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

Session Young Investigator Award session 2 - Cardiac Rehabilitation and Sports Cardiology

Speaker Justien Cornelis

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2016

  • Topic : preventive cardiology
  • Sub-topic : Exercise Testing
  • Session type : Young Investigator Award Abstracts

Authors : J Cornelis (Antwerp,BE), P Beckers (Antwerp,BE), J Taeymans (Bern,CH), C Vrints (Antwerp,BE), D Vissers (Antwerp,BE)

J Cornelis1 , P Beckers2 , J Taeymans3 , C Vrints2 , D Vissers1 , 1University of Antwerp, Department of Physiotherapy (REVAKI) - Antwerp - Belgium , 2University of Antwerp Hospital (Edegem), Department of Cardiology - Antwerp - Belgium , 3Bern University of Applied Sciences, Health - Bern - Switzerland ,

European Journal of Preventive Cardiology ( September 2016 ) 23 ( Supplement 1 ), S29

Background: Several exercise modalities are suggested to improve exercise capacity and therefore prognosis in patients with heart failure (HF). Moreover, quality of life (QOL) and functional modifications of the heart seem to be changeable with training. However, it is not clear which modality of physical activity is superior.
Purpose: In order to assess effect sizes of different exercise modalities, a systematic review and meta-analysis was performed according the PRISMA statement.
Methods: Randomized clinical trials (RCTs) in PubMed, Cochrane Library and Web of Science were selected. Primary outcome data were cardiorespiratory parameters i.e. peak oxygen uptake (peakVO2), ventilation over carbon dioxide slope (VE/VCO2slope), oxygen uptake efficiency slope (OUES), exercise oscillatory ventilation (EOV), rest and peak pulmonary end-tidal CO2 (PETCO2). Secondary variables were QOL, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD). Extracted data were pooled using random or fixed effects meta-analysis, if appropriate.
Results: Twenty RCTs (n=811) met the a-priori stated inclusion criteria. Studies were categorized into four different groups i.e. "interval training (IT1) versus IT and strength (IT1-S)" (n=156), "continuous training (CT1) versus CT and strength (CT1-S)" (n=130), "IT2 versus CT2" (n=501) and "CT3 versus strength (S3)" (n=24). No significant random effects of exercise modality were revealed assessing VE/VCO2slope. However, a trend was seen towards IT2 for peakVO2 (P=0.099). Insufficient data were reported to assess the other primary parameters. There was a significant improvement in QOL with IT1-S (P<0.001). Comparing IT2 versus CT2, LVEDD and LVEF were significantly improved when applying IT2 (P<0.001).
Conclusions: There is some evidence to support high intensity interval training could be more effective to improve QOL, LVEF and LVEDD. Towards cardiorespiratory prognostic parameters however, it is not clear which training modality is outstanding. The fact that patients with HF are actively involved in whatever kind of exercise training seems to be enough to improve prognostic parameters, QOL and anatomic function of the heart.

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