Effect of Aerobic Exercise on Peak Oxygen Consumption, VE/VCO2 Slope, and Health-Related Quality of Life in Patients with Heart Failure with Preserved Left Ventricular Ejection Fraction: a Systematic Review and Meta-Analysis
- 100 Downloads
Purpose of Review
The aim of this study was to determine the effects of aerobic exercise on peak oxygen uptake (peak VO2), minute ventilation/carbon dioxide production (VE/VCO2 slope), and health-related quality of life (HRQoL) among patients with heart failure (HF) and preserved ejection fraction (HFpEF).
We conducted a Cochrane Library, MEDLINE/PubMed, Physiotherapy Evidence Database, and SciELO search (from 1985 to May 2019) for randomized controlled trials that evaluated the effects of aerobic exercise in HFpEF patients. We calculated the mean differences (MD) and 95% confidence interval (CI). Ten intervention studies were included providing a total of 399 patients. Compared with control, aerobic exercise resulted in improvement in peak VO2 MD 1.9 mL kg−1 min−1 (95% CI 1.3 to 2.5; N = 314) and HRQoL measured by Minnesota Living with Heart Failure MD 5.4 (95% CI − 10.5 to − 0.2; N = 256). No significant difference in VE/VCO2 slope was found between participants in the aerobic exercise group and the control group. The quality of evidence for peak VO2 and HRQoL was assessed as being moderate.
Aerobic exercise moderately improves peak VO2 and HRQoL and should be considered a strategy of rehabilitation of HFpEF individuals.
KeywordsAerobic exercise Heart failure Left ventricular ejection fraction
Compliance with Ethical Standards
Conflict of Interest
Mansueto Gomes Neto, André Rodrigues Durães, Lino Sergio Rocha Conceição, Leonardo Roever, Tong Liu7 Gary Tse, Giuseppe Biondi-Zoccai, Ana Lucia Barbosa Goes, Lura Gonzalez Nogueira Alves, Øyvind Ellingsen, and Vitor Oliveira Carvalho declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 4.Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18:891–975.CrossRefGoogle Scholar
- 7.Upadhya B, Haykowsky MJ, Eggebeen J, Kitzman DW. Exercise intolerance in heart failure with preserved ejection fraction: more than a heart problem. JGeriatrCardiol. 2015;12(3):294–304. https://doi.org/10.11909/j.issn.1671-5411.2015.03.013.CrossRefGoogle Scholar
- 9.Gomes Neto M, Durães AR, Conceição LSR, Saquetto MB, Ellingsen Ø, Carvalho VO. High intensity interval training versus moderate intensity continuous training on exercise capacity and quality of life in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis. Int J Cardiol. 2018;261:134–41.CrossRefGoogle Scholar
- 13.Higgins JPT, Green S. The Cochrane library. Issue 4. Chichester: John Wiley & Sons; 2006. Cochrane handbook for Systematic Reviews of Interventions 4.2.6 [update September 2006Google Scholar
- 14.Olivo SA, Macedo LG, Gadotti IN, Fuentes J, Stanton T, Magee DJ. Scales to assess the quality of randomized controlled trials: a systematic review. PhysTher. 2008;88(2):156–75.Google Scholar
- 19.Collaboration TC. Available at: www.cochrane.org. [Accessed 3 Feb 2008].
- 20.• Maldonado-Martín S, Brubaker PH, Eggebeen J, Stewart KP, Kitzman DW. Association between 6-minute walk test distance and objective variables of functional capacity after exercise training in elderly heart failure patients with preserved ejection fraction: a randomized exercise trial. Arch Phys Med Rehabil. 2017;98(3):600–3 This study demonstrated Peak VO2 improved in the AE. CrossRefGoogle Scholar
- 21.Kitzman DW, Brubaker P, Morgan T, Haykowsky M, Hundley G, Kraus WE, et al. Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical trial. JAMA. 2016;315(1):36–46.CrossRefGoogle Scholar
- 22.• Angadi SS, Mookadam F, Lee CD, Tucker WJ, Haykowsky MJ, Gaesser GA. High-intensity interval training vs. moderate-intensity continuous exercise training in heart failure with preserved ejection fraction: a pilot study. J Appl Physiol (1985). 2015;119(6):753–8 This study demonstrated the HIIT improved VO 2 peak and left ventricular diastolic dysfunction grade. CrossRefGoogle Scholar
- 23.• Kitzman DW, Brubaker PH, Herrington DM, Morgan TM, Stewart KP, Hundley WG, et al. Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. J Am Coll Cardiol. 2013;62(7):584–92. https://doi.org/10.1016/j.jacc.2013.04.033 Exercise training increased peak VO 2 and quality of life. CrossRefPubMedPubMedCentralGoogle Scholar
- 25.• Alves AJ, Ribeiro F, Goldhammer E, Rivlin Y, Rosenschein U, Viana JL, et al. Exercise training improves diastolic function in heart failure patients. Med Sci Sports Exerc. 2012;44(5):776–85 Exercise training increased the mean ratio of early to late mitral inflow velocities (E/A ratio) and decreased deceleration time (DT) of early filling in patients with mild and preserved LVEF. CrossRefGoogle Scholar
- 26.Haykowsky MJ, Brubaker PH, Stewart KP, Morgan TM, Eggebeen J, Kitzman DW. Effect of endurance training on the determinants of peak exercise oxygen consumption in elderly patients with stable compensated heart failure and preserved ejection fraction. J Am Coll Cardiol. 2012;60(2):120–8.CrossRefGoogle Scholar
- 27.• Smart NA, Haluska B, Jeffriess L, Leung D. Exercise training in heart failure with preserved systolic function: a randomized controlled trial of the effects on cardiac function and functional capacity. Congest Heart Fail. 2012;18(6):295–301 After exercise training, the increment in peak VO 2. CrossRefGoogle Scholar
- 34.Arnold M, Rajda M, Ignaszewski A, Howlett J, Leblanc M-H. Changes in the Minnesota living with heart failure questionnaire score and clinical outcomes in a large contemporary population of ambulatory heart failure patients in the Canadian heart failure network. J Card Fail. 2012;18(8 Supplement):S79.CrossRefGoogle Scholar
- 36.Sato T, Yoshihisa A, Kanno Y, Suzuki S, Yamaki T, Sugimoto K, et al. Cardiopulmonary exercise testing as prognostic indicators: comparisons among heart failure patients with reduced, mid-range and preserved ejection fraction. Eur J Prev Cardiol. 2017;24(18):1979–87. https://doi.org/10.1177/2047487317739079.CrossRefPubMedGoogle Scholar