Effect of Physical Exercise on LVEF, Health-Related Quality of Life and Other Cardiopulmonary Parameters in Heart Patients: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.55489/njcm.150920244162Keywords:
Cardiac Rehabilitation, Exercise, HRQOL, Ejection FractionAbstract
Introduction: This study aims to determine the effect of high-intensity physical exercise on various cardiopulmonary parameters and HRQOL in heart disease patients.
Methodology: We searched databases including PubMed, Scopus, Embase, and Google Scholar using the PRISMA checklist to find research publications between year 2004 and 2024. R software 4.3.0 was utilised to perform the meta-analysis, and Cochrane’s ROB tool 2.0 was employed for the quality appraisal. Heterogeneity was assessed using I2 statistics. A funnel plot and Egger's test were used to evaluate publication bias.
Results: 22 articles in this meta-analytic study discovered that there was a substantial difference in the two patient groups' LVEF [2.41, (−1.29; 6.12), p<0.01], resting systolic [-2.24, (−4.77; 0.29), p=0.87] and diastolic BP [0.28, (−1.34; 1.89), p=0.53], resting heart rate [-1.54, (−6.11; 3.03), p<0.01], peak oxygen uptake [1.13, (−0.36; 2.61), p<0.01], and HRQOL including physical [4.00, (−4.29; 12.29), p<0.01], mental [2.19, (−0.50; 4.87), p=0.01], emotional [1.67, ( −2.34; 5.68, p=0.46) and social components [4.33, (0.23; 8.42), p=0.69].
Conclusion: In addition to improving LVEF, HRQOL, cardiac function, and peak oxygen uptake, cardiac rehabilitation training lowers the risk of CVD and lengthens life expectancy, all of which should be encouraged in the therapeutic context.
References
Balady GJ, Ades PA, Bittner VA, et al. Referral, enrolment, and delivery of cardiac rehabilitation/ secondary prevention programs at clinical centres and beyond a presidential advisory from the American Heart Association. Circulation 2011;124: 2951-60. Doi: https://doi.org/10.1161/CIR.0b013e31823b21e2 PMid:22082676
Smith SC Jr., Benjamin EJ, Bonow RO, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. J Am Coll Cardiol 2011; 58:2432-46. Doi: https://doi.org/10.1016/j.jacc.2011.10.824 PMid:22055990
Perk J, De Backer G, Gohlke H, et al. European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012; 33:1635-701. Doi: https://doi.org/10.1093/eurheartj/ehs092 PMid:22555213
Wenger NK, Froelicher ES, Smith LK, et al. Cardiac rehabilitation as secondary prevention. Agency for Health Care Policy and Research and National Heart, Lung, and Blood Institute. Clin Pract Guide Quick Ref Guide Clin 1995; 17:1-23.
Piepoli MF, Corra U, Benzer W, Bjarnason-Wehrens B, Dendale P, Gaita D, et al. Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. European Journal of Cardiovascular Prevention & Rehabilitation 2010; Vol. 17, issue 1:1-17. Doi: https://doi.org/10.1097/HJR.0b013e3283313592 PMid:19952757
Bernardi L, Radaelli A, Passino C, Falcone C, Auguadro C, Martinelli L, et al. Effects of physical training on cardiovascular control after heart transplantation. International Journal of Cardiology 2007;118(3):356-62. Doi: https://doi.org/10.1016/j.ijcard.2006.07.032 PMid:17050012
Nytrøen K, Rustad LA, Gude E, Hallén J, Fiane AE, Rolid K, et al. Muscular exercise capacity and body fat predict VO2 peak in heart transplant recipients. European Journal of Preventive Cardiology 2014;21(1):21-9. Doi: https://doi.org/10.1177/2047487312450540 PMid:22659939
