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. 2024 Jun 26;4(4):oeae033.
doi: 10.1093/ehjopen/oeae033. eCollection 2024 Jul.

Exercise training improves exercise capacity and quality of life in heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials

Ranu Baral  1 , Jamie Sin Ying Ho  2 , Ayesha Nur Soroya  3 , Melissa Hanger  3 , Rosemary Elizabeth Clarke  3 , Sara Fatima Memon  3 , Hannah Glatzel  4 , Mahmood Ahmad  2 , Rui Providencia  3   5 , Jonathan James Hyett Bray  6 , Fabrizio D'Ascenzo  7
Affiliations

Exercise training improves exercise capacity and quality of life in heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials

Ranu Baral et al. Eur Heart J Open. .

Abstract

Aims: Heart failure with preserved ejection fraction (HFpEF) is associated with high morbidity and mortality, and there are limited proven therapeutic strategies. Exercise has been shown to be beneficial in several studies. We aimed to evaluate the efficacy of exercise on functional, physiological, and quality-of-life measures.

Methods and results: A comprehensive search of Medline and Embase was performed. Randomized controlled trials (RCTs) of adult HFpEF patients with data on exercise intervention were included. Using meta-analysis, we produced pooled mean difference (MD) estimates with 95% confidence intervals (CIs) with Review Manager (RevMan) software for the peak oxygen uptake (VO2), Minnesota living with heart failure (MLWHF) and, other diastolic dysfunction scores. A total of 14 studies on 629 HFpEF patients were included (63.2% female) with a mean age of 68.1 years. Exercise was associated with a significant improvement in the peak VO2 (MD 1.96 mL/kg/min, 95% CI 1.25-2.68; P < 0.00001) and MLWHF score (MD -12.06, 95% CI -17.11 to -7.01; P < 0.00001) in HFpEF. Subgroup analysis showed a small but significant improvement in peak VO2 with high-intensity interval training (HIIT) vs. medium-intensity continuous exercise (MCT; MD 1.25 mL/kg/min, 95% CI 0.41-2.08, P = 0.003).

Conclusion: Exercise increases the exercise capacity and quality of life in HFpEF patients, and high-intensity exercise is associated with a small but statistically significant improvement in exercise capacity than moderate intensity. Further studies with larger participant populations and longer follow-up are needed to confirm these findings and elucidate potential differences between high- and medium-intensity exercise.

Keywords: Exercise training; HFpEF; Heart failure; Heart failure with preserved ejection fraction; Meta-analysis.

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Conflict of interest statement

Conflict of interest: none declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram of the trial selection process.
Figure 2
Figure 2
Forest plot showing the effect of exercise training on peak oxygen uptake (VO2) among participants with heart failure and preserved ejection fraction. CI, confidence interval; MD, mean difference.
Figure 3
Figure 3
Subgroup analysis of studies investigating high- vs. moderate-intensity exercise. Forest plot showing the effect of exercise training on peak oxygen uptake (VO2) among participants with heart failure and preserved ejection fraction. CI, confidence interval; MD, mean difference.
Figure 4
Figure 4
Effect of exercise training on quality of life. Forest plot showing the effect of exercise training quality of life, estimated using the Minnesota living with heart failure (MLWHF) score, among participants with heart failure and preserved ejection fraction. CI, confidence interval; MD, mean difference.
Figure 5
Figure 5
Effect of exercise training on diastolic function. Forest plot showing the effect of exercise training on the E/A ratio (A), deceleration time (B) on the E/e′ ratio (C) among participants with heart failure and preserved ejection fraction. CI, confidence interval; MD, mean difference.
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