Abstract
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.
Zusammenfassung
Hintergrund
Trainingsbasierte kardiale Rehabilitation hat positive Auswirkungen auf Patienten mit chronischer Herzinsuffizienz (CHF), aber die Auswahl der Trainingsintensität ist umstritten. Ziel der vorliegenden systematischen Übersicht und Metaanalyse war es, die Auswirkungen verschiedener Trainingsintensitäten auf die Herz-Lungen-Funktion und Lebensqualität (QoL) bei Patienten mit CHF zu untersuchen.
Methoden
Randomisierte kontrollierte Studien (RCT) zu unterschiedlichen Trainingsintensitäten bei Patienten mit CHF wurden in den Datenbanken PubMed, Web of Science, der Cochrane Library und Embase von Beginn bis Dezember 2021 gesucht. Die Studienauswahl und Datenextraktion erfolgten gleichzeitig durch 2 unabhängige Untersucher unter Verwendung der Physiotherapy Evidence Database Scale (PEDro) für die Qualitätsbeurteilung der einbezogenen Literatur. Die gewichteten mittleren Differenzen (WMD) oder standardisierten mittleren Differenzen (SMD) wurden unter Einsatz eines Fixed- oder Random-Effects-Modells berechnet. Zu den weiteren statistischen Analysen gehörten die Subgruppen- und die Sensitivitätsanalyse. Die Qualität der Evidenz wurde anhand der GRADE-Methode (Grade of Recommendation, Assessment, Development, and Evaluation) beurteilt.
Ergebnisse
In die Analyse wurden 8 RCT eingeschlossen. Die Auswertung ergab keine signifikante Verbesserung bei der linksventrikulären Ejektionsfraktion (LVEF; WMD = 0,47, 95 %-Konfidenzintervall, 95 %-KI: −4,10; 5,03; p = 0,841), dem Spitzenwert der Sauerstoffaufnahme (PeakVO2; SMD = 0,38; 95 %-KI:−0,03; 0,80; p = 0,069) und der 6‑min-Gehstrecke (6MWD; WMD = 14,10; 95 %-KI:−9,51; 37,72; p = 0,242). Trainingsinterventionen verschiedener Intensität führten zu geringen bis mittleren positiven Auswirkungen auf die QoL (WMD = −4,99; 95 %-KI:−8,29; −1,68; p = 0,003), die sich jedoch bei der Langzeitnachbeobachtung abzuschwächen schienen (WMD = 2,12; 95 %-KI:−2,91; 7,16; p = 0,409).
Schlussfolgerung
Training hoher Intensität bringt keinen deutlichen Vorteil gegenüber Training mittlerer Intensität in Bezug auf die Verbesserung der Herz-Lungen-Funktion und der aeroben Kapazität bei Patienten mit CHF. Positive Veränderungen der QoL durch Training hoher Intensität schienen auch während der Langzeitnachbeobachtung abzunehmen, was auf einen kumulativen Effekt der Wirksamkeit von Training hoher Intensität hinweist.
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Contributions
Conceptualization, Yan Bai and Fengying Wang; methodology, Fengying Wang; software, Fengying Wang and Wenqin Zhou; data curation, Yan Bai and Fengying Wang; writing-original draft preparation, Xiaoyan Wang; writing-review and editing, Xiaoyan Wang and Bin Hua. All authors have read and agreed to the published version of the manuscript.
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F. Wang, Y. Bai, B. Hua, W. Zhou and X. Wang declare that they have no competing interests.
For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.
Additional information
The authors Fengying Wang and Yan Bai contributed equally to this work.
Data Availability Statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Appendix
Appendix
Sensitivity analysis of LVEF
Sensitivity analysis of peak VO2
Sensitivity analysis of 6WMT
Sensitivity analysis of QoL
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Wang, F., Bai, Y., Hua, B. et al. Effect of different intensity exercises on cardiopulmonary function and quality of life of patients with chronic heart failure. Herz 49, 134–146 (2024). https://doi.org/10.1007/s00059-023-05202-5
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DOI: https://doi.org/10.1007/s00059-023-05202-5