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Kaddoura R, Al-Tamimi H, Abushanab D, Hayat S, Papasavvas T. Cardiac rehabilitation for participants with implantable cardiac devices: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200255. [PMID: 38737437 PMCID: PMC11087999 DOI: 10.1016/j.ijcrp.2024.200255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/17/2024] [Accepted: 03/07/2024] [Indexed: 05/14/2024]
Abstract
Aim The aim is to discuss efficacy and safety of exercise-based cardiac rehabilitation (CR) programmes in participants with implantable cardiac devices compared with usual care. Methods MEDLINE, EMBASE and Cochrane databases were searched from inspection till July 15, 2022. Randomized controlled trials were included if they enrolled adult participants with implantable cardiac devices and tested exercise-based CR interventions in comparison with any control. Risk of bias was assessed, and endpoints data were pooled using random-effects model. Results Sixteen randomized trials enrolling 2053 participants were included. Study interventions differed between studies in terms of programme components, setting, exercise intensity, and follow-up. All studies included physical exercise component. In both implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) groups, exercise training in CR programmes improved peak oxygen uptake (VO2) [(mean difference (MD) 2.08 ml/kg/min; 95 % CI: 1.44-2.728, p < 0.0001; I2 = 99 %) and (MD 2.24 ml/kg/min; 95 % CI: 1.43-3.04, p < 0.0001; I2 = 96 %), respectively] and 6-min walk test in ICD group (MD 41.51 m; 95 % CI: 15.19-67.82 m, p = 0.002; I2 = 95 %) compared with usual care. In CRT group, there was no statistically significant improvement in left ventricular ejection fraction change between comparison groups. The results were consistent in subgroup analysis according to high or low-to-moderate exercise intensity for change in peak VO2 and ejection fraction in CRT group. There was no difference in number of ICD shocks between the comparators. Conclusion Exercise-based CR programmes appear to be safe when enrolling participants with implantable cardiac devices and leading to favourable functional outcomes.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Tamimi
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Dina Abushanab
- Drug Information Centre, Hamad Medical Corporation, Doha, Qatar
| | - Sajad Hayat
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Theodoros Papasavvas
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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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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Callum K, Swinton P, Gorely T, Crabtree D, Leslie S. Physiological and psychological outcomes of high intensity interval training in patients with heart failure compared to moderate continuous training and usual care: A systematic review with meta analysis. Heart Lung 2024; 64:117-127. [PMID: 38159428 DOI: 10.1016/j.hrtlng.2023.12.002] [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: 08/07/2023] [Revised: 11/06/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND An important component of secondary prevention of CVD (including HF) is comprehensive cardiac rehab, including exercise. Novel, individualised approaches are needed to increase uptake and adherence to exercise programmes, one area offering potential is HIIT. HIIT has been shown to be both safe and effective for improving cardiovascular fitness in both coronary artery disease and HF patients. OBJECTIVES To provide a current and up to date evaluation of the physiological and psychological outcomes of HIIT in patients with HF compared to MCT and UC. Secondly to perform sub-group analyses comparing short and long HIIT protocols. METHODS A systematic review and meta-analysis of randomised controlled trials was undertaken. Medline, Embase, Scopus, CINAHL and SportDISCUS were searched up to July 2022. Trials were included if they carried out a HIIT intervention (defined at intensity ≥ 80% peak HR or ≥ 80% VO2peak) in HF patients (HFpEF or HFrEF) for at least 6 weeks. Comparator group was UC or MCT. RESULTS HIIT was shown to be superior to MCT and UC for improving VO2peak (HIIT mean improvement 3.1 mL.kg-1min-1). HITT was superior to MCT and UC for improving LVEF (HIIT mean improvement 5.7%). HIIT was superior to MCT and UC for improving HRQoL, using the MLHFQ (HIIT mean point change of -12.8). Subgroup analysis showed no difference between long and short HIIT. CONCLUSION HIIT improves VO2peak, LVEF and HRQoL in patients with HF, the improvements seen in VO2peak and LVEF are superior in HIIT compared to MCT and UC.
