Background

Exercise-based cardiac rehabilitation has positive benefits for patients with chronic heart failure (CHF), but the choice of exercise intensity has been controversial. The aim of this systematic review and meta-analysis was to investigate the effects of different exercise intensities on cardiopulmonary function and quality of life (QoL) of patients with CHF.

Methods

Randomized controlled trials (RCTs) of different exercise intensities applied to patients with CHF were searched in PubMed, Web of Science, the Cochrane Library, and Embase databases from inception to December 2021. Study selection and data extraction were performed simultaneously by two independent reviewers, using the Physiotherapy Evidence Database Scale (PEDro) for quality assessment of the included literature. The weighted mean differences (WMD) or standardized mean difference (SMD) were calculated by employing a fixed or random effects model. Other statistical analyses included subgroup analysis and sensitivity analysis. Quality of evidence was evaluated by the Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) method.

Results

Eight RCTs were included. Analyses reported no significant improvement in left ventricular ejection fractions (LVEF; WMD = 0.47, 95% CI [−4.10, 5.03], p = 0.841), peak oxygen uptake (peak VO₂) (SMD = 0.38, 95% CI [−0.03, 0.80], p = 0.069) and 6‑min walking distance (6MWD) (WMD = 14.10, 95% CI [−9.51, 37.72], p = 0.242). Exercise interventions of varying intensity produced small-to-moderate beneficial effects on QoL (WMD = −4.99, 95% CI [−8.29, −1.68], p = 0.003), which appeared to be attenuated at long-term follow-up (WMD = 2.12, 95% CI [−2.91, 7.16], p = 0.409).

Conclusion

High-intensity exercise does not have a significant advantage over moderate-intensity exercise in improving cardiopulmonary function and aerobic capacity in patients with CHF. Beneficial changes in QoL from high-intensity exercise also appeared to decrease during long-term follow-up, indicating a cumulative effect of the efficacy of high-intensity exercise.

中文翻译：

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不同强度运动对慢性心力衰竭患者心肺功能及生活质量的影响

背景

以运动为基础的心脏康复对于慢性心力衰竭（CHF）患者具有积极的益处，但运动强度的选择一直存在争议。本系统评价和荟萃分析的目的是探讨不同运动强度对 CHF 患者心肺功能和生活质量 (QoL) 的影响。

方法

从开始到 2021 年 12 月，在 PubMed、Web of Science、Cochrane 图书馆和 Embase 数据库中检索了应用于 CHF 患者的不同运动强度的随机对照试验 (RCT)。研究选择和数据提取由两名独立评审员同时进行，使用物理治疗证据数据库量表（PEDro）对纳入的文献进行质量评估。加权平均差（WMD）或标准化平均差（SMD）是通过采用固定或随机效应模型计算的。其他统计分析包括亚组分析和敏感性分析。证据质量通过推荐等级、评估、制定和评估（GRADE）方法进行评估。

结果

其中包括八项随机对照试验。分析报告左心室射血分数（LVEF；WMD = 0.47，95% CI [−4.10, 5.03]，p  = 0.841）、峰值摄氧量（峰值 VO ₂）（SMD = 0.38，95% CI [−4.10, 5.03]，p = 0.841）没有显着改善。 0.03, 0.80], p  = 0.069) 和 6 分钟步行距离 (6MWD) (WMD = 14.10, 95% CI [−9.51, 37.72], p  = 0.242)。不同强度的运动干预对生活质量产生小到中度的有益影响（WMD = -4.99，95% CI [-8.29，-1.68]，p  = 0.003），这种影响在长期随访中似乎减弱了（ WMD = 2.12，95% CI [−2.91, 7.16]，p  = 0.409）。

结论

高强度运动在改善CHF患者心肺功能和有氧能力方面并不比中等强度运动具有显着优势。在长期随访期间，高强度运动带来的生活质量的有益变化似乎也有所减少，这表明高强度运动的功效具有累积效应。