Effects of exercise training on left ventricular remodelling in heart failure patients: an updated meta-analysis of randomised controlled trials
International Journal of Clinical Practice, 08/03/2012
Chen YM et al. – Aerobic exercise training, especially long–term duration (≥6 months) reverses left ventricular remodelling in clinically stable patients with heart failure. Strength training (alone or plus aerobic training) did not improve or worsen ventricular remodelling.Methods
- Articles were searched in MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, EMBASE and PubMed (up until October, 2011).
- The anti–remodelling benefit of exercise training was assessed by ejection fraction (EF), end–diastolic volume (EDV) and end–systolic volume (ESV).
- Standardised mean difference (SMD) together with 95% confidence intervals (CI) was calculated.
- Subgroup meta–analysis with exercise duration was also conducted.
- Fifteen randomised controlled trials with 813 patients were included.
- Aerobic exercise training improved EF (SMD=0.44; 95% CI 0.28 to 0.61), EDV (SMD= –0.33; 95% CI –0.49 to –0.16) and ESV (SMD= –0.40; 95% CI –0.57 to –0.23).
- Subgroup analysis indicated that long–term aerobic exercise (≥6 months) had a marked positive effect on EF (SMD=0.5; 95% confidence interval 0.31 to 0.69), EDV (SMD= –0.38; 95% CI –0.57 to –0.19) and ESV (SMD= –0.48; 95% CI –0.67 to –0.29), but there was no evidence of benefit with short–term aerobic exercise (<6 months): EF (SMD=0.27; 95% CI –0.08 to 0.61), EDV (SMD= –0.14; 95% CI –0.48 to 0.21) and ESV (SMD= –0.08; 95% CI –0.47 to 0.30).
- Strength training (alone or plus aerobic training) was not associated with improvements in EDV and ESV, with all confidence intervals including 0.