Comparative Efficacy of Various Exercise Modes on Inflammatory Markers in Patients with Heart Failure: A Pairwise and...

The aim of this systematic review with pairwise and network meta-analyses was to identify the most effective exercise mode for reducing pro-inflammatory markers in patients with heart failure (HF).

A systematic electronic search was carried out in PubMed, Scopus, and Web of Science from inception to June 2024 in English-language publications. Randomized trials investigating the effect of any mode of exercise training, including aerobic training (AT), resistance training (RT), combined training (CT), or Tai Chi/Yoga on pro-inflammatory markers, including IL-6, TNF-α, or CRP in patients with HF with reduced or preserved left ventricular ejection fraction (LVEF) were included. Standardized mean differences (SMDs) and 95% CIs were determined using random-effects models for meta-analyses.

A total of 21 studies involving 1,022 patients with HF were included. Overall, compared with controls (CON), exercise training was significantly more effective for reducing IL-6 (SMD -0.33, 95% CI -0.56 to -0.11, p=0.003), TNF-α (SMD -0.17, 95% CI -0.34 to -0.00, p=0.04), and CRP (SMD -0.57, 95% CI -1.02 to -0.13, p=0.01). Particularly, RT (SMD -0.91, 95% CI -1.32 to -0.49, p=0.001) and Tai Chi/Yoga (SMD -0.70, 95% CI -1.22 to -0.19, p=0.006) was the most effective modality for reducing IL-6, CT (SMD -0.44, 95%CI -0.80 to -0.09, p=0.01) and AT (SMD -0.25, 95% CI -0.49 to 0.01, p=0.03) was the optimal modality for lowering TNF-α, and CT (SMD -1.34, 95% CI -2.28 to -0.40, p=0.004) was the optimal modality for lowering CRP.

Exercise training may contribute to improvements in chronic low-grade inflammation in patients with HF. RT is likely to be the most effective exercise mode for reducing IL-6, while of the exercise modalities studied, CT was optimal for lowering TNF-α and CRP. These findings should, however, be interpreted with caution due to heterogeneity and the limited number of studies.