intervention group were slightly lower than those in the control group. The adverse reactions of bone marrow suppression at T3 were much lower than those in the control group, and the differences were significant (P=0.003, P=0.043). The control group had higher incidence and more severe symptoms of nausea, vomiting and diarrhea than the intervention group (P=0.002, P=0.042). The symptoms of breast pain and swelling at T1 in the intervention group were significantly lower than those in the control group (P=0.000, P=0.000). There was no significant difference in breast symptoms between the two groups at T2 and T3 (p>0.05). At the time of T2 and T3 of chemotherapy, the health promotion behavior scores of the intervention group were higher than the control group, and the difference was statistically significant (PT2=0.000, PT3=0.000). Conclusion Perceptual stress reduction control intervention can effectively relieve bone marrow suppression, digestive tract discomfort and breast symptoms, and promote health promotion behavior.
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Affiliation(s)
- Zhongru Cao
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, P.R. China
| | - Yuting Li
- Ward IV, Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150040, P.R. China
| | - Li Wang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, P.R. China
| | - Yanhua Liu
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, P.R. China
| | - Lei Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, P.R. China
| | - Li Ma
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, P.R. China
| | - Yunfei An
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, P.R. China
| | - Yibo Wang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin 150040, P.R. China
| | - Huiyan Li
- Nursing Department, Harbin Medical University Cancer Hospital, Harbin 150040, P.R. China
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Taylor RS, Walker S, Ciani O, Warren F, Smart NA, Piepoli M, Davos CH. Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis. Health Technol Assess 2020; 23:1-98. [PMID: 31140973 DOI: 10.3310/hta23250] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Current national and international guidelines on the management of heart failure (HF) recommend exercise-based cardiac rehabilitation (ExCR), but do not differentiate this recommendation according to patient subgroups. OBJECTIVES (1) To obtain definitive estimates of the impact of ExCR interventions compared with no exercise intervention (control) on mortality, hospitalisation, exercise capacity and health-related quality of life (HRQoL) in HF patients; (2) to determine the differential (subgroup) effects of ExCR in HF patients according to their age, sex, left ventricular ejection fraction, HF aetiology, New York Heart Association class and baseline exercise capacity; and (3) to assess whether or not the change in exercise capacity mediates for the impact of the ExCR on final outcomes (mortality, hospitalisation and HRQoL), and determine if this is an acceptable surrogate end point. DESIGN This was an individual participant data (IPD) meta-analysis. SETTING An international literature review. PARTICIPANTS HF patients in randomised controlled trials (RCTs) of ExCR. INTERVENTIONS ExCR for at least 3 weeks compared with a no-exercise control, with 6 months' follow-up. MAIN OUTCOME MEASURES All-cause and HF-specific mortality, all-cause and HF-specific hospitalisation, exercise capacity and HRQoL. DATA SOURCES IPD from eligible RCTs. REVIEW METHODS RCTs from the Exercise Training Meta-Analysis of Trials for Chronic Heart Failure (ExTraMATCH/ExTraMATCH II) IPD meta-analysis and a 2014 Cochrane systematic review of ExCR (Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev 2014;4:CD003331). RESULTS Out of the 23 eligible RCTs (4398 patients), 19 RCTs (3990 patients) contributed data to this IPD meta-analysis. There was a wide variation in exercise programme prescriptions across included studies. Compared with control, there was no statistically significant difference in pooled time-to-event estimates in favour of ExCR, although confidence intervals (CIs) were wide: all-cause mortality had a hazard ratio (HR) of 0.83 (95% CI 0.67 to 1.04); HF-related mortality had a HR of 0.84 (95% CI 0.49 to 1.46); all-cause hospitalisation had a HR of 0.90 (95% CI 0.76 to 1.06); and HF-related hospitalisation had a HR of 0.98 (95% CI 0.72 to 1.35). There was a statistically significant difference in favour of ExCR for exercise capacity and HRQoL. Compared with the control, improvements were seen in the 6-minute walk test (6MWT) (mean 21.0 m, 95% CI 1.57 to 40.4 m) and Minnesota Living with Heart Failure Questionnaire score (mean -5.94, 95% CI -1.0 to -10.9; lower scores indicate improved HRQoL) at 12 months' follow-up. No strong evidence for differential intervention effects across patient characteristics was found for any outcomes. Moderate to good levels of correlation (R 2 trial > 50% and p > 0.50) between peak oxygen uptake (VO2peak) or the 6MWT with mortality and HRQoL were seen. The estimated surrogate threshold effect was an increase of 1.6 to 4.6 ml/kg/minute for VO2peak. LIMITATIONS There was a lack of consistency in how included RCTs defined and collected the outcomes: it was not possible to obtain IPD from all includable trials for all outcomes and patient-level data on exercise adherence was not sought. CONCLUSIONS In comparison with the no-exercise control, participation in ExCR improved the exercise and HRQoL in HF patients, but appeared to have no effect on their mortality or hospitalisation. No strong evidence was found of differential intervention effects of ExCR across patient characteristics. VO2peak and 6MWT may be suitable surrogate end points for the treatment effect of ExCR on mortality and HRQoL in HF. Future studies should aim to achieve a consensus on the definition of outcomes and promote reporting of a core set of HF data. The research team also seeks to extend current policies to encourage study authors to allow access to RCT data for the purpose of meta-analysis. STUDY REGISTRATION This study is registered as PROSPERO CRD42014007170. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sarah Walker
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Oriana Ciani
- Institute of Health Research, University of Exeter Medical School, Exeter, UK.,Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Fiona Warren
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Neil A Smart
- School of Science and Technology, University of New England, Armidale, NSW, Australia
| | - Massimo Piepoli
- Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy
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Early exercise training feasibility after aortic valve repair: A multicentre prospective French survey on behalf of the Aortic Valve repair International Registry (AVIATOR). Arch Cardiovasc Dis 2020; 113:168-175. [PMID: 32067947 DOI: 10.1016/j.acvd.2019.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/16/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Standardization of aortic valve repair by the external ring annuloplasty approach is an alternative to valve replacement to avoid prosthetic valve-related events. Although the benefit of exercise training to improve postoperative exercise tolerance has been demonstrated in many conditions after cardiac surgery, it has never been described after aortic valve repair. OBJECTIVES To evaluate the feasibility of an early exercise training programme after aortic valve repair. METHODS Consecutive patients were prospectively included in 13 postoperative centres. Patients underwent an exercise training programme for approximately 3-5 weeks. Transthoracic echocardiography and a cardiopulmonary exercise test were performed before and after the exercise training programme. RESULTS Fifty patients (mean±standard deviation [SD] age: 50±13 years) were included a mean of 13.6±12.0 days after aortic valve repair. The preoperative degree of aortic insufficiency was moderate to severe in 35 patients (70%) and the aortic valve was bicuspid in 24 patients (48%). Valve-sparing root replacement and isolated aortic valve repair (including 10% supracoronary aorta replacement) were performed in 64% and 36% of patients, respectively. We found no aortic insufficiency occurrence or worsening and no adverse clinical events after the exercise training programme. Mean left ventricular ejection fraction increased significantly (from 54%±8% to 57%±9%; P=0.0007). Mean peak oxygen consumption and first ventilatory threshold increased from 17.0±5.3 to 22.5±7.8mL/kg/min (32% increase) and from 12.0±3.9 to 14.3±5.2mL/kg/min (19% increase), respectively (both P<0.05). CONCLUSION Exercise training early after aortic valve repair is safe and seems to significantly improve exercise capacity.