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Affiliation(s)
- Kara Callum
- NHS Highland, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, United Kingdom; Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, United Kingdom.
| | - Paul Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, United Kingdom
| | - Daniel Crabtree
- Rowett Institute, University of Aberdeen, Aberdeen AB25 2ZD, United Kingdom
| | - Stephen Leslie
- Division of Biomedical Sciences, University of the Highlands and Islands, Inverness, United Kingdom; Cardiologist NHS Highland, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, United Kingdom
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Yang C, Zhang L, Cheng Y, Zhang M, Zhao Y, Zhang T, Dong J, Xing J, Zhen Y, Wang C. High intensity interval training vs. moderate intensity continuous training on aerobic capacity and functional capacity in patients with heart failure: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1302109. [PMID: 38450369 PMCID: PMC10915068 DOI: 10.3389/fcvm.2024.1302109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/07/2024] [Indexed: 03/08/2024] Open
Abstract
Background Exercise training is commonly employed as a efficacious supplementary treatment for individuals suffering from heart failure, but the optimal exercise regimen is still controversial. The objective of the review was to compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on the exercise capacity, cardiac function, quality of life (QoL) and heart rate among patients with heart failure with reduced ejection fraction. Methods A systematic search was performed using the following eight databases from their inception to July 5, 2023: PubMed, Web of Science, Embase, Cochrane Library, Clinical Trials, China Knowledge Network, Wan fang Data, and the China Biology Medicine databases. The meta-analysis results were presented as mean difference (MD) and 95% confidence interval (CI). The Cochrane Risk of Bias tool was used for the included studies. The Grading of Recommendations Assessment, Development, and Evaluations was used to assess the certainty of evidence. Results Thirteen randomized controlled trials were included in the study. The results showed that HIIT had a significant positive effect on peak oxygen uptake (MD = 1.78, 95% CI for 0.80-2.76), left ventricular ejection fraction (MD = 3.13, 95% CI for 1.25-5.02), six-minute walk test (MD = 28.13, 95% CI for 14.56-41.70), and Minnesota Living with Heart Failure Questionnaire (MD = -4.45, 95% CI for -6.25 to -2.64) compared to MICT. However, there were no statistically significant differences observed in resting heart rate and peak heart rate. Conclusions HIIT significantly improves peak oxygen uptake, left ventricular ejection fraction, six-minute walk test, and Minnesota Living with Heart Failure Questionnaire in patients with heart failure with reduced ejection fraction. Additionally, HIIT exhibits greater effectiveness in improving peak oxygen uptake among patients with lower body mass index. Systematic Review Registration https://www.doi.org/10.37766/inplasy2023.7.0100, identifier (INPLASY2023.7.0100).
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Affiliation(s)
- Changran Yang
- Department of Rehabilitation, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lizhuang Zhang
- Department of Rehabilitation, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yu Cheng
- Department of Rehabilitation, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Manman Zhang
- Department of Rehabilitation, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuxin Zhao
- Department of Rehabilitation, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Tianzi Zhang
- Department of Rehabilitation, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiawang Dong
- Department of Rehabilitation, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jun Xing
- Department of Rehabilitation, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yuzhi Zhen
- Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Cuihua Wang
- Department of Rehabilitation, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Yamamoto S, Okamura M, Akashi YJ, Tanaka S, Shimizu M, Tsuchikawa Y, Ashikaga K, Kamiya K, Kato Y, Nakayama A, Makita S, Isobe M. Impact of Long-Term Exercise-Based Cardiac Rehabilitation in Patients With Chronic Heart Failure - A Systematic Review and Meta-Analysis. Circ J 2024:CJ-23-0820. [PMID: 38220206 DOI: 10.1253/circj.cj-23-0820] [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] [Indexed: 01/16/2024]
Abstract
BACKGROUND This study aimed to clarify the effects of exercise-based cardiac rehabilitation (CR) on patients with heart failure.Methods and Results: Patients were divided into groups according to intervention duration (<6 and ≥6 months). We searched for studies published up to July 2023 in Embase, MEDLINE, PubMed, and the Cochrane Library, without limitations on data, language, or publication status. We included randomized controlled trials comparing the efficacy of CR and usual care on mortality, prehospitalization, peak oxygen uptake (V̇O2), and quality of life. Seventy-two studies involving 8,495 patients were included in this review. It was found that CR reduced the risk of rehospitalization for any cause (risk ratio [RR] 0.80; 95% confidence interval [CI] 0.70-0.92) and for heart failure (RR 0.88; 95% CI 0.78-1.00). Furthermore, CR was found to improve exercise tolerance (measured by peak V̇O2and the 6-min walk test) and quality of life. A subanalysis performed based on intervention duration (<6 and ≥6 months) revealed a similar trend. CONCLUSIONS Our meta-analysis showed that although CR does not reduce mortality, it is effective in reducing rehospitalization rates and improving exercise tolerance and quality of life, regardless of the intervention duration.
