Meta-analysis of Exercise Training on Left Ventricular Ejection Fraction in Heart Failure with Reduced Ejection Fraction: A 10-year Update.

Abstract

BACKGROUND\nThe role of exercise training modality to attenuate left ventricular (LV) remodeling in heart failure patients with reduced ejection fraction (HFrEF) remains uncertain. The authors performed a systematic review and meta-analysis of published reports on exercise training (moderate-intensity continuous aerobic, high-intensity interval aerobic, and resistance exercise) and LV remodeling in clinically stable HFrEF patients.\n\n\nMETHODS\nWe searched MEDLINE, Cochrane Central Registry of Controlled Trials, CINAHL, and PubMed (2007 to 2017) for randomized controlled trials of exercise training on resting LV ejection fraction (EF) and end-diastolic and end-systolic volumes in HFrEF patients.\n\n\nRESULTS\n18 trials reported LV ejection fraction (LVEF) data, while 8 and 7 trials reported LV end-diastolic and LV end-systolic volumes, respectively. Overall, moderate-intensity continuous training (MICT) significantly increased LVEF (weighted mean difference, WMD\u202f=\u202f3.79%; 95% confidence interval, CI, 2.08 to 5.50%) with no change in LV volumes versus control. In trials ≥6\u202fmonths duration, MICT significantly improved LVEF (WMD\u202f=\u202f6.26%; 95% CI 4.39 to 8.13%) while shorter duration (<6\u202fmonths) trials modestly increased LVEF (WMD\u202f=\u202f2.33%; 95% CI 0.84 to 3.82%). High-intensity interval training (HIIT) significantly increased LVEF compared to control (WMD\u202f=\u202f3.70%; 95% CI 1.63 to 5.77%) but was not different than MICT (WMD\u202f=\u202f3.17%; 95% CI -0.87 to 7.22%). Resistance training performed alone or combined with aerobic training (MICT or HIIT) did not significantly change LVEF.\n\n\nCONCLUSIONS\nIn clinically stable HFrEF patients, MICT is an effective therapy to attenuate LV remodeling with the greatest benefits occurring with long-term (≥6\u202fmonths) training. HIIT performed for 2 to 3\u202fmonths is superior to control, but not MICT, for improvement of LVEF.