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10
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Gerlach S, Mermier C, Kravitz L, Degnan J, Dalleck L, Zuhl M. Comparison of Treadmill and Cycle Ergometer Exercise During Cardiac Rehabilitation: A Meta-analysis. Arch Phys Med Rehabil 2019; 101:690-699. [PMID: 31738893 DOI: 10.1016/j.apmr.2019.10.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/22/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare treadmill versus cycling-based exercise in cardiac rehabilitation (CR) on functional capacity (FC) outcomes. DATA SOURCE Databases were searched for randomized studies using single modality continuous exercise. STUDY SELECTION Studies implemented a continuous cycling or treadmill protocol for patients with either coronary artery disease (CAD) or chronic heart failure (CHF). The effect of single modality exercise on FC (VO2peak) was analyzed. Differences in the effect of CR on FC was assessed between the mode subgroup (cycling vs treadmill) and disease state subgroup (CAD vs CHF) within both the cycling and treadmill groups. DATA EXTRACTION Data were extracted from 23 studies including 600 patients (mean age 60y, 86% men). DATA SYNTHESIS There was a significant difference in effect size between studies that used cycling, Hedges' g=0.85 (95% confidence interval [95% CI], 0.52-1.17; k=13) and studies that used treadmill exercise, Hedges' g=0.46 (95% CI, 0.22-0.70; k=8). Within cycling studies (n=14), FC was higher among CAD patients, Hedges' g=1.03 (95% CI, 0.65-1.42; k=9) compared to those with CHF, Hedges' g=0.40 (95% CI, 0.09-0.71; k=4, P<.001). Conversely, among treadmill studies (n=9), FC was higher among CHF patients, Hedges' g=0.94 (95% CI, 0.23-1.65; k=2) compared to CAD, Hedges' g=0.33 (95% CI, 0.19-0.47; k=5; P<.01). CONCLUSIONS According to identified studies, when cycling was the primary mode of exercise in CR, there was larger change in FC compared to treadmill exercise. In addition, CAD patients experienced greater gains in FC when cycling was the primary mode of exercise in CR, while CHF patients benefited more from treadmill-based exercise programs.
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Affiliation(s)
- Stephanie Gerlach
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque, NM; Department of Health, Physical Education and Recreation, Missouri Western State University, St. Joseph, MO.
| | - Christine Mermier
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque, NM
| | - Len Kravitz
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque, NM
| | - James Degnan
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM
| | - Lance Dalleck
- Recreation, Exercise and Sport Science Department, Western Colorado University, Gunnison, CO
| | - Micah Zuhl
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque, NM; School of Health Sciences, Central Michigan University, Mt. Pleasant, MI
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11
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Bjarnason-Wehrens B, Nebel R, Jensen K, Hackbusch M, Grilli M, Gielen S, Schwaab B, Rauch B. Exercise-based cardiac rehabilitation in patients with reduced left ventricular ejection fraction: The Cardiac Rehabilitation Outcome Study in Heart Failure (CROS-HF): A systematic review and meta-analysis. Eur J Prev Cardiol 2019; 27:929-952. [PMID: 31177833 PMCID: PMC7272131 DOI: 10.1177/2047487319854140] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background In heart failure with reduced left ventricular ejection fraction (HFrEF)
patients the effects of exercise-based cardiac rehabilitation on top of
state-of-the-art pharmacological and device therapy on mortality,
hospitalization, exercise capacity and quality-of-life are not well
established. Design The design of this study involved a structured review and meta-analysis. Methods Evaluation of randomised controlled trials of exercise-based cardiac
rehabilitation in HFrEF-patients with left ventricular ejection fraction
≤40% of any aetiology with a follow-up of ≥6 months published in 1999 or
later. Results Out of 12,229 abstracts, 25 randomised controlled trials including 4481
HFrEF-patients were included in the final evaluation. Heterogeneity in study
population, study design and exercise-based cardiac
rehabilitation-intervention was evident. No significant difference in the
effect of exercise-based cardiac rehabilitation on mortality compared to
control-group was found (hazard ratio 0.75, 95% confidence interval
0.39–1.41, four studies; 12-months follow-up: relative risk 1.29, 95%
confidence interval 0.66–2.49, eight studies; six-months follow-up: relative
risk 0.91, 95% confidence interval 0.26–3.16, seven studies). In addition
there was no significant difference between the groups with respect to
‘hospitalization-for-any-reason’ (12-months follow-up: relative risk 0.79,
95% confidence interval 0.41–1.53, four studies), or
‘hospitalization-due-to-heart-failure’ (12-months follow-up: relative risk
0.59, 95% confidence interval 0.12–2.91, four studies; six-months follow-up:
relative risk 0.84, 95% confidence interval 0.07–9.71, three studies). All
studies show improvement of exercise capacity. Participation in
exercise-based cardiac rehabilitation significantly improved quality-of-life
as evaluated with the Kansas City Cardiomyopathy Questionnaire: (six-months
follow-up: mean difference 1.94, 95% confidence interval 0.35–3.56, two
studies), but no significant results emerged for quality-of-life measured by
the Minnesota Living with Heart Failure Questionnaire (nine-months or more
follow-up: mean difference –4.19, 95% confidence interval –10.51–2.12, seven
studies; six-months follow-up: mean difference –5.97, 95% confidence
interval –16.17–4.23, four studies). Conclusion No association between exercise-based cardiac rehabilitation and mortality or
hospitalisation could be observed in HFrEF patients but exercise-based
cardiac rehabilitation is likely to improve exercise capacity and quality of
life.
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Affiliation(s)
| | - R Nebel
- Hermann-Albrecht-Klinik Mettnau, Germany
| | - K Jensen
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - M Hackbusch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - M Grilli
- Medical Faculty University Library, University of Mannheim-Heidelberg, Germany
| | - S Gielen
- Department of Cardiology, Angiology and Intensive Care, Klinikum Lippe, Detmold, Germany.,Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - B Schwaab
- Curschmann Klinik, Timmendorfer Strand, Germany
| | - B Rauch
- Institut für Herzinfarktforschung (IHF), Ludwigshafen, Germany
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12
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Taylor RS, Walker S, Smart NA, Piepoli MF, Warren FC, Ciani O, Whellan D, O'Connor C, Keteyian SJ, Coats A, Davos CH, Dalal HM, Dracup K, Evangelista LS, Jolly K, Myers J, Nilsson BB, Passino C, Witham MD, Yeh GY. Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis. J Am Coll Cardiol 2019; 73:1430-1443. [PMID: 30922474 PMCID: PMC8351793 DOI: 10.1016/j.jacc.2018.12.072] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/27/2018] [Accepted: 12/11/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous systematic reviews have indicated that exercise-based cardiac rehabilitation (ExCR) for patients with heart failure (HF) has a beneficial effect on health-related quality-of-life (HRQoL) and exercise capacity. However, there is uncertainty regarding potential differential effects of ExCR across HF patient subgroups. OBJECTIVES The authors sought to undertake an individual participant data (IPD) meta-analysis to: 1) assess the impact of ExCR on HRQoL and exercise capacity in patients with HF; and 2) investigate differential effects of ExCR according to a range of patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischemic etiology, ejection fraction, and exercise capacity. METHODS A single dataset was produced, comprising randomized trials where ExCR (delivered for 3 weeks or more) was compared with a no exercise control group. Each trial provided IPD on HRQoL or exercise capacity (or both), with follow-up of 6 months or more. One- and 2-stage meta-analysis models were used to investigate the effect of ExCR overall and the interactions between ExCR and participant characteristics. RESULTS IPD was obtained from 13 trials for 3,990 patients, predominantly (97%) with reduced ejection fraction HF. Compared with the control group, there was a statistically significant difference in favor of ExCR for HRQoL and exercise capacity. At 12-month follow-up, improvements were seen in 6-min walk test (mean 21.0 m; 95% confidence interval: 1.57 to 40.4 m; p = 0.034) and Minnesota Living With HF score (mean improvement 5.9; 95% confidence interval: 1.0 to 10.9; p = 0.018). No consistent evidence was found of differential intervention effects across patient subgroups. CONCLUSIONS These results, based on an IPD meta-analysis of randomized trials, confirm the benefit of ExCR on HRQoL and exercise capacity and support the Class I recommendation of current international clinical guidelines that ExCR should be offered to all HF patients. (Exercise Training for Chronic Heart Failure [ExTraMATCH II]: protocol for an individual participant data meta-analysis; PROSPERO: international database of systematic reviews CRD42014007170).