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Affiliation(s)
| | - Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin
| | | | - Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital
| | - Masashi Shimizu
- Department of Rehabilitation, Osaka Metropolitan University Hospital
| | | | - Kohei Ashikaga
- Department of Sports Medicine, St. Marianna University School of Medicine
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University
| | - Yuko Kato
- Department of Cardiology, The Cardiovascular Institute
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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: 13] [Impact Index Per Article: 6.5] [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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Marriott CFS, Petrella AFM, Marriott ECS, Boa Sorte Silva NC, Petrella RJ. High-Intensity Interval Training in Older Adults: a Scoping Review. SPORTS MEDICINE - OPEN 2021; 7:49. [PMID: 34279765 PMCID: PMC8289951 DOI: 10.1186/s40798-021-00344-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 07/04/2021] [Indexed: 12/12/2022]
Abstract
High-intensity interval training (HIIT) is an increasingly popular form of aerobic exercise which includes bouts of high-intensity exercise interspersed with periods of rest. The health benefits, risks, and optimal design of HIIT are still unclear. Further, most research on HIIT has been done in young and middle-aged adults, and as such, the tolerability and effects in senior populations are less well-known. The purpose of this scoping review was to characterize HIIT research that has been done in older adults including protocols, feasibility, and safety and to identify gaps in the current knowledge. Five databases were searched with variations of the terms, "high-intensity interval training" and "older adults" for experimental or quasi-experimental studies published in or after 2009. Studies were included if they had a treatment group with a mean age of 65 years or older who did HIIT, exclusively. Of 4644 papers identified, 69 met the inclusion criteria. The average duration of training was 7.9 (7.0) weeks (mean [SD]) and protocols ranged widely. The average sample size was 47.0 (65.2) subjects (mean [SD]). Healthy populations were the most studied group (n = 30), followed by subjects with cardiovascular (n = 12) or cardiac disease (n = 9), metabolic dysfunction (n = 8), and others (n = 10). The most common primary outcomes included changes in cardiorespiratory fitness (such as VO2peak) as well as feasibility and safety of the protocols as measured by the number of participant dropouts, adverse events, and compliance rate. HIIT protocols were diverse but were generally well-tolerated and may confer many health advantages to older adults. Larger studies and more research in clinical populations most representative of older adults are needed to further evaluate the clinical effects of HIIT in these groups.
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Affiliation(s)
- Catherine F. S. Marriott
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Andrea F. M. Petrella
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Emily C. S. Marriott
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Narlon C. Boa Sorte Silva
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
- Aging, Mobility, and Cognitive Neuroscience Lab, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert J. Petrella
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON Canada
- School of Kinesiology, Western University, London, ON Canada
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 320 - 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
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8
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Harwood AE, Russell S, Okwose NC, McGuire S, Jakovljevic DG, McGregor G. A systematic review of rehabilitation in chronic heart failure: evaluating the reporting of exercise interventions. ESC Heart Fail 2021; 8:3458-3471. [PMID: 34235878 PMCID: PMC8497377 DOI: 10.1002/ehf2.13498] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/17/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022] Open
Abstract
A large body of research supports the use of exercise to improve symptoms, quality of life, and physical function in patients with chronic heart failure. Previous reviews have focused on reporting outcomes of exercise interventions such as cardiorespiratory fitness. However, none have critically examined exercise prescription. The aim of this review was to evaluate the reporting and application of exercise principles in randomised control trials of exercise training in patients with chronic heart failure. A systematic review of exercise intervention RCTs in patients with CHF, using the Consensus on Exercise Reporting Template (CERT), was undertaken. The Ovid Medline/PubMed, Embase, Scopus/Web of Science, and Cochrane Library and Health Technology Assessment Databases were searched from 2000 to June 2020. Prospective RCTs in which patients with CHF were randomized to a structured exercise programme were included. No limits were placed on the type or duration of exercise structured exercise programme or type of CHF (i.e. preserved or reduced ejection fraction). We included 143 studies, comprising of 181 different exercise interventions. The mean CERT score was 10 out of 19, with no study achieving a score of 19. Primarily, details were missing regarding motivational strategies, home-based exercise components, and adherence/fidelity to the intervention. Exercise intensity was the most common principle of exercise prescription missing from intervention reporting. There was no improvement in the reporting of exercise interventions with time (R2 = 0.003). Most RCTs of exercise training in CHF are reported with insufficient detail to allow for replication, limiting the translation of evidence to clinical practice. We encourage authors to provide adequate details when reporting future interventions. Where journal word counts are restrictive, we recommend using supplementary material or publishing trial protocols prior to beginning the study.
