Exercise therapy and autonomic function in heart failure patients: a systematic review and meta-analysis

Pearson, Melissa J.; Smart, Neil A.

doi:10.1007/s10741-017-9662-z

Cited by 84 publications

(68 citation statements)

References 96 publications

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“…Recent meta-analysis on the effects of exercise (supervised, or unsupervised and of variable intensities) increased HRV measures in individuals with various cardiovascular diseases and diabetes imply that the postexercise state is associated with increased vagal modulation and decreased sympathetic tone. These findings have also been shown by Pearson et al [ 11 ] and others for heart failure subjects [ 22 , 23 ] and those with diabetes and metabolic syndrome [ 12 , 24 , 25 ]. The beneficial effects of improving HRV in subjects with reduced HRV such as heart failure, diabetes, and the frail elderly has been shown by others [ 12 , 24 – 26 ].…”

Section: Discussionsupporting

confidence: 80%

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The Effects of Passive Simulated Jogging on Short-Term Heart Rate Variability in a Heterogeneous Group of Human Subjects

Adams

Patel

López³

et al. 2018

Journal of Sports Medicine

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Background Heart rate variability (HRV) reflects neural balance between sympathetic and parasympathetic autonomic nervous systems (ANS). Reduced HRV occurs in several chronic diseases and physical inactivity. External addition of pulses to the circulation restores HRV. A new method to add pulses to the circulation can be accomplished with a passive simulated jogging device (JD). We hypothesized that application of JD might increase HRV in seated and supine postures in a heterogeneous group of volunteer subjects. Methods Twenty ambulatory persons (age range 31-88) were recruited. The physical activity intervention (JD) moved the feet in a repetitive and alternating manner; upward movement of the pedal is followed by a downward movement of the forefoot tapping against a semirigid bumper to simulate tapping of feet against the ground during jogging. Each subject underwent four, 30 min sessions in seated and supine postures with the active JD and same with Sham. HRV was assessed at baseline (BL), and Recovery (REC) from analysis of an electrocardiogram. Time domain variables were computed, namely, standard deviation of all normal RR intervals (SDNN) and square root of the mean of the sum of the squares of differences between adjacent RR intervals (RMSSD). Frequency domain measures were determined using a standard Fast Fourier spectral analysis, as well as parameters of Poincaré plots. Results Thirty minutes of JD significantly increased time domain measures and Poincaré parameters of HRV in both seated and supine postures. Frequency domain parameters showed no change. The effects of JD on HRV measures were not affected by age, gender, or posture. Conclusion The passive simulated jogging device increased HRV in both seated and supine postures. This intervention that provided effortless physical activity is a novel method to harness the beneficial effects of increasing HRV.

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Section: Discussionsupporting

confidence: 80%

“…Normal HRV is beneficial in the aging and frail, those with cognitive decline, diabetes, coronary artery disease, and heart failure [ 4 , 7 , 11 , 12 ]. Various interventions modify HRV, with physical activity being the most studied intervention [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

The Effects of Passive Simulated Jogging on Short-Term Heart Rate Variability in a Heterogeneous Group of Human Subjects

Adams

Patel

López³

et al. 2018

Journal of Sports Medicine

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“…Heart failure (HF) is a complex syndrome resulting from multiple conditions and underlying disorders and continues to be a significant burden on the healthcare system. Over the past three decades, an increasing number of studies have provided evidence on a range of benefits of exercise training in patients with HF 1–5. In patients with stable HF, exercise training is now a Class 1 recommendation in HF guidelines 6 7…”

Section: Introductionmentioning

confidence: 99%

Effect of exercise therapy on established and emerging circulating biomarkers in patients with heart failure: a systematic review and meta-analysis

