Effects of Exercise on LV Remodeling in Heart Failure
Effects of Exercise on LV Remodeling in Heart Failure
Exercise training was associated with a significant improvement in EF when data from 16 comparisons were pooled (SMD = 0.33; 95% CI 0.13 to 0.52), this analysis demonstrated significant heterogeneity (p = 0.05). Aerobic training demonstrated significant improvement benefits in EF (SMD = 0.44; 95% CI 0.28 to 0.61). Strength training and combined training (aerobic plus strength exercise) did not show any benefit in EF (Table 2).
In the aerobic training group, however, the effect of long-term aerobic training on EF (≥6 months) was much better than that of short-term training (Table 2).
Sixteen comparisons (15 trials) examined the effects of exercise training on EDV, and 15 comparisons (14 trials) on ESV. Overall, exercise training was not associated with a decline in EDV (SMD = −0.20; 95% CI −0.20 to −0.06) and ESV (SMD = −0.26; 95% CI −0.40 to −0.12). Aerobic training led to significant improvements in EDV (12 trials; 573 patients; SMD = −0.33; 95% CI −0.49 to −0.16) and ESV (11 trials; 548 patients; SMD = −0.40; 95% CI −0.57 to −0.23). The effects of combined aerobic and strength training were inconclusive for both EDV (3 trials; 218 patients; SMD = 0.11; 95% CI −0.15 to 0.38) and ESV (3 trials; 218 patients; SMD = 0.09; 95% CI −0.18 to 0.35).
Long-term aerobic exercise (≥6 months) had a marked positive effect on EDV (SMD = −0.38; 95% confidence interval −0.57 to −0.19) and ESV (SMD = −0.48; 95% confidence interval −0.67 to −0.29) (Figures 2 and 3), but there was no evidence of benefit with short-term duration (<6 months): EDV (−0.14; 95% confidence interval −0.48 to 0.21) and ESV (−0.08; 95% confidence interval −0.47 to 0.30).
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Figure 2.
Long-term (≥6 months) aerobic training and end-diastolic volume
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Figure 3.
Long-term (≥6month) aerobic training and end-systolic volume
Whether training duration was short or long, the effects of combined training on remodelling were inconclusive, with all confidence intervals including 0. One trials testing strength training alone which duration were less than 6 months was also inconclusive (Table 2).
Exclusion of the low quality study. and the heaviest trial. did not change the positive direction of our results (Table 2).
No evidence of publication bias was found either by visually at inspection of funnel plots (Figure 4) or analytically at Egger test (p = 0.41).
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Figure 4.
Funnel plot for publication bias
Meta-analysis Results
Exercise Training and Ejection Fraction
Exercise training was associated with a significant improvement in EF when data from 16 comparisons were pooled (SMD = 0.33; 95% CI 0.13 to 0.52), this analysis demonstrated significant heterogeneity (p = 0.05). Aerobic training demonstrated significant improvement benefits in EF (SMD = 0.44; 95% CI 0.28 to 0.61). Strength training and combined training (aerobic plus strength exercise) did not show any benefit in EF (Table 2).
In the aerobic training group, however, the effect of long-term aerobic training on EF (≥6 months) was much better than that of short-term training (Table 2).
Exercise Training and Left Ventricular Volumes
Sixteen comparisons (15 trials) examined the effects of exercise training on EDV, and 15 comparisons (14 trials) on ESV. Overall, exercise training was not associated with a decline in EDV (SMD = −0.20; 95% CI −0.20 to −0.06) and ESV (SMD = −0.26; 95% CI −0.40 to −0.12). Aerobic training led to significant improvements in EDV (12 trials; 573 patients; SMD = −0.33; 95% CI −0.49 to −0.16) and ESV (11 trials; 548 patients; SMD = −0.40; 95% CI −0.57 to −0.23). The effects of combined aerobic and strength training were inconclusive for both EDV (3 trials; 218 patients; SMD = 0.11; 95% CI −0.15 to 0.38) and ESV (3 trials; 218 patients; SMD = 0.09; 95% CI −0.18 to 0.35).
Long-term aerobic exercise (≥6 months) had a marked positive effect on EDV (SMD = −0.38; 95% confidence interval −0.57 to −0.19) and ESV (SMD = −0.48; 95% confidence interval −0.67 to −0.29) (Figures 2 and 3), but there was no evidence of benefit with short-term duration (<6 months): EDV (−0.14; 95% confidence interval −0.48 to 0.21) and ESV (−0.08; 95% confidence interval −0.47 to 0.30).
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Figure 2.
Long-term (≥6 months) aerobic training and end-diastolic volume
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Figure 3.
Long-term (≥6month) aerobic training and end-systolic volume
Whether training duration was short or long, the effects of combined training on remodelling were inconclusive, with all confidence intervals including 0. One trials testing strength training alone which duration were less than 6 months was also inconclusive (Table 2).
Sensitivity Analysis
Exclusion of the low quality study. and the heaviest trial. did not change the positive direction of our results (Table 2).
Publication Bias
No evidence of publication bias was found either by visually at inspection of funnel plots (Figure 4) or analytically at Egger test (p = 0.41).
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Figure 4.
Funnel plot for publication bias
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