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Affiliation(s)
- Rod S Taylor
- Institute of Health Research, College of Medicine and Health, University of Exeter and Institute of Health and Well Being, University of Glasgow, Glasgow, United Kingdom.
| | - Sarah Walker
- Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom. https://twitter.com/Sarah1003Walker
| | - Neil A Smart
- University of New England, Armidale, New South Wales, Australia
| | | | - Fiona C Warren
- Exeter Collaboration for Academic Primary Care, Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
| | - Oriana Ciani
- Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom; Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - David Whellan
- Department of Medicine, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | | | | | | | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Hasnain M Dalal
- Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom; Research, Development & Innovation, Royal Cornwall Hospital, Truro, United Kingdom
| | - Kathleen Dracup
- School of Nursing, University of California San Francisco, San Francisco, California
| | | | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Myers
- VA Palo Alto Health Care System/Stanford University, Stanford, California
| | - Birgitta B Nilsson
- Division of Medicine, Oslo University Hospital and Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Claudio Passino
- Fondazione G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy
| | - Miles D Witham
- NIHR Newcastle Biomedical Research Centre, Institute of Neuroscience, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Gloria Y Yeh
- Beth Israel Deaconess Medical Center, Department of Medicine, Boston, Massachusetts
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13
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Šimaitytė M, Petrėnas A, Kravčenko J, Kaldoudi E, Marozas V. Objective evaluation of physical activity pattern using smart devices. Sci Rep 2019; 9:2006. [PMID: 30765783 PMCID: PMC6375941 DOI: 10.1038/s41598-019-38638-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/02/2019] [Indexed: 11/17/2022] Open
Abstract
Physical activity session frequency and distribution over time may play a significant role on survival after major cardiovascular events. However, the existing amount-based metrics do not account for these properties, thus the physical activity pattern is not fully evaluated. The aim of this work is to introduce a metric which accounts for the difference between the actual and uniform distribution of physical activity, thus its value depends on physical activity aggregation over time. The practical application is demonstrated on a step data from 40 participants, half of them diagnosed with chronic cardiovascular disease (CVD). The metric is capable of discriminating among different daily patterns, including going to and from work, walking in a park and being active the entire day. Moreover, the results demonstrate the tendency of CVD patients being associated with higher aggregation values, suggesting that CVD patients spend more time in a sedentary behaviour compared to healthy participants. By combining the aggregation with the intensity metric, such common weekly patterns as inactivity, regular activity and "weekend warrior" can be captured. The metric is expected to have clinical relevance since it may provide additional information on the relationship between physical activity pattern and health outcomes.
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Affiliation(s)
- Monika Šimaitytė
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania.
| | - Andrius Petrėnas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Julija Kravčenko
- Faculty of Electrical and Electronics Engineering, Kaunas University of Technology, Kaunas, Lithuania
| | - Eleni Kaldoudi
- Medical Imaging and Telemedicine, School of Medicine, Democritus University of Thrace, Dragana, Alexandroupoli, Greece
| | - Vaidotas Marozas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
- Faculty of Electrical and Electronics Engineering, Kaunas University of Technology, Kaunas, Lithuania
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14
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Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, Coats AJS, Dalal H, Rees K, Singh SJ, Taylor RS. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev 2019; 1:CD003331. [PMID: 30695817 PMCID: PMC6492482 DOI: 10.1002/14651858.cd003331.pub5] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic heart failure (HF) is a growing global health challenge. People with HF experience substantial burden that includes low exercise tolerance, poor health-related quality of life (HRQoL), increased risk of mortality and hospital admission, and high healthcare costs. The previous (2014) Cochrane systematic review reported that exercise-based cardiac rehabilitation (CR) compared to no exercise control shows improvement in HRQoL and hospital admission among people with HF, as well as possible reduction in mortality over the longer term, and that these reductions appear to be consistent across patient and programme characteristics. Limitations noted by the authors of this previous Cochrane Review include the following: (1) most trials were undertaken in patients with HF with reduced (< 45%) ejection fraction (HFrEF), and women, older people, and those with preserved (≥ 45%) ejection fraction HF (HFpEF) were under-represented; and (2) most trials were undertaken in the hospital/centre-based setting. OBJECTIVES To determine the effects of exercise-based cardiac rehabilitation on mortality, hospital admission, and health-related quality of life of people with heart failure. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and three other databases on 29 January 2018. We also checked the bibliographies of systematic reviews and two trial registers. SELECTION CRITERIA We included randomised controlled trials that compared exercise-based CR interventions with six months' or longer follow-up versus a no exercise control that could include usual medical care. The study population comprised adults (> 18 years) with evidence of HF - either HFrEF or HFpEF. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references and rejected those that were clearly ineligible for inclusion in the review. We obtained full papers of potentially relevant trials. Two review authors independently extracted data from the included trials, assessed their risk of bias, and performed GRADE analyses. MAIN RESULTS We included 44 trials (5783 participants with HF) with a median of six months' follow-up. For this latest update, we identified 11 new trials (N = 1040), in addition to the previously identified 33 trials. Although the evidence base includes predominantly patients with HFrEF with New York Heart Association classes II and III receiving centre-based exercise-based CR programmes, a growing body of studies include patients with HFpEF and are undertaken in a home-based setting. All included studies included a no formal exercise training intervention comparator. However, a wide range of comparators were seen across studies that included active intervention (i.e. education, psychological intervention) or usual medical care alone. The overall risk of bias of included trials was low or unclear, and we downgraded results using the GRADE tool for all but one outcome.Cardiac rehabilitation may make little or no difference in all-cause mortality over the short term (≤ one year of follow-up) (27 trials, 28 comparisons (2596 participants): intervention 67/1302 (5.1%) vs control 75/1294 (5.8%); risk ratio (RR) 0.89, 95% confidence interval (CI) 0.66 to 1.21; low-quality GRADE evidence) but may improve all-cause mortality in the long term (> 12 months follow up) (6 trials/comparisons (2845 participants): intervention 244/1418 (17.2%) vs control 280/1427 (19.6%) events): RR 0.88, 95% CI 0.75 to 1.02; high-quality evidence). Researchers provided no data on deaths due to HF. CR probably reduces overall hospital admissions in the short term (up to one year of follow-up) (21 trials, 21 comparisons (2182 participants): (intervention 180/1093 (16.5%) vs control 258/1089 (23.7%); RR 0.70, 95% CI 0.60 to 0.83; moderate-quality evidence, number needed to treat: 14) and may reduce HF-specific hospitalisation (14 trials, 15 comparisons (1114 participants): (intervention 40/562 (7.1%) vs control 61/552 (11.1%) RR 0.59, 95% CI 0.42 to 0.84; low-quality evidence, number needed to treat: 25). After CR, a clinically important improvement in short-term disease-specific health-related quality of life may be evident (Minnesota Living With Heart Failure questionnaire - 17 trials, 18 comparisons (1995 participants): mean difference (MD) -7.11 points, 95% CI -10.49 to -3.73; low-quality evidence). Pooling across all studies, regardless of the HRQoL measure used, shows there may be clinically important improvement with exercise (26 trials, 29 comparisons (3833 participants); standardised mean difference (SMD) -0.60, 95% CI -0.82 to -0.39; I² = 87%; Chi² = 215.03; low-quality evidence). ExCR effects appeared to be consistent different models of ExCR delivery: centre vs. home-based, exercise dose, exercise only vs. comprehensive programmes, and aerobic training alone vs aerobic plus resistance programmes. AUTHORS' CONCLUSIONS This updated Cochrane Review provides additional randomised evidence (11 trials) to support the conclusions of the previous version (2014) of this Cochane Review. Compared to no exercise control, CR appears to have no impact on mortality in the short term (< 12 months' follow-up). Low- to moderate-quality evidence shows that CR probably reduces the risk of all-cause hospital admissions and may reduce HF-specific hospital admissions in the short term (up to 12 months). CR may confer a clinically important improvement in health-related quality of life, although we remain uncertain about this because the evidence is of low quality. Future ExCR trials need to continue to consider the recruitment of traditionally less represented HF patient groups including older, female, and HFpEF patients, and alternative CR delivery settings including home- and using technology-based programmes.