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Affiliation(s)
- Amy E Harwood
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK
| | - Sophie Russell
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK
| | - Nduka C Okwose
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK.,Cardiovascular Research Division, Translational and Clinical Research Institute, Newcastle University, UK
| | - Scott McGuire
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK
| | - Djordje G Jakovljevic
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK.,Cardiovascular Research Division, Translational and Clinical Research Institute, Newcastle University, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gordon McGregor
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry, CV1 2DS, UK.,Department of Cardiopulmonary Rehabilitation, Centre for Exercise and Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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9
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Guo R, Wen Y, Xu Y, Jia R, Zou S, Lu S, Liu G, Cui K. The impact of exercise training for chronic heart failure patients with cardiac resynchronization therapy: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25128. [PMID: 33787595 PMCID: PMC8021321 DOI: 10.1097/md.0000000000025128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/15/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Systematically review the current published literature on the impact of exercise training (ET) in chronic heart failure (CHF) patients who were conducted cardiac resynchronization therapy (CRT). METHODS PubMed, EMBASE, and the Cochrane Library of Controlled Trails databases were searched for trials comparing the additional effects of ET in CHF patients after CRT implantation with no exercise or usual care control up until 2020.03.07. We independently screened the literature, extracted data, employed the tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) to evaluate study quality and risk of bias, and performed meta-analysis with Revman 5.3 software. RESULTS Eight trials were identified for qualitative analysis and 7 randomized controlled trails (RCTs) included 235 participants (120 ET; 115 controls) for quantitative analysis. The results showed that the maximal workload (mean difference [MD] 26.32 W, 95% CI 19.41-33.23; P < .00001, I2 = 0%) and the exercise duration (MD 68.95 seconds, 95% CI 15.41-122.48; P = .01, I2 = 76%) had significant improvement in the ET group versus control. Subgroup analysis showed that compared with control, the change in peak oxygen uptake (VO2) (MD 3.05 ml/kg/minute, 95% CI 2.53-3.56; P < .00001, I2 = 0%), left ventricular ejection fraction (LVEF) (MD 4.97%, 95% CI 1.44-8.49; P = .006, I2 = 59%), and health related quality of life (HRQoL) (the change in Minnesota living with heart failure questionnaire [MLHFQ]: MD -19.96, 95% CI -21.57 to -18.34; P < .00001, I2 = 0%) were significantly improved in the light to moderate intensity training (non-HIT) group, while there seemed no statistical difference of above endpoints in the high intensity training (HIT) group. CONCLUSION During the short term (up to 6 months), non-HIT could improve exercise capacity, cardiac function, and HRQoL in CHF patients with CRT. However, due to the small number of participants, a high-quality large-sample multicenter trial is demanded.
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Affiliation(s)
- Ran Guo
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
| | - Yi Wen
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
| | - Ying Xu
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
| | - Ruikun Jia
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
| | - Song Zou
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
| | - Sijie Lu
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
| | - Guobin Liu
- Department of Cardiology, The First People's Hospital of Jintang County, Sichuan, China
| | - Kaijun Cui
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University
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