Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH)

Abstract

Objective To determine the effect of exercise training on survival in patients with heart failure due to left ventricular systolic dysfunction. Design Collaborative meta-analysis. Inclusion criteria Randomised parallel group controlled trials of exercise training for at least eight weeks with individual patient data on survival for at least three months. Studies reviewed Nine datasets, totalling 801 patients: 395 received exercise training and 406 were controls. Main outcome measure Death from all causes. Results During a mean (SD) follow up of 705 (729) days there were 88 (22%) deaths in the exercise arm and 105 (26%) in the control arm. Exercise training significantly reduced mortality (hazard ratio 0.65, 95% confidence interval, 0.46 to 0.92; log rank 2 = 5.9; P = 0.015). The secondary end point of death or admission to hospital was also reduced (0.72, 0.56 to 0.93; log rank 2 = 6.4; P = 0.011). No statistically significant subgroup specific treatment effect was observed. Conclusion Meta-analysis of randomised trials to date gives no evidence that properly supervised medical training programmes for patients with heart failure might be dangerous, and indeed there is clear evidence of an overall reduction in mortality. Further research should focus on optimising exercise programmes and identifying appropriate patient groups to target.

Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

“…332 Meta-analyses and a large, randomized, clinical trial have demonstrated the beneficial effects of an exercise program in patients with established HFrEF. 230,241,319,333 The ExTraMATCH (Exercise Training Meta Analysis of Trials in Chronic Heart Failure Patients) meta-analysis of 9 prospective studies (n=801) demonstrated a reduction in overall mortality with exercise that translated into a number needed to treat of 17 to prevent 1 death. 333 As mentioned in the obesity section, the HF-ACTION trial randomized 2331 outpatients with HF (EF <35%) to an exercise program or usual care.…”

“…230,241,319,333 The ExTraMATCH (Exercise Training Meta Analysis of Trials in Chronic Heart Failure Patients) meta-analysis of 9 prospective studies (n=801) demonstrated a reduction in overall mortality with exercise that translated into a number needed to treat of 17 to prevent 1 death. 333 As mentioned in the obesity section, the HF-ACTION trial randomized 2331 outpatients with HF (EF <35%) to an exercise program or usual care. 230,241 The exercise regimen consisted of 36 supervised sessions over 3 months followed by homebased training.…”

Peripheral muscle training with resistance exercise bands in patients with chronic heart failure. Long‐term effects on walking distance and quality of life; a pilot study

“…The progression of the effects of exercise training can be divided into three stages: (i) initial, (ii) improvement, and (iii) maintenance. Achieving the maintenance phase takes at least 6 months 27, 33. The maintenance phase should be lifelong.…”

Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction

“…Although not yet separately demonstrated in patients with HFpEF, an active lifestyle and/or a structured training intervention prevents the development of HF7, 8, 9 and is associated with considerable improvement of survival in patients at risk for HF and in symptomatic HFrEF 10, 11, 12. In addition, several training interventions have shown significant improvement of exercise capacity and quality of life (QoL) in patients with HF 10, 13…”