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Affiliation(s)
- Linda Long
- University of Exeter Medical SchoolInstitute of Health ResearchExeterUK
| | - Ify R Mordi
- University of DundeeMolecular and Clinical MedicineNinewells Hospital and Medical SchoolDundeeUK
| | - Charlene Bridges
- University College LondonInstitute of Health Informatics Research222 Euston RoadLondonUKNW1 2DA
| | - Viral A Sagar
- King's College HospitalDenmark HillBrixtonLondonUKSE5 9RS
| | - Edward J Davies
- Royal Devon & Exeter Healthcare Foundation TrustDepartment of CardiologyBarrack RoadExeterDevonUKEX2 5DW
| | - Andrew JS Coats
- University of East AngliaElizabeth Fry Building University of East AngliaNorwichNorfolkUKNR4 7TJ
| | - Hasnain Dalal
- University of Exeter Medical SchoolInstitute of Health ResearchExeterUK
- University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospitals TrustDepartment of Primary CareTruroUKTR1 3HD
| | - Karen Rees
- University of WarwickDivision of Health Sciences, Warwick Medical SchoolCoventryUKCV4 7AL
| | - Sally J Singh
- Glenfield HospitalCardiac and Pulmonary RehabilitationUniversity Hospitals of LeicesterLeicesterUKLE3 9QP
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchExeterUK
- University of GlasgowInstitute of Health & WellbeingGlasgowUK
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15
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Santos FV, Chiappa GR, Ramalho SHR, de Lima ACGB, de Souza FSJ, Cahalin LP, Durigan JLQ, de Castro I, Cipriano G. Resistance exercise enhances oxygen uptake without worsening cardiac function in patients with systolic heart failure: a systematic review and meta-analysis. Heart Fail Rev 2019; 23:73-89. [PMID: 29199385 DOI: 10.1007/s10741-017-9658-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recent literature suggests that resistance training (RT) improves peak oxygen uptake ([Formula: see text] peak), similarly to aerobic exercise (AE) in patients with heart failure (HF), but its effect on cardiac remodeling is controversial. Thus, we examined the effects of RT and AE on [Formula: see text] peak and cardiac remodeling in patients with heart failure (HF) via a systematic review and meta-analysis. MEDLINE, EMBASE, Cochrane Library and CINAHL, AMEDEO and PEDro databases search were extracted study characteristics, exercise type, and ventricular outcomes. The main outcomes were [Formula: see text] peak (ml kg-1 min-1), LVEF (%) and LVEDV (mL). Fifty-nine RCTs were included. RT produced a greater increase in [Formula: see text] peak (3.57 ml kg-1 min-1, P < 0.00001, I 2 = 0%) compared to AE (2.63 ml kg-1 min-1, P < 0.00001, I 2 = 58%) while combined RT and AE produced a 2.48 ml kg-1 min-1 increase in [Formula: see text]; I 2 = 69%) compared to control group. Comparison among the three forms of exercise revealed similar effects on [Formula: see text] peak (P = 0.84 and 1.00, respectively; I 2 = 0%). AE was associated with a greater gain in LVEF (3.15%; P < 0.00001, I 2 = 17%) compared to RT alone or combined exercise which produced similar gains compared to control groups. Subgroup analysis revealed that AE reduced LVEDV (- 10.21 ml; P = 0.007, I 2 = 0%), while RT and combined RT and AE had no effect on LVEDV compared with control participants. RT results in a greater gain in [Formula: see text] peak, and induces no deleterious effects on cardiac function in HF patients.
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Affiliation(s)
- Francisco V Santos
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
- Cancer Institute of Sao Paulo, Sao Paulo, Brazil
| | - Gaspar R Chiappa
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
| | - Sergio Henrique Rodolpho Ramalho
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
- Sarah Network of Rehabilitation Hospitals, Brasilia, Brazil
| | - Alexandra Correa Gervazoni Balbuena de Lima
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
| | - Fausto Stauffer Junqueira de Souza
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - João Luiz Quagliotti Durigan
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil
| | - Isac de Castro
- Department of Medicine, Division of Molecular Medicine, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Gerson Cipriano
- Health Sciences and Technology and Rehabilitation Sciencies Program, University of Brasilia, Centro Metropolitano, Conjunto A - Lote 01 - Ceilândia, Brasília, DF, 72220-900, Brazil.
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16
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Taylor RS, Walker S, Smart NA, Piepoli MF, Warren FC, Ciani O, O’Connor C, Whellan D, Keteyian SJ, Coats A, Davos CH, Dalal HM, Dracup K, Evangelista L, Jolly K, Myers J, McKelvie RS, Nilsson BB, Passino C, Witham MD, Yeh GY, Zwisler ADO. Impact of exercise-based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual patient data meta-analysis of randomised trials. Eur J Heart Fail 2018; 20:1735-1743. [PMID: 30255969 PMCID: PMC7262555 DOI: 10.1002/ejhf.1311] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 12/18/2022] Open
Abstract
AIMS To undertake an individual patient data (IPD) meta-analysis to assess the impact of exercise-based cardiac rehabilitation (ExCR) in patients with heart failure (HF) on mortality and hospitalisation, and differential effects of ExCR according to patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischaemic aetiology, ejection fraction, and exercise capacity. METHODS AND RESULTS Randomised trials of exercise training for at least 3 weeks compared with no exercise control with 6-month follow-up or longer, providing IPD time to event on mortality or hospitalisation (all-cause or HF-specific). IPD were combined into a single dataset. We used Cox proportional hazards models to investigate the effect of ExCR and the interactions between ExCR and participant characteristics. We used both two-stage random effects and one-stage fixed effect models. IPD were obtained from 18 trials including 3912 patients with HF with reduced ejection fraction. Compared to control, there was no statistically significant difference in pooled time to event estimates in favour of ExCR although confidence intervals (CIs) were wide [all-cause mortality: hazard ratio (HR) 0.83, 95% CI 0.67-1.04; HF-specific mortality: HR 0.84, 95% CI 0.49-1.46; all-cause hospitalisation: HR 0.90, 95% CI 0.76-1.06; and HF-specific hospitalisation: HR 0.98, 95% CI 0.72-1.35]. No strong evidence was found of differential intervention effects across patient characteristics. CONCLUSION Exercise-based cardiac rehabilitation did not have a significant effect on the risk of mortality and hospitalisation in HF with reduced ejection fraction. However, uncertainty around effect estimates precludes drawing definitive conclusions.
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Affiliation(s)
- Rod S. Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter, UK,Corresponding author. Institute of Health Research, University of Exeter Medical School, College House, St. Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK. Tel: +44 7968, 152537,
| | - Sarah Walker
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | | | | | - Fiona C. Warren
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Oriana Ciani
- Institute of Health Research, University of Exeter Medical School, Exeter, UK,Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | | | - David Whellan
- Department of Medicine, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | | | | | - Constantinos H. Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Hasnain M. Dalal
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Kathleen Dracup
- School of Nursing, University of California San Francisco, CA, USA
| | | | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, UK
| | - Jonathan Myers
- Palo Alto Health Care System/Stanford University, Palo Alto, CA, USA
| | | | - Birgitta B. Nilsson
- Division of Medicine, Oslo University Hospital and Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Claudio Passino
- Fondazione G. Monasterio and Scuola Superiore Sant’Anna, Pisa, Italy
| | | | - Gloria Y. Yeh
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ann-Dorthe O. Zwisler
- National Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Nyborg, Denmark
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17
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Abstract
We critically appraised all available evidence regarding exercise interventions for improving patient survival and reducing hospital admissions in adults with chronic heart failure (HF). We searched 4 databases up to April 2018 and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation working group approach. We reviewed 7 meta-analyses and the publications of 48 randomized controlled trials (RCTs). In HF with reduced ejection fraction, low-quality evidence suggests that exercise prevents all-cause hospitalizations [Relative risk (RR), 0.77; 95% confidence interval (CI), 0.63 to 0.93; 1328 patients in 15 RCTs] and hospitalizations due to HF (RR, 0.57; 95% CI, 0.37 to 0.88; 1073 patients in 13 RCTs) and improves quality of life (standardized mean difference, -0.37; 95% CI, -0.60 to -0.14; 1270 patients in 25 RCTs) but has no effect on mortality. In HF with preserved ejection fraction, low-quality evidence suggests that exercise improves peak oxygen uptake (mean difference, 2.36; 95% CI, 1.16 to 3.57; 171 patients in 3 RCTs) and quality of life (mean difference, -4.65; 95% CI, -8.46 to -0.83; 203 patients in 4 RCTs). In patients after heart transplantation, low-quality evidence suggests that exercise improves peak oxygen uptake (standardized mean difference, 0.68; 95% CI, 0.43 to 0.93; 284 patients in 9 RCTs) but does not improve quality of life. In order to reduce hospitalization and improve quality of life for adults with HF and reduced ejection fraction, clinicians should recommend exercise interventions. For adults with HF and preserved ejection fraction and in those undergoing heart transplantation, clinicians may recommend exercise interventions in order to improve peak oxygen uptake.
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18
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Dibben GO, Dalal HM, Taylor RS, Doherty P, Tang LH, Hillsdon M. Cardiac rehabilitation and physical activity: systematic review and meta-analysis. Heart 2018; 104:1394-1402. [PMID: 29654095 PMCID: PMC6109237 DOI: 10.1136/heartjnl-2017-312832] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 11/25/2022] Open
Abstract
Objective To undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies. Methods Databases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis. Results Forty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor. Conclusion Overall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA.
