Review
Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity

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Abstract

Purpose

To determine the efficacy of exercise training and its effects on outcomes in patients with heart failure.

Methods

MEDLINE, Medscape, and the Cochrane Controlled Trials Registry were searched for trials of exercise training in heart failure patients. Data relating to training protocol, exercise capacity, and outcome measures were extracted and reviewed.

Results

A total of 81 studies were identified: 30 randomized controlled trials, five nonrandomized controlled trials, nine randomized crossover trials, and 37 longitudinal cohort studies. Exercise training was performed in 2387 patients. The average increment in peak oxygen consumption was 17% in 57 studies that measured oxygen consumption directly, 17% in 40 studies of aerobic training, 9% in three studies that only used strength training, 15% in 13 studies of combined aerobic and strength training, and 16% in the one study on inspiratory training. There were no reports of deaths that were directly related to exercise during more than 60,000 patient-hours of exercise training. During the training and follow-up periods of the randomized controlled trials, there were 56 combined (deaths or adverse events) events in the exercise groups and 75 combined events in the control groups (odds ratio [OR] = 0.98; 95% confidence interval [CI]: 0.61 to 1.32; P = 0.60). During this same period, 26 exercising and 41 nonexercising subjects died (OR = 0.71; 95% CI: 0.37 to 1.02; P = 0.06).

Conclusion

Exercise training is safe and effective in patients with heart failure. The risk of adverse events may be reduced, but further studies are required to determine whether there is any mortality benefit.

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.

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