Comparing exercise training modalities in heart failure: A systematic review and meta-analysis

Area of Science:

• Cardiology and Exercise Physiology
• Heart Failure Management

Background:

• Exercise training (ET) is recognized for improving exercise capacity, prognosis, and quality of life (QOL) in heart failure (HF) patients.
• Optimal ET modality for HF patients remains unclear.

Purpose of the Study:

• To systematically review and meta-analyze the effectiveness of different ET modalities on cardiopulmonary exercise test (CPET) parameters, QOL, and left ventricular remodeling in HF.
• To identify the best ET approach for improving patient outcomes.

Main Methods:

• Systematic review and meta-analysis of randomized clinical trials (RCTs) from three databases.
• Included 20 RCTs (n=811) with data on peak oxygen uptake, ventilation/carbon dioxide slope, QOL, left ventricular ejection fraction (LVEF), and left ventricular end-diastolic diameter (LVEDD).
• Studies categorized into interval training (IT) vs. combined IT and strength training (IT1S), continuous training (CT1) vs. combined CT and strength training (CT1S), IT2 vs. CT2, and CT3 vs. strength training (S3).

Main Results:

• No significant differences in CPET parameters across exercise modalities.
• Combined continuous and strength training (CT1S) significantly improved QOL (P<0.001).
• Interval training (IT2) significantly improved LVEDD and LVEF compared to continuous training (CT2) (P<0.001).

Conclusions:

• Interval training may be more effective for improving left ventricular remodeling (LVEF and LVEDD) in HF patients.
• Any form of supervised exercise training appears sufficient to enhance prognosis, QOL, and cardiac function in HF.
• Further research into specific ET protocols is warranted.