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Affiliation(s)
- Grace Olivia Dibben
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospitals NHS Trust, University of Exeter Medical School, Truro, UK
| | - Hasnain M Dalal
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospitals NHS Trust, University of Exeter Medical School, Truro, UK.,Institute of Health Research (Primary Care), University of Exeter Medical School, Exeter, UK
| | - Rod S Taylor
- Institute of Health Research (Primary Care), University of Exeter Medical School, Exeter, UK
| | | | - Lars Hermann Tang
- National Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Melvyn Hillsdon
- Department of Sport and Health Sciences, University of Exeter, Exeter, UK
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19
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Objective Improvement in Daily Physical Activity in Heart Failure Remains Elusive: A Systematic Review. Cardiopulm Phys Ther J 2018. [DOI: 10.1097/cpt.0000000000000071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Concurrent Validity of Daily Activity Data From Medtronic ICD/CRT Devices and the Actigraph GT3X Triaxial Accelerometer: A Pilot Study. Cardiopulm Phys Ther J 2017. [DOI: 10.1097/cpt.0000000000000042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Shoemaker MJ, Oberholtzer NL, Jongekrijg LE, Bowen TE, Cartwright K, Hanson K, Serba D, Dickinson MG, Kowalk A. Exercise- and Psychosocial-Based Interventions to Improve Daily Activity in Heart Failure: A Pilot Study. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2016. [DOI: 10.1177/1084822316683660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In individuals with heart failure (HF), low daily activity is associated with a poorer prognosis. The purpose of this pilot study was to investigate the effects of two home-based interventions on the primary HF-related outcome of daily activity and secondary outcomes of exercise tolerance, HF-related health status, and lower extremity functional strength in 16 patients with HF and implanted Medtronic implantable cardioverter defibrillator and cardiac resynchronization devices using a single-blind, randomized controlled pilot trial. Interventions were either daily activity feedback and encouragement or health coaching and home-based exercise. There were no significant differences in primary or secondary outcomes either between or within groups. Three subjects in each treatment group improved in two or more secondary outcomes, and only one improved in daily activity. Although the present pilot study incorporated both exercise and psychosocial components in the intervention, there was no effect on daily activity, perhaps because readiness for behavioral change was not accounted for either in group stratification/allocation or inclusion criteria.
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Affiliation(s)
| | | | | | | | | | - Kim Hanson
- Grand Valley State University, Grand Rapids, MI, USA
| | - Deb Serba
- Grand Valley State University, Grand Rapids, MI, USA
| | - Michael G. Dickinson
- Frederik Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, MI, USA
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22
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Gupta S, Larsen E, Garg A, John F, Bansal M, Eckman PM, Sembrano R. Functional Effectiveness of Inpatient Rehabilitation After Heart Transplantation. PM R 2016; 8:855-9. [DOI: 10.1016/j.pmrj.2016.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 01/26/2016] [Accepted: 01/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Saurabh Gupta
- Division of General Internal Medicine, University of Minnesota Medical Center, M Health, 2450 Riverside Ave, Minneapolis, MN 55415
| | - Elizabeth Larsen
- Rehabilitation Services, University of Minnesota Medical Center, M Health, Minneapolis, MN
| | - Ankur Garg
- Indiana University School of Medicine, Indianapolis, IN
| | - Florence John
- University of Minnesota Medical School, Minneapolis, MN
| | - Mukesh Bansal
- Department of systems biology, Columbia University, New York, NY
| | - Peter M. Eckman
- Division of Cardiology, University of Minnesota Medical Center, M Health, Minneapolis, MN
| | - Roderick Sembrano
- Division of PM&R, University of Minnesota Medical Center, M Health, Minneapolis, MN
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23
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Galdas P, Darwin Z, Fell J, Kidd L, Bower P, Blickem C, McPherson K, Hunt K, Gilbody S, Richardson G. A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN). HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundSelf-management support interventions can improve health outcomes, but their impact is limited by the numbers of patients able or willing to access them. Men’s attendance at, and engagement with, self-management support appears suboptimal despite their increased risk of developing serious and disabling long-term conditions (LTCs).ObjectivesTo assess the effectiveness, cost-effectiveness, accessibility and acceptability of self-management support interventions in men with LTCs.MethodsA quantitative systematic review with meta-analysis and a qualitative review using a metaethnography approach. The findings of the two reviews were integrated in parallel synthesis.Data sourcesIn the quantitative review, the Cochrane Database of Systematic Reviews was searched to identify published reviews of self-management support interventions. Relevant reviews were screened to identify randomised controlled trials (RCTs) of self-management support interventions conducted in men alone, or which analysed the effects of interventions by gender. In the qualitative review, the databases Cumulative Index to Nursing and Allied Health Literature, EMBASE, Medical Literature Analysis and Retrieval System Online, PsycINFO and Social Science Citation Index (July 2013) were searched from inception to July 2013.Review methodsIn the quantitative review, data on relevant outcomes, patient populations, intervention type and study quality were extracted. Quality appraisal was conducted independently by two reviewers using the Cochrane risk of bias tool. Meta-analysis was conducted to compare the effects of interventions in male, female and mixed-sex groups. In the metaethnography, study details, participant quotes (first-order constructs) and study authors’ themes/concepts (second-order constructs) were extracted. Quality appraisal was conducted independently by two reviewers using the Critical Appraisal Skills Programme tool. Data were synthesised according to a metaethnography approach. Third-order interpretations/constructs were derived from the extracted data and integrated to generate a ‘line-of-argument’ synthesis.ResultsForty RCTs of self-management support interventions in male-only samples, and 20 RCTs where an analysis by gender was reported, were included in the quantitative review. Meta-analysis suggested that interventions including physical activity, education and peer support have a positive impact on quality of life in men, and that men may derive more benefit than women from them, but there is currently insufficient evidence to draw definitive conclusions. Thirty-eight qualitative studies relevant to men’s experiences of, and perceptions of, self-management support were included in the qualitative review. The metaethnography identified four concepts: (1) need for purpose; (2) trusted environments; (3) value of peers; and (4) becoming an expert. Findings indicated that men may feel less comfortable engaging in support if it is perceived to be incongruous with valued aspects of masculine identities. Men may find support interventions more attractive when they have a clear purpose, are action-oriented and offer practical strategies that can be integrated into daily life. Support delivered in an environment that offers a sense of shared understanding can be particularly appealing to some men.ConclusionsHealth professionals and those involved in designing interventions may wish to consider whether or not certain components (e.g. physical activity, education, peer support) are particularly effective in men, although more research is needed to fully determine and explore this. Interventions are most likely to be accessible and acceptable to men when working with, not against, valued aspects of masculine identities.Study registrationThis study is registered as PROSPERO CRD42013005394.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Paul Galdas
- Department of Health Sciences, University of York, York, UK
| | - Zoe Darwin
- School of Healthcare, Faculty of Medicine, University of Leeds, Leeds, UK
| | - Jennifer Fell
- Department of Health Sciences, University of York, York, UK
| | - Lisa Kidd
- School of Health and Life Sciences/Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Christian Blickem
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Kerri McPherson
- School of Health and Life Sciences/Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Kate Hunt
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
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24
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Sagar VA, Davies EJ, Briscoe S, Coats AJS, Dalal HM, Lough F, Rees K, Singh S, Taylor RS. Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart 2015; 2:e000163. [PMID: 25685361 PMCID: PMC4316592 DOI: 10.1136/openhrt-2014-000163] [Citation(s) in RCA: 163] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/04/2014] [Accepted: 11/04/2014] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To update the Cochrane systematic review of exercise-based cardiac rehabilitation (CR) for heart failure. METHODS A systematic review and meta-analysis of randomised controlled trials was undertaken. MEDLINE, EMBASE and the Cochrane Library were searched up to January 2013. Trials with 6 or more months of follow-up were included if they assessed the effects of exercise interventions alone or as a component of comprehensive CR programme compared with no exercise control. RESULTS 33 trials were included with 4740 participants predominantly with a reduced ejection fraction (<40%) and New York Heart Association class II and III. Compared with controls, while there was no difference in pooled all-cause mortality between exercise CR with follow-up to 1 year (risk ratio (RR) 0.93; 95% CI 0.69 to 1.27, p=0.67), there was a trend towards a reduction in trials with follow-up beyond 1 year (RR 0.88; 0.75 to 1.02, 0.09). Exercise CR reduced the risk of overall (RR 0.75; 0.62 to 0.92, 0.005) and heart failure-specific hospitalisation (RR 0.61; 0.46 to 0.80, 0.0004) and resulted in a clinically important improvement in the Minnesota Living with Heart Failure questionnaire (mean difference: -5.8 points, -9.2 to -2.4, 0.0007). Univariate meta-regression analysis showed that these benefits were independent of the type and dose of exercise CR, and trial duration of follow- up, quality or publication date. CONCLUSIONS This updated Cochrane review shows that improvements in hospitalisation and health-related quality of life with exercise-based CR appear to be consistent across patients regardless of CR programme characteristics and may reduce mortality in the longer term. An individual participant data meta-analysis is needed to provide confirmatory evidence of the importance of patient subgroup and programme level characteristics (eg, exercise dose) on outcome.
