ReviewExercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity☆
Section snippets
Search strategy and study selection
We searched MEDLINE (1966 to August 2003), Medscape (1979 to August 2003), and the Cochrane Controlled Trials Registry (1979 to August 2003), using combinations of the terms exercise training, heart failure, left ventricular dysfunction, physical training, resistance training, and aerobic exercise, for clinical trials of exercise training in patients with heart failure. There were no restrictions on the year of publication. We examined the latest editions of relevant journals that were not yet
Results
Of the 109 papers searched, 81 studies met the inclusion criteria. Of these, 30 (37%) were randomized parallel group trials, five (6%) were nonrandomized controlled trials, nine (11%) were randomized crossover trials, and 37 (46%) were longitudinal cohort studies (Table 1) — contributing a total of 2387 exercising subjects. Of 1197 patients enrolled in controlled studies, 622 were in the exercise-training group and 575 were in the nonexercising control group. Patients were on stable medical
Discussion
The results of this systematic review indicate that exercise training for patients with heart failure is safe and associated with a meaningful increment in peak oxygen consumption. There is also evidence of a reduction in the composite endpoint of death and adverse events, as well as a possible survival benefit following exercise training. The optimal form of training remains undefined, and although intermittent aerobic exercise appears to be effective, strength training alone may not be as
Acknowledgements
The authors are grateful for the advice of Professor Paul Glasziou and Colin Case from the University of Queensland.
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Supported in part by a Research Grant Award from the Medical Benefits Fund, Sydney, Australia, and a Research Scholarship from the Heart Foundation of Australia.