2018

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BackgroundBiomarkers are important in the diagnosis, risk stratification and management of patients with heart failure (HF). The established biomarkers of myocardial stretch, brain natriuretic peptide (BNP) and amino (N) portion of BNP (NT-proBNP) have been extensively studied, and early analyses have demonstrated response to exercise training. Several other biomarkers have been identified over the last decade and may provide valuable and complementary information which may guide treatment strategies, including exercise therapy.MethodsA systematic search of PubMed, EMBASE and Cochrane Trials Register to 31 October 2017 was conducted for exercise-based rehabilitation trials in HF. Randomised and controlled trials that reported biomarkers, BNP, NT-proBNP, soluble ST2, galectin-3, mid-regional atrial natriuretic peptide, mid-regional adrenomedullin and copeptin, were included.ResultsForty-three studies were included in the systematic review, with 27 studies suitable for meta-analyses. Data pooling was only possible for NT-proBNP and BNP. Meta-analyses of conventional training studies demonstrated a statistically significant improvement in NT-proBNP (pmol/L); mean difference (MD) −32.80 (95% CI −56.19 to −9.42), p=0.006 and in BNP (pmol/L); MD −17.17 (95% CI −29.56 to −4.78), p=0.007. Pooled data of non-conventional training failed to demonstrate any statistically significant improvements.ConclusionPooled data indicated a favourable effect of conventional exercise therapy on the established biomarkers, NT-proBNP and BNP; however, this was in contrast to a number of studies that could not be pooled. Limited evidence exists as to the effect of exercise training on emerging biomarkers.

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“…Apart from the PEA, specialised rehabilitation with exercise training has previously been shown to improve mPAP, PVR, and right heart size [11]. Furthermore, autonomic balance [24, 25] and endothelial [26] and skeletal muscle function [27] can be improved by increasing oxygen delivery and by reversing both systemic and local inflammatory processes. Therefore, exercise training may be a useful add-on therapy to PEA to also further improve those exercise-limiting factors which persist even after the normalisation of haemodynamics, as described by Corsico et al [10] in up to 40% of patients.…”

Section: Discussionmentioning

confidence: 99%

Supervised Exercise Training in Patients with Chronic Thromboembolic Pulmonary Hypertension as Early Follow-Up Treatment after Pulmonary Endarterectomy: A Prospective Cohort Study

et al. 2020

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Background: Data on exercise training in chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary endarterectomy (PEA) as well as data on clinical and haemodynamic changes shortly after PEA are lacking. Objective: The objective of this prospective study was to analyse the safety, feasibility, and the effectiveness of combined supervised inpatient rehabilitation in patients with CTEPH directly after PEA. Methods: CTEPH patients started a 19-week rehabilitation program (3 weeks as inpatients and continued at home for another 16 weeks) with supervised exercise training as follow-up treatment shortly after PEA. Haemodynamics were assessed by right heart catheterisation before PEA and 22 weeks after PEA. Non-invasive assessments as trans-thoracic echocardiography and 6-min walking distance (6MWD) were performed before PEA and after 3 (that is, beginning of rehabilitation), 6, and 22 weeks following PEA. Adverse events were recorded throughout the study. Results: Forty-five CTEPH patients were included (49% female, 57.6 ± 12.4 years old, 60% WHO functional class III). Rehabilitation was started 3.3 ± 0.9 weeks after PEA. Exercise training was well tolerated in all patients without severe side effects. Haemodynamics measured by right heart catheterisation significantly improved from pre-PEA to 22 weeks post-PEA in cardiac output (+1.2 ± 1.5 L/min, 33.4%, p = 0.001) and mean pulmonary arterial pressure (-19 ± 13 mm Hg,-39.6%, p < 0.0001). Right heart size measured by echocardiography, 6MWD, quality of life, and oxygen saturation significantly improved not only within the first 3 weeks after PEA but also during the following 19 weeks of exercise training. Conclusions: Supervised exercise training was feasible as early follow-up treatment after PEA. Further controlled studies are needed to discriminate the effects of PEA and early followup rehabilitation. Trial Registration: The study was regis-Nagel et al.

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Exercise therapy and autonomic function in heart failure patients: a systematic review and meta-analysis

Cited by 84 publications

References 96 publications

The Effects of Passive Simulated Jogging on Short-Term Heart Rate Variability in a Heterogeneous Group of Human Subjects

The Effects of Passive Simulated Jogging on Short-Term Heart Rate Variability in a Heterogeneous Group of Human Subjects

Effect of exercise therapy on established and emerging circulating biomarkers in patients with heart failure: a systematic review and meta-analysis

Supervised Exercise Training in Patients with Chronic Thromboembolic Pulmonary Hypertension as Early Follow-Up Treatment after Pulmonary Endarterectomy: A Prospective Cohort Study

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