Wesley J Tucker1, Rhys I Beaudry1, Yuanyuan Liang2, Alexander M Clark3, Corey R Tomczak4, Michael D Nelson1, Oyvind Ellingsen5, Mark J Haykowsky6. 1. College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA. 2. University of Maryland School of Medicine, Baltimore, MD, USA. 3. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. 4. College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. 5. K. G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St. Olav's Hospital, Trondheim, Norway. 6. College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA. Electronic address: mark.haykowsky@uta.edu.
Abstract
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.
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.
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690
Authors: P Dubach; J Myers; G Dziekan; U Goebbels; W Reinhart; P Muller; P Buser; P Stulz; P Vogt; R Ratti Journal: J Am Coll Cardiol Date: 1997-06 Impact factor: 24.094
Authors: An L M Stevens; Dominique Hansen; Lieven Herbots; Inez Wens; An Creemers; Paul Dendale; Bert O Eijnde Journal: J Cardiopulm Rehabil Prev Date: 2015 Jan-Feb Impact factor: 2.081
Authors: Artur Klecha; Kalina Kawecka-Jaszcz; Bogumiła Bacior; Aleksandra Kubinyi; Mieczysław Pasowicz; Piotr Klimeczek; Robert Banyś Journal: Eur J Cardiovasc Prev Rehabil Date: 2007-02
Authors: Peter H Brubaker; J Brian Moore; Kathryn P Stewart; Debra J Wesley; Dalane W Kitzman Journal: J Am Geriatr Soc Date: 2009-11 Impact factor: 5.562
Authors: Christopher M O'Connor; David J Whellan; Kerry L Lee; Steven J Keteyian; Lawton S Cooper; Stephen J Ellis; Eric S Leifer; William E Kraus; Dalane W Kitzman; James A Blumenthal; David S Rendall; Nancy Houston Miller; Jerome L Fleg; Kevin A Schulman; Robert S McKelvie; Faiez Zannad; Ileana L Piña Journal: JAMA Date: 2009-04-08 Impact factor: 56.272
Authors: Willeke R Naaktgeboren; Wim G Groen; Judy N Jacobse; Lars C Steggink; Annemiek M E Walenkamp; Wim H van Harten; Martijn M Stuiver; Neil K Aaronson; Berthe M P Aleman; Peter van der Meer; Michael Schaapveld; Gabe S Sonke; Jourik A Gietema; Flora E van Leeuwen; Anne M May Journal: JACC CardioOncol Date: 2022-04-19
Authors: Prisca Eser; Lukas D Trachsel; Thimo Marcin; David Herzig; Irina Freiburghaus; Stefano De Marchi; Andreas J Zimmermann; Jean-Paul Schmid; Matthias Wilhelm Journal: Front Cardiovasc Med Date: 2022-06-17
Authors: Karen S W Chia; Christine T Shiner; Karen Brown; Cameron J Holloway; Camila Moreyra; Nicole Bart; Peter K K Wong; Steven G Faux; Eugene Kotlyar Journal: Pulm Circ Date: 2022-05-11 Impact factor: 2.886
Authors: Tainá Fabri; Aparecida Maria Catai; Fábio H O Ribeiro; Jonas A Araújo Junior; Juliana Milan-Mattos; Danielle A A Rossi; Regina C Coneglian; Ricardo C Borra; Silmeia Garcia Zanati Bazan; João Carlos Hueb; Beatriz Bojikian Matsubara; Meliza Goi Roscani Journal: Cardiol Res Pract Date: 2019-09-03 Impact factor: 1.866