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Affiliation(s)
- Viral A Sagar
- Maidstone & Tunbridge Wells NHS Trust , Maidstone , UK
| | - Edward J Davies
- South West Cardiothoracic Centre, Derriford Hospital , Plymouth , UK
| | - Simon Briscoe
- Peninsula Technology Assessment Group (PenTAG) , University of Exeter Medical School , Exeter , UK
| | | | - Hasnain M Dalal
- Truro & Primary Care Research Group, Department of Research and Development, Knowledge Spa , Royal Cornwall Hospitals Trust, University of Exeter Medical School , Truro , UK
| | - Fiona Lough
- The Hatter Institute, UCLH NHS Trust , London , UK
| | - Karen Rees
- Division of Health Sciences , Warwick Medical School, University of Warwick , Coventry , UK
| | - Sally Singh
- Centre for Exercise and Rehabilitation Science, Glenfield Hospital, University Hospitals of Leicester NHS Trust , Leicester , UK
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School , Exeter , UK
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25
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van der Bom T, Winter MM, Knaake JL, Cervi E, de Vries LSC, Balducci A, Meregalli PG, Pieper PG, van Dijk APJ, Bonvicini M, Mulder BJM, Bouma BJ. Long-term benefits of exercise training in patients with a systemic right ventricle. Int J Cardiol 2014; 179:105-11. [PMID: 25464425 DOI: 10.1016/j.ijcard.2014.10.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/14/2014] [Accepted: 10/18/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of the present study is to determine the long-term effects of a ten-week exercise training program in adult patients with a systemic right ventricle. METHODS All patients who participated in a 2009 randomized controlled trial were approached. At approximately three years of follow-up from initial baseline, patients underwent cardiopulmonary exercise testing, filled out two quality of life questionnaires, and NT proBNP levels were measured. All examinations were performed according to the protocols of the 2009 trial. In addition, patients were asked about their current sports habits. RESULTS Of the 54 patients who were randomized in the 2009-trial 40 participated in the current re-evaluation (male 50%, ccTGA 35%, age 36 ± 10 years, intervention group n=22, control group n=18). After three years, no persistent effect of exercise training on V'O₂peak training remained (-2% of predicted, 95% CI -3% to 5%; p=.56). However, patients who already participated in regular sports or exercise at baseline (n=23/40 (58%)) showed higher V'O₂peak of 13% of predicted (95% CI 4% to 23%; p>.01) and a decrease of 62% in plasma NT-proBNP (95% CI -115% to -10%; p>.03) during follow-up, when compared to patients who did not. Moreover, sports were associated with a lower incidence of clinical events (p=.032). CONCLUSION Short-term beneficial effects of exercise training did not persist over a three-year follow-up period. However, sports participation at baseline was associated with better exercise capacity, lower neurohormone levels, and increased event-free survival.
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Affiliation(s)
- Teun van der Bom
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Michiel M Winter
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jennifer L Knaake
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Elena Cervi
- Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Bologna, Italy
| | - Leonie S C de Vries
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Anna Balducci
- Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Bologna, Italy
| | - Paola G Meregalli
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Petronella G Pieper
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Marco Bonvicini
- Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Bologna, Italy
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
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Williams MA, Pozehl B. Reasonable expectations: how much aerobic capacity, muscle strength, and quality of life can improve with exercise training in heart failure. Heart Fail Clin 2014; 11:37-57. [PMID: 25432473 DOI: 10.1016/j.hfc.2014.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In this article, the literature that describes the magnitude of functional and quality of life gains with a traditional moderate-intensity aerobic and resistance training programs is reviewed, and differences between the impact of exercise training in heart failure with preserved ejection fraction versus heart failure with reduced ejection fraction are discussed.
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Affiliation(s)
- Mark A Williams
- Division of Cardiology, Creighton University School of Medicine, 3006 Webster Street, Omaha, NE 68131, USA.
| | - Bunny Pozehl
- University of Nebraska Medical Center, College of Nursing, Lincoln Division, 1230 "O" Street, Suite 131, P.O. Box 880220, Lincoln, NE 68588-0220, USA
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Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJS, Dalal H, Lough F, Rees K, Singh SJ, Mordi IR. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev 2014; 2014:CD003331. [PMID: 24771460 PMCID: PMC6485909 DOI: 10.1002/14651858.cd003331.pub4] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Previous systematic reviews and meta-analyses consistently show the positive effect of exercise-based rehabilitation for heart failure (HF) on exercise capacity; however, the direction and magnitude of effects on health-related quality of life, mortality and hospital admissions in HF remain less certain. This is an update of a Cochrane systematic review previously published in 2010. OBJECTIVES To determine the effectiveness of exercise-based rehabilitation on the mortality, hospitalisation admissions, morbidity and health-related quality of life for people with HF. Review inclusion criteria were extended to consider not only HF due to reduced ejection fraction (HFREF or 'systolic HF') but also HF due to preserved ejection fraction (HFPEF or 'diastolic HF'). SEARCH METHODS We updated searches from the previous Cochrane review. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue1, 2013) from January 2008 to January 2013. We also searched MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and PsycINFO (Ovid) (January 2008 to January 2013). We handsearched Web of Science, bibliographies of systematic reviews and trial registers (Controlled-trials.com and Clinicaltrials.gov). SELECTION CRITERIA Randomised controlled trials of exercise-based interventions with six months' follow-up or longer compared with a no exercise control that could include usual medical care. The study population comprised adults over 18 years and were broadened to include individuals with HFPEF in addition to HFREF. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references and rejected those that were clearly ineligible. We obtained full-text papers of potentially relevant trials. One review author independently extracted data from the included trials and assessed their risk of bias; a second review author checked data. MAIN RESULTS We included 33 trials with 4740 people with HF predominantly with HFREF and New York Heart Association classes II and III. This latest update identified a further 14 trials. The overall risk of bias of included trials was moderate. There was no difference in pooled mortality between exercise-based rehabilitation versus no exercise control in trials with up to one-year follow-up (25 trials, 1871 participants: risk ratio (RR) 0.93; 95% confidence interval (CI) 0.69 to 1.27, fixed-effect analysis). However, there was trend towards a reduction in mortality with exercise in trials with more than one year of follow-up (6 trials, 2845 participants: RR 0.88; 95% CI 0.75 to 1.02, fixed-effect analysis). Compared with control, exercise training reduced the rate of overall (15 trials, 1328 participants: RR 0.75; 95% CI 0.62 to 0.92, fixed-effect analysis) and HF specific hospitalisation (12 trials, 1036 participants: RR 0.61; 95% CI 0.46 to 0.80, fixed-effect analysis). Exercise also resulted in a clinically important improvement superior in the Minnesota Living with Heart Failure questionnaire (13 trials, 1270 participants: mean difference: -5.8 points; 95% CI -9.2 to -2.4, random-effects analysis) - a disease specific health-related quality of life measure. However, levels of statistical heterogeneity across studies in this outcome were substantial. Univariate meta-regression analysis showed that these benefits were independent of the participant's age, gender, degree of left ventricular dysfunction, type of cardiac rehabilitation (exercise only vs. comprehensive rehabilitation), mean dose of exercise intervention, length of follow-up, overall risk of bias and trial publication date. Within these included studies, a small body of evidence supported exercise-based rehabilitation for HFPEF (three trials, undefined participant number) and when exclusively delivered in a home-based setting (5 trials, 521 participants). One study reported an additional mean healthcare cost in the training group compared with control of USD3227/person. Two studies indicated exercise-based rehabilitation to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years (QALYs) and life-years saved. AUTHORS' CONCLUSIONS This updated Cochrane review supports the conclusions of the previous version of this review that, compared with no exercise control, exercise-based rehabilitation does not increase or decrease the risk of all-cause mortality in the short term (up to 12-months' follow-up) but reduces the risk of hospital admissions and confers important improvements in health-related quality of life. This update provides further evidence that exercise training may reduce mortality in the longer term and that the benefits of exercise training on appear to be consistent across participant characteristics including age, gender and HF severity. Further randomised controlled trials are needed to confirm the small body of evidence seen in this review for the benefit of exercise in HFPEF and when exercise rehabilitation is exclusively delivered in a home-based setting.
