Exercise interventions in patients with ICDs and CRT-Ds significantly reduced the occurrence of ICD shocks during follow-up (15.6% vs 23%; OR 0.68; 95% CI 0.48-0.80; P<0.001).
Systematic Review (n=2,547)
Do exercise interventions improve exercise performance and reduce ICD shocks in patients with implantable cardioverter-defibrillators and cardiac resynchronization therapy?
Exercise interventions in patients with ICDs and CRT-Ds appear safe, significantly improve exercise capacity, and are associated with a reduction in ICD shocks during follow-up.
Effect estimate: OR 0.68 (95% CI 0.48-0.80)
Absolute Event Rate: 15.6% vs 23%
p-value: p=< .001
PURPOSE: Physical activity improves outcomes across a broad spectrum of cardiovascular disease. The safety and effectiveness of exercise-based interventions in patients with implantable cardioverter-defibrillators (ICDs) including cardiac resynchronization therapy defibrillators (CRT-Ds) remain poorly understood. METHODS: We identified clinical studies using the following search terms: "implantable cardioverter-defibrillators"; "ICD"; "cardiac resynchronization therapy"; "CRT"; and any one of the following: "activity"; "exercise"; "training"; or "rehabilitation"; from January 1, 2000 to October 1, 2015. Eligible studies were evaluated for design and clinical endpoints. RESULTS: A total of 16 studies were included: 8 randomized controlled trials, 5 single-arm trials, 2 observational cohort trials, and 1 randomized crossover trial. A total of 2547 patients were included (intervention groups = 1215 patients, control groups = 1332 patients). Exercise interventions varied widely in character, duration (median 84 d, range: 23-168 d), and follow-up time (median 109 d, range: 23 d to 48 mo). Exercise performance measures were the most common primary endpoints (87.5%), with most studies (81%) demonstrating significant improvement. Implantable cardioverter-defibrillator shocks were uncommon during active exercise intervention, with 6 shocks in 635 patients (0.9%). Implantable cardioverter-defibrillator shocks in follow-up were less common in patients receiving any exercise intervention (15.6% vs 23%, OR = 0.68; 95% CI, 0.48-0.80, P < .001). (Equation is included in full-text article.)O2 peak improved significantly in patients receiving exercise intervention (1.98 vs 0.36 mL/kg/min, P < .001). CONCLUSION: In conclusion, exercise interventions in patients with ICDs and CRT-Ds appear safe and effective. Lack of consensus on design and endpoints remains a barrier to broader application to this important patient population.
Steinhaus et al. (Thu,) conducted a systematic review in Patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) (n=2,547). Exercise interventions vs. Control groups was evaluated on Implantable cardioverter-defibrillator shocks in follow-up (OR 0.68, 95% CI 0.48-0.80, p=< .001). Exercise interventions in patients with ICDs and CRT-Ds significantly reduced the occurrence of ICD shocks during follow-up (15.6% vs 23%; OR 0.68; 95% CI 0.48-0.80; P<0.001).