Key result
Endurance training, functional electrical stimulation, and inspiratory muscle training significantly improved peak oxygen uptake (MD 1.89, 2.28, and 2.72 ml/kg/min, respectively) in patients with HFpEF.
Why the study?
To better understand the effects of endurance training, combined exercise, functional electrical stimulation, and inspiratory muscle training on diastolic function, exercise performance, and quality of life in HFpEF patients.
Do exercise training and physiotherapies improve exercise capacity, diastolic function, and quality of life in patients with HFpEF?
Meta-Analysis (n=673)
Do exercise training and physiotherapies improve exercise capacity, diastolic function, and quality of life in patients with HFpEF?
Functional electrical stimulation and inspiratory muscle training offer similar benefits to endurance training for improving functional capacity and quality of life in patients with HFpEF.
FES/IMT improve capacity and QoL in HFpEF similarly to endurance training; extends options for patients intolerant to conventional exercise.
Background: We aimed to better understand the effects of two exercise training interventions [endurance training and a combination of endurance and resistance training (combined exercise)] and two physiotherapies [functional electrical stimulation (FES) and inspiratory muscle training (IMT)] on diastolic function, exercise performance and quality of life (QoL) in heart failure with preserved ejection fraction (HFpEF) patients. Methods: Cochrane Library, EMBASE and MEDLINE via PubMed for randomized controlled trials were searched from their inception to May 2020. The methodological quality was assessed using the Physiotherapy Evidence Database sacle. All analyses were used by STATA. Results: A total of 14 articles on 13 trials were included in this meta-analysis with 673 HFpEF patients. The pooling revealed that peak oxygen uptake was improved by endurance training [MD (95% CI): 1.89 ml.kg -1 .min -1 (1.32, 2.46), P < 0.001], FES [MD (95% CI): 2.28 ml.kg -1 .min -1 (0.92, 3.65), P = 0.001] and IMT [MD (95% CI): 2.72 ml.kg -1 .min -1 (1.44, 3.99), P < 0.001]. Similar results were observed for 6-minute walk test and QoL. Besides, endurance training increased arterial venous oxygen difference [MD (95% CI): 1.41 (0.09, 2.74), P = 0.036]. Combined exercise was beneficial to the ratio of peak early to late diastolic mitral inflow velocities [MD (95% CI): -2.90 (-4.97, -0.83), P = 0.006] and the early diastolic mitral annual velocity [MD (95% CI): 1.40 (0.68, 2.12), P = 0.006]. IMT improved ventilation/carbon dioxide ratio slope [MD (95% CI): -3.36 ml.kg -1 .min -1 (-6.17, -0.54), P = 0.019]. Conclusions: FES and IMT may be therapeutic options to improve functional capacity and QoL in HFpEF patients, and the outcomes are similar to endurance training. Combined exercise tends to improve diastolic function in HFpEF patients.
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Zhuang et al. (2021) conducted a meta-analysis in Heart failure with preserved ejection fraction (HFpEF) (n=673). Exercise training (endurance/combined), FES, and IMT vs. Sedentary lifestyle or usual care was evaluated on Peak oxygen uptake (peak VO2) with endurance training (MD 1.89, 95% CI 1.32, 2.46, p=< 0.001). Endurance training, functional electrical stimulation, and inspiratory muscle training significantly improved peak oxygen uptake (MD 1.89, 2.28, and 2.72 ml/kg/min, respectively) in patients with HFpEF.
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