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Affiliation(s)
- Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Viral A Sagar
- Maidstone & Tunbridge Wells HospitalHermitage LaneBarmingMaidstoneUKME16 9QQ
| | - Edward J Davies
- Royal Devon & Exeter Healthcare Foundation TrustDepartment of CardiologyBarrack RoadExeterUKEX2 5DW
| | - Simon Briscoe
- University of Exeter Medical SchoolNIHR CLAHRC South West Peninsula (PenCLAHRC)South CloistersSt Luke's CampusExeterUKEX1 2LU
| | - Andrew JS Coats
- University of East AngliaElizabeth Fry Building University of East AngliaNorwichUKNR4 7TJ
| | | | - Fiona Lough
- The Hatter Institute, UCLH NHS Trust67 Chenies MewsLondonUKWC1E 6HX
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Sally J Singh
- Glenfield HospitalCardiac & Pulmonary RehabilitationUniversity Hospitals of LeicesterLeicesterUKLE3 9QP
| | - Ify R Mordi
- University of DundeeMolecular and Clinical MedicineNinewells Hospital and Medical SchoolDundeeUK
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Clinically meaningful change estimates for the six-minute walk test and daily activity in individuals with chronic heart failure. Cardiopulm Phys Ther J 2013. [PMID: 23997688 DOI: 10.1097/01823246-201324030-00004] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of the present pilot study was to provide a preliminary estimate of the minimum detectable difference (MDD) and minimum clinically important difference (MCID) of the six-minute walk test (6MWT) and daily activity in outpatients with chronic heart failure (CHF). METHODS A convenience sample of 22 adults with stable New York Heart Association Functional Class II and III CHF performed two baseline 6MWTs separated by 30 minutes of rest. Subjects then wore a triaxial accelerometer for 7 days to monitor daily activity. After 7 weeks of usual care, subjects again wore the accelerometer for 7 days and then returned to the clinic to complete the Global Rating of Change Scale (GRS) with regard to their heart disease and perform another set of 6MWTs. For the 6MWT, the MDD was calculated using the two baseline 6MWT distances. For daily activity, the MDD was calculated using two methods: (1) day-to-day test-retest reliability during baseline monitoring, and (2) baseline to follow-up test-retest reliability in those who reported no change on the GRS. The MCID for the 6MWT and daily activity was calculated using the mean and 95% confidence interval (CI95%) for those subjects who reported 'improvement' on the GRS. RESULTS The MDD at the CI95% for the 6MWT was 32.4 meters. The MCID for the 6MWT was 30.1 (CI95% 20.8, 39.4) meters. The MDD for daily activity was 5,909 vector magnitude units (VMU·hr.(-1)) The MCID for daily activity was 1,337 VMU·hr.(-1) There was good alignment of the MDD and MCID for the 6MWT, suggesting that clinically meaningful change is approximately 32 meters. However, the calculated MCID was substantially less than measurement error as represented by the MDD, indicating that the MCID was underestimated in this sample or that daily activity may be robust to change in overall disease status.
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Shoemaker MJ, Keenoy B, Smith B, Slotman P. Interventions to improve daily activity in individuals with COPD and CHF: A systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjcd.2013.33044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Whellan DJ. Long-term exercise training and adherence: it is not just exercise. J Am Coll Cardiol 2012; 60:1529-30. [PMID: 22999726 DOI: 10.1016/j.jacc.2012.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 07/02/2012] [Indexed: 11/29/2022]
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Shoemaker MJ, Curtis AB, Vangsnes E, Dickinson MG, Paul R. Analysis of daily activity data from implanted cardiac defibrillators: The minimum clinically important difference and relationship to mortality/life expectancy. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/wjcd.2012.23021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Teffaha D, Mourot L, Vernochet P, Ounissi F, Regnard J, Monpère C, Dugué B. Relevance of Water Gymnastics in Rehabilitation Programs in Patients With Chronic Heart Failure or Coronary Artery Disease With Normal Left Ventricular Function. J Card Fail 2011; 17:676-83. [DOI: 10.1016/j.cardfail.2011.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 04/07/2011] [Accepted: 04/11/2011] [Indexed: 11/30/2022]
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Müller L, Myers J, Kottman W, Lüchinger R, Dubach P. Long-term myocardial adaptations after cardiac rehabilitation in heart failure: a randomized six-year evaluation using magnetic resonance imaging. Clin Rehabil 2010; 23:986-94. [PMID: 19880673 DOI: 10.1177/0269215509339003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess exercise capacity and left ventricular function using magnetic resonance imaging (MRI) among patients with chronic heart failure randomized to a residential rehabilitation programme at baseline and six years after participation. DESIGN Randomized controlled study. SETTING Residential cardiac rehabilitation centre and community hospital. INTERVENTION One month of intensive exercise and risk reduction therapy including educational sessions, a low-fat diet, and 2 hours of individually prescribed exercise daily. Control subjects received usual care. Subjects were evaluated at baseline, after completing the one-month residential programme and six years later. SUBJECTS From an original study group of 50, 16 patients (8 exercise, 8 controls) with chronic heart failure were alive and available for evaluation after six years. MAIN MEASURES Cardiopulmonary exercise test responses and ventricular size and function using MRI. RESULTS Peak Vo(2) was 20.0 and 12.4% higher after the rehabilitation programme and six years later, respectively, whereas minimal changes were observed among controls. Left ventricular mass and volumes tended to decrease among subjects in the exercise group, whereas left ventricular mass and volumes tended to increase among control subjects after six years. Ejection fraction increased approximately 20% in both groups. CONCLUSION Six years after participation in a concentrated residential rehabilitation programme, exercise capacity was preserved and no significant changes were observed in ventricular size or function. These findings provide further support for exercise rehabilitation in chronic heart failure.
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Affiliation(s)
- Lionel Müller
- Cardiology Division, Kantonsspital, Chur, Switzerland
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Hwang CL, Chien CL, Wu YT. Resistance training increases 6-minute walk distance in people with chronic heart failure: a systematic review. J Physiother 2010; 56:87-96. [PMID: 20482475 DOI: 10.1016/s1836-9553(10)70038-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
QUESTION Does resistance training, either alone or as an adjunct to aerobic training, improve cardiac function, exercise capacity and quality of life in people with chronic heart failure? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS Adults with stable chronic heart failure. INTERVENTION Progressive resistance exercise training, alone or as an adjunct to aerobic training. OUTCOME MEASURES Cardiac function, exercise capacity and quality of life. RESULTS 241 participants from eight trials performed 2 to 6 months of moderate-intensity resistance training (50-75% of 1RM). Most programs consisted of 5 to 6 exercises for large limb and trunk muscles with two sets of 8 to 12 repetitions, three times a week. Resistance training significantly increased 6-minute walk distance (WMD 52 m, 95% CI 19 to 85) but not peak oxygen consumption (WMD 1.4 ml/kg/min, 95% CI -0.3 to 3.1). When used as an adjunct to aerobic training, resistance training did not significantly alter left ventricular ejection fraction (WMD -0.5%, 95% CI -4.3 to 3.3), peak oxygen consumption (WMD -0.7 ml/kg/min, 95% CI -2.3 to 1.0), or Minnesota Living with Heart Failure Questionnaire scores (WMD -0.9, 95% CI -5.4 to 3.7), compared with aerobic training alone. CONCLUSION Resistance training increased 6-minute walk distance compared to no training, but had no other benefits on cardiac function, exercise capacity, or quality of life if used alone or as an adjunct to aerobic training in people with chronic heart failure. However, further high quality, large scale, randomised trials are needed.
