Effects of exercise training on left ventricular remodelling in heart failure patients: an updated meta-analysis of randomised controlled trials

Abstract

Objectives: The purpose of this updated meta-analysis was to determine whether exercise training reversed left ventricular remodelling in heart failure patients. 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. Results: 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. Conclusions: 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.

Endurance Exercise Training in Young Adults with Barth Syndrome: A Pilot Study

“…However, in the current study we did not observe improvements in resting nor exercise-stimulated left ventricular function, plasma pro-BNP, or plasma TNF-a following endurance exercise training in four participants with BTHS. It is possible that the training period was not long enough to demonstrate improvements in cardiac function as the majority of studies in non-BTHS heart failure that demonstrated cardiac improvements had training period !6 months (Chen et al 2012). Like skeletal muscle, it is also possible that endurance exercise training in BTHS increased more genetically impaired cardiac mitochondria that did not result in improvement of cardiac energetics and function; however, this is also speculative as cardiac biopsies were not performed.…”

“…Moderate-intensity endurance exercise training has been shown to improve left ventricular function in individuals with non-BTHS heart failure as well as improve levels of plasma markers known to be associated with the severity of cardiac impairment (e.g., TNF-a and pro-BNP) (Adamopoulos et al 2002;Conraads et al 2004;Chen et al 2012). However, in the current study we did not observe improvements in resting nor exercise-stimulated left ventricular function, plasma pro-BNP, or plasma TNF-a following endurance exercise training in four participants with BTHS.…”

The Effect of Cardiac Rehabilitation Exercise Training on Cardiopulmonary Function in Ischemic Cardiomyopathy With Reduced Left Ventricular Ejection Fraction

“…Two previous studies reported abnormal remodeling in some patients; although training did not appear to have any effect on this process [2930]. Also, two recent studies related to the effects of exercise training on LV remodeling showed that exercise training has beneficial effects on LV remodeling and it even reverses LV remodeling in patients with heart failure [3132]. Also, it has been observed that CR has a direct influence on the myocardium, and it increases the myocardial perfusion which in turn increases the exercise capacity.…”

Cardiac rehabilitation program in patients with Chagas heart failure: a single-arm pilot study

“…Similarly, a metaanalysis conducted by Chen et al (33) , including data from 16 trials (813 patients), demonstrated a standardized mean increase of 0.33 (95% CI 0.13-0.52) in LVEF following exercise interventions. Given that LV dysfunction is a primary predictor of mortality in Chagas heart disease (28) (34) (35) , exercise training may constitute an important strategy to improve prognosis in CHF.…”