Key result
Exercise training increases maximal workload by ~26 W vs control in HF patients with CRT.
Why the study?
The authors aimed to systematically review published literature on the impact of exercise training in chronic heart failure patients who received cardiac resynchronization therapy.
Does exercise training improve exercise capacity, cardiac function, and health-related quality of life in chronic heart failure patients with cardiac resynchronization therapy?
Meta-Analysis (n=235)
Does exercise training improve exercise capacity, cardiac function, and health-related quality of life in chronic heart failure patients with cardiac resynchronization therapy?
Effect estimate: MD 26.32 W (95% CI 19.41-33.23)
p-value: p=<0.00001
Light to moderate exercise training safely improves exercise capacity, cardiac function, and quality of life in chronic heart failure patients who have received cardiac resynchronization therapy.
Supports recommending exercise training for HF patients with CRT; extends cardiac rehabilitation evidence to this subgroup.
BACKGROUND AND OBJECTIVE: Systematically review the current published literature on the impact of exercise training (ET) in chronic heart failure (CHF) patients who were conducted cardiac resynchronization therapy (CRT). METHODS: PubMed, EMBASE, and the Cochrane Library of Controlled Trails databases were searched for trials comparing the additional effects of ET in CHF patients after CRT implantation with no exercise or usual care control up until 2020.03.07. We independently screened the literature, extracted data, employed the tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) to evaluate study quality and risk of bias, and performed meta-analysis with Revman 5.3 software. RESULTS: Eight trials were identified for qualitative analysis and 7 randomized controlled trails (RCTs) included 235 participants (120 ET; 115 controls) for quantitative analysis. The results showed that the maximal workload (mean difference [MD] 26.32 W, 95% CI 19.41-33.23; P < .00001, I2 = 0%) and the exercise duration (MD 68.95 seconds, 95% CI 15.41-122.48; P = .01, I2 = 76%) had significant improvement in the ET group versus control. Subgroup analysis showed that compared with control, the change in peak oxygen uptake (VO2) (MD 3.05 ml/kg/minute, 95% CI 2.53-3.56; P < .00001, I2 = 0%), left ventricular ejection fraction (LVEF) (MD 4.97%, 95% CI 1.44-8.49; P = .006, I2 = 59%), and health related quality of life (HRQoL) (the change in Minnesota living with heart failure questionnaire [MLHFQ]: MD -19.96, 95% CI -21.57 to -18.34; P < .00001, I2 = 0%) were significantly improved in the light to moderate intensity training (non-HIT) group, while there seemed no statistical difference of above endpoints in the high intensity training (HIT) group. CONCLUSION: During the short term (up to 6 months), non-HIT could improve exercise capacity, cardiac function, and HRQoL in CHF patients with CRT. However, due to the small number of participants, a high-quality large-sample multicenter trial is demanded.
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Guo et al. (2021) conducted a meta-analysis in Chronic heart failure with cardiac resynchronization therapy (n=235). Exercise training vs. No exercise or usual care was evaluated on Maximal workload (MD 26.32 W, 95% CI 19.41-33.23, p=<0.00001). Exercise training significantly improved maximal workload by a mean difference of 26.32 W and exercise duration by 68.95 seconds compared to control in chronic heart failure patients with cardiac resynchronization therapy.
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