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Meta-Analysis
. 2022 May 1;79(5):698-710.
doi: 10.1097/FJC.0000000000001254.

Physical Exercise Modalities for the Management of Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Affiliations
Meta-Analysis

Physical Exercise Modalities for the Management of Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

Yuan Guo et al. J Cardiovasc Pharmacol. .

Abstract

Different physical exercise modalities have been widely studied in patients having heart failure with preserved ejection fraction (HFpEF) but with variably reported findings. We, therefore, conducted a systematic review and meta-analysis to evaluate whether the efficacy of physical activity in the management of HFpEF is related to exercise modalities. PubMed and Embase were searched up to July 2021. The eligible studies included randomized controlled trials that identified effects of physical exercise on patients with HFpEF. Sixteen studies were included to evaluate the efficiency of physical exercise in HFpEF. A pooled analysis showed that exercise training significantly improved peak oxygen uptake (VO2), ventilatory anaerobic threshold, distance covered in the 6-minute walking test, the ratio of early diastolic mitral inflow to annular velocities, the Short Form 36 physical component score, and the Minnesota Living with Heart Failure Questionnaire total score. However, the changes in other echocardiographic parameters including the ratio of peak early to late diastolic mitral inflow velocities, early diastolic mitral annular velocity, and left atrial volume index were not significant. Both high-intensity and moderate-intensity training significantly improved exercise capacity (as defined by peak VO2), with moderate-intensity exercise having a superior effect. Furthermore, exercise-induced improvement in peak VO2 was partially correlated with exercise duration. Physical exercise could substantially improve exercise capacity, quality of life, and some indicators of cardiac diastolic function in patients with HFpEF. A protocol of moderate-intensity exercise training lasting a longer duration might be more beneficial compared with high-intensity training for patients with HFpEF.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Flow diagram of the systematic review.
FIGURE 2.
FIGURE 2.
Forest plot showing effects of physical exercise on exercise capacity. The indicators of exercise capacity were calculated as differences between the means at baseline and the end of exercise training. After data pooled as continuous variables and analyzed with random-effects models, the difference was considered significant when P < 0.05. Heterogeneity was assessed using Cochran's Q and I2 statistic, and P < 0.05 with I2 > 50% was considered significant. All results are reported as an SMD (baseline after exercise) with a 95% CI. A, Peak VO2 (P < 0.001). B, VAT (P < 0.001). C, VE/VCO2 slope (P = 0.06). D, 6MWT distance (P < 0.001).
FIGURE 3.
FIGURE 3.
Forest plot showing effects of exercise training on cardiac diastolic function. The indicators of cardiac diastolic function were calculated as differences between the means at baseline and the end of exercise training. After data pooled as continuous variables and analyzed with random-effects models, the difference was considered significant when P < 0.05. Heterogeneity was assessed using Cochran's Q and I2 statistic, and P < 0.05 with I2 > 50% was considered significant. All results are reported as an SMD (baseline—after exercise) with a 95% CI. A, E/A (P = 0.79). B, E/e′ (P = 0.023). C, e′ (P = 0.381). D, LAVI (P = 0.065).
FIGURE 4.
FIGURE 4.
Forest plot for the effect of exercise training on quality of life. The indicators of quality of life were calculated as differences between the means at baseline and the end of exercise training. After data pooled as continuous variables and analyzed with random-effects models, the difference was considered significant when P < 0.05. Heterogeneity was assessed using Cochran's Q and I2 statistic, and P < 0.05 with I2 > 50% was considered significant. All results are reported as an SMD (baseline—after exercise) with a 95% CI. A, SF-36 score (P < 0.001). B, MLWHF score (P < 0.001). C, KCCQ score (P = 0.088).
FIGURE 5.
FIGURE 5.
Effects of exercise intensity on exercise capacity and cardiac diastolic function across subgroups. High-intensity and moderate-intensity exercise training on peak VO2, E/e′, and e′ were, respectively, compared. All results are reported as an SMD (baseline after exercise) with a 95% CI. Peak VO2 reflects exercise capacity. E/e′ means the ratio of early diastolic mitral inflow to annular velocities, and e′ means early diastolic mitral annular velocity, which indicates left ventricular diastolic function.

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References

    1. Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017;14:591–602. - PubMed
    1. Cuijpers I, Simmonds SJ, van Bilsen M, et al. Microvascular and lymphatic dysfunction in HFpEF and its associated comorbidities. Basic Res Cardiol. 2020;115:39. - PMC - PubMed
    1. Mishra S, Kass DA. Cellular and molecular pathobiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2021;18:400–423. - PMC - PubMed
    1. Bozkurt B, Fonarow GC, Goldberg LR, et al. Cardiac rehabilitation for patients with heart failure: JACC Expert Panel. J Am Coll Cardiol. 2021;77:1454–1469. - PubMed
    1. Thomas RJ, Beatty AL, Beckie TM, et al. Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. J Am Coll Cardiol. 2019;74:133–153. - PMC - PubMed