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Meta-analysis of Exercise Training on Left Ventricular Ejection Fraction in Heart Failure with Reduced Ejection Fraction: A 10-year Update

期刊

PROGRESS IN CARDIOVASCULAR DISEASES
卷 62, 期 2, 页码 163-171

出版社

W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.pcad.2018.08.006

关键词

Exercise therapy; Moderate-intensity continuous training; High-intensity interval training; Resistance training; Left ventricular ejection fraction

资金

  1. American Heart Association (AHA) [18POST33990210]
  2. Moritz Chair in Geriatrics at the University of Texas at Arlington
  3. National Institutes of Health (NIH) [R15NR016826-01]

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Background: The role of exercise training modality to attenuate left ventricular (LV) remodeling in heart failure patients with reduced ejection fraction (HFrEF) remains uncertain. The authors performed a systematic review and meta-analysis of published reports on exercise training (moderate-intensity continuous aerobic, high intensity interval aerobic, and resistance exercise) and LV remodeling in clinically stable HFrEF patients. Methods: We searched MEDLINE, Cochrane Central Registry of Controlled Trials, CINAHL, and PubMed (2007 to 2017) for randomized controlled trials of exercise training on resting LV ejection fraction (EF) and end-diastolic and end-systolic volumes in HFrEF patients. Results: 18 trials reported LV ejection fraction (LVEF) data, while 8 and 7 trials reported LV end-diastolic and LV end-systolic volumes, respectively. Overall, moderate-intensity continuous training (MICT) significantly increased LVEF (weighted mean difference, WMD = 3.79%; 95% confidence interval, CI, 2.08 to 5.50%) with no change in LV volumes versus control. In trials >= 6 months duration, MICT significantly improved LVEF (WMD = 6.26%; 95% CI 4.39 to 8.13%) while shorter duration (<6 months) trials modestly increased LVEF (WMD = 2.33%; 95% CI 0.84 to 3.82%). High-intensity interval training (HIIT) significantly increased LVEF compared to control (WMD = 3.70%; 95% CI 1.63 to 5.77%) but was not different than MICT (WMD = 3.17%; 95% CI -0.87 to 7.22%). Resistance training performed alone or combined with aerobic training (MICT or HIIT) did not significantly change LVEF. Conclusions: In clinically stable HFrEF patients, MICT is an effective therapy to attenuate LV remodeling with the greatest benefits occurring with long-term (>= 6 months) training. HIIT performed for 2 to 3 months is superior to control, but not MICT, for improvement of LVEF. (C) 2018 Elsevier Inc. All rights reserved.

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