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Davies EJ, Moxham T, Rees K, Singh S, Coats AJS, Ebrahim S, Lough F, Taylor RS. Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis. Eur J Heart Fail 2010; 12:706-15. [PMID: 20494922 PMCID: PMC2891490 DOI: 10.1093/eurjhf/hfq056] [Citation(s) in RCA: 258] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 02/07/2010] [Accepted: 02/09/2010] [Indexed: 11/13/2022] Open
Abstract
AIMS To determine the effect of exercise training on clinical events and health-related quality of life (HRQoL) of patients with systolic heart failure. METHODS AND RESULTS We searched electronic databases including Medline, EMBASE, and Cochrane Library up to January 2008 to identify randomized controlled trials (RCTs) comparing exercise training and usual care with a minimum follow-up of 6 months. Nineteen RCTs were included with a total of 3647 patients, the majority of whom were male, low-to-medium risk, and New York Heart Association class II-III with a left ventricular ejection fraction of <40%. There was no significant difference between exercise and control in short-term ( CONCLUSION Compared with usual care, in selected heart failure patients, exercise training reduces heart failure-related hospitalizations and results in clinically important improvements in HRQoL. High-quality RCT and cost-effectiveness evidence is needed for the effect of exercise training in community-based settings and in more severe heart failure patients, elderly people, and women.
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Affiliation(s)
- Edward J Davies
- Cardiothoracic Department, Plymouth Hospitals NHS Trust, Terrance Lewis Building, 9th Floor, Derriford Hospital, Plymouth Hospitals NHS Trust, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, UK.
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Davies EJ, Moxham T, Rees K, Singh S, Coats AJ, Ebrahim S, Lough F, Taylor RS. Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev 2010:CD003331. [PMID: 20393935 DOI: 10.1002/14651858.cd003331.pub3] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND From previous systematic reviews and meta-analyses there is consensus about the positive effect of exercise training on exercise capacity; however, the effects on health-related quality of life, mortality and hospital admissions in heart failure remain uncertain. OBJECTIVES To update the previous systematic review which determined the effectiveness of exercise-based interventions on the mortality, hospitalisation admissions, morbidity and health-related quality of life for patients with systolic heart failure. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 4). To update searches from the previous review, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched (2001 to January 2008). ISI Proceedings and bibliographies of identified reviews were checked. SELECTION CRITERIA Randomised controlled trials of exercise-based interventions with six months follow up or longer compared to usual medical care or placebo. The study population comprised adults of all ages (> 18 years) with evidence of chronic systolic heart failure. DATA COLLECTION AND ANALYSIS All identified references were independently screened by two review authors and those that were clearly ineligible were rejected. Full papers of potentially relevant trials were obtained. Data were independantly extracted from the included trials and their risk of bias assessed by a single review author and checked by a second. MAIN RESULTS Nineteen trials (3647 participants) met the inclusion criteria. One large trial recuited 2331 of the participants. There was no significant difference in pooled mortality between groups in the 13 trials with < 1 year follow up. There was evidence of a non-significant trend toward a reduction in pooled mortality with exercise in the four trials with > 1 year follow up. A reduction in the hospitalisation rate was demonstrated with exercise training programmes. Hospitalisations due to systolic heart failure were reduced with exercise and there was a significant improvement in health-related quality of life (HRQoL). The effect of cardiac exercise training on total mortality and HRQoL were independent of the degree of left ventricular dysfunction, type of cardiac rehabilitation, dose of exercise intervention, length of follow up, trial quality, and trial publication date. AUTHORS' CONCLUSIONS The previous version of this review showed that exercise training improved exercise capacity in the short term in patients with mild to moderate heart failure when compared to usual care. This updated review provides evidence that in a similar population of patients, exercise does not increase the risk of all-cause mortality and may reduce heart failure-related hospital admissions. Exercise training may offer important improvements in patients' health-related quality of life.
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Affiliation(s)
- Ed J Davies
- Department of Cardiology, Royal Devon & Exeter Healthcare Foundation Trust, Barrack Road, Exeter, Devon, UK, EX2 5DW
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Effects of Tai Chi Training on Improving Physical Function in Patients With Coronary Heart Diseases. J Exerc Sci Fit 2010. [DOI: 10.1016/s1728-869x(10)60012-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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One-year adherence to exercise in elderly patients receiving postacute inpatient rehabilitation after cardiac surgery. Am J Phys Med Rehabil 2009; 88:727-34. [PMID: 19692790 DOI: 10.1097/phm.0b013e3181b332a1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Promoting an active lifestyle through an appropriate physical exercise prescription is one of the major targets of cardiac rehabilitation. However, information on the effectiveness of cardiac rehabilitation in promoting lifestyle changes in elderly patients is still scant. DESIGN In 131 patients over the age of 65 yrs (86 men, and 45 women, mean age 75 yrs +/- 6 SD) who have attended postacute inpatient cardiac rehabilitation after cardiac surgery, we tested the 1-yr adherence to the physical exercise prescription received at the end of the cardiac rehabilitation by using a questionnaire on physical activity and the 6-min walk test. RESULTS All of the 36 patients who reported an active lifestyle and 49 of the 95 patients who reported a sedentary lifestyle in the year preceding the cardiac operation reported at least 1 hr/day on 5 days each week of light regular physical activity in the year after the cardiac rehabilitation. Further, the distance walked at the follow-up 6-min walk test was significantly related to the physical activity score gathered from the questionnaire. CONCLUSIONS Our data show that 65% of the elderly patients who have attended postacute inpatient cardiac rehabilitation after cardiac surgery are still capable of recovering or even increasing their regular physical activity and of maintaining these favorable lifestyle changes at least for 1 yr.
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Mandic S, Tymchak W, Kim D, Daub B, Quinney HA, Taylor D, Al-Kurtass S, Haykowsky MJ. Effects of aerobic or aerobic and resistance training on cardiorespiratory and skeletal muscle function in heart failure: a randomized controlled pilot trial. Clin Rehabil 2009; 23:207-16. [PMID: 19218296 DOI: 10.1177/0269215508095362] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examined the effects of different training modalities on exercise capacity (Vo( 2peak)), systolic function, muscular strength and endurance and quality of life in heart failure patients. DESIGN Randomized controlled trial. SETTING Cardiac rehabilitation centre in Canada. SUBJECTS Forty-two individuals with heart failure (62 +/- 12 years; New York Heart Association (NYHA) classes I-III). INTERVENTIONS Aerobic training (n = 14), combined aerobic and resistance training (n = 15) or usual care (n = 13) three times per week for 12 weeks. MAIN MEASURES (1) Vo( 2peak) measured by symptom-limited graded exercise test on cycle ergometer; (2) systolic function assessed by two-dimensional echocardiography; (3) muscular strength and muscular endurance measured by one-repetition maximum procedure; and (4) quality of life assessed by questionnaires. RESULTS In the intention-to-treat analysis, neither aerobic nor combined aerobic and resistance training significantly improved Vo(2peak), systolic function or quality of life compared with usual care. However, combined aerobic and resistance training significantly improved upper extremity strength (40.7 (14.0)-48.5 (16.0) kg, P<0.05) and muscular endurance (5.7 (2.7)-11.6 (7.6) reps, P<0.05) compared with aerobic training or usual care. In compliant participants (exercise adherence 80%), Vo(2peak) increased in the aerobic group (16.9 (6.0)-19.0 (6.8), P= 0.026) and tended to increase in the combined training group (15.9 (5.0)-17.6 (5.6), P= 0.058) compared with usual care. Quality of life was improved in the aerobic group only. CONCLUSIONS Both aerobic and combined aerobic and resistance training are effective interventions to improve Vo(2peak) in compliant heart failure patients. Combined training may be more effective in improving muscle strength and endurance.
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Affiliation(s)
- Sandra Mandic
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada.
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Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol 2009; 53:e1-e90. [PMID: 19358937 DOI: 10.1016/j.jacc.2008.11.013] [Citation(s) in RCA: 1186] [Impact Index Per Article: 79.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, Konstam MA, Mancini DM, Rahko PS, Silver MA, Stevenson LW, Yancy CW. 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. Circulation 2009; 119:1977-2016. [PMID: 19324967 DOI: 10.1161/circulationaha.109.192064] [Citation(s) in RCA: 1059] [Impact Index Per Article: 70.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009; 119:e391-479. [PMID: 19324966 DOI: 10.1161/circulationaha.109.192065] [Citation(s) in RCA: 1080] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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