Ioannidis JP. Interpretation of tests of heterogeneity and bias in meta-analysis. J Eval Clin Pract. 2008; 14:951-7. Doi: https://doi.org/10.1111/j.1365-2753.2008.00986.x PMid:19018930
Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315:629-34. Doi: https://doi.org/10.1136/bmj.315.7109.629 PMid:9310563 PMCid:PMC2127453
McGregor G, Powell R, Begg B, Birkett ST, Nichols S, Ennis S, McGuire S, Prosser J, Fiassam O, Hee SW, Hamborg T. High-intensity interval training in cardiac rehabilitation: a multi-centre randomized controlled trial. European journal of preventive cardiology. 2023 Jul;30(9):745-55. Doi: https://doi.org/10.1093/eurjpc/zwad039 PMid:36753063
Saeidi M, Ravanbod R, Pourgharib-Shahi MH, Navid H, Goosheh B, Baradaran A, Torkaman G. The Acute Effects of 2 Different Intensities of Resistance Exercise on Autonomic Function in Heart Failure Patients: A Randomized Controlled Trial. Anatolian Journal of Cardiology. 2023 May;27(5):266. Doi: https://doi.org/10.14744/AnatolJCardiol.2022.2282 PMid:37119185 PMCid:PMC10160845
Terada T, Cotie LM, Tulloch H, Mistura M, Vidal-Almela S, O'Neill CD, Reid RD, Pipe A, Reed JL. Sustained effects of different exercise modalities on physical and mental health in patients with coronary artery disease: a randomized clinical trial. Canadian Journal of Cardiology. 2022 Aug 1;38(8):1235-43. Doi: https://doi.org/10.1016/j.cjca.2022.03.017 PMid:35961757
Reed JL, Terada T, Vidal-Almela S, Tulloch HE, Mistura M, Birnie DH, Wells GA, Nair GM, Hans H, Way KL, Chirico D. Effect of high-intensity interval training in patients with atrial fibrillation: a randomized clinical trial. JAMA network open. 2022 Oct 3;5(10): e2239380. Doi: https://doi.org/10.1001/jamanetworkopen.2022.39380 PMid:36315143 PMCid:PMC9623436
Khadanga S, Savage PD, Pecha A, Rengo J, Ades PA. Optimizing training response for women in cardiac rehabilitation: a randomized clinical trial. JAMA cardiology. 2022 Feb 1;7(2):215-8. Doi: https://doi.org/10.1001/jamacardio.2021.4822 PMid:34817540 PMCid:PMC8613699
Nakaya Y, Akamatsu M, Ogimoto A, Kitaoka H. Early cardiac rehabilitation for acute decompensated heart failure safely improves physical function (PEARL study): a randomized controlled trial. European Journal of Physical and Rehabilitation Medicine. 2021 Jul 22;57(6):985-93. Doi: https://doi.org/10.23736/S1973-9087.21.06727-7 PMid:34291626
Nagyova I, Jendrichovsky M, Kucinsky R, Lachytova M, Rus V. Effects of Nordic walking on cardiovascular performance and quality of life in coronary artery disease. European Journal of physical and rehabilitation Medicine. 2020 Jun 23;56(5):616-24. Doi: https://doi.org/10.23736/S1973-9087.20.06120-1 PMid:32573523
Deng B, Shou X, Ren A, Liu X, Wang Q, Wang B, Wang Y, Yan T, Zhao X, Zhu L. Effect of aerobic training on exercise capacity and quality of life in patients older than 75 years with acute coronary syndrome undergoing percutaneous coronary intervention. Physiotherapy Theory and Practice. 2022 Sep 2;38(9):1135-44. Doi: https://doi.org/10.1080/09593985.2020.1825580 PMid:32991232
Taylor JL, Holland DJ, Keating SE, Leveritt MD, Gomersall SR, Rowlands AV, Bailey TG, Coombes JS. Short-term and long-term feasibility, safety, and efficacy of high-intensity interval training in cardiac rehabilitation: the FITR heart study randomized clinical trial. JAMA cardiology. 2020 Dec 1;5(12):1382-9. Doi: https://doi.org/10.1001/jamacardio.2020.3511 PMid:32876655 PMCid:PMC7489382
Tsai E, Mouhayar E, Lenihan D, Song J, Durand JB, Fadol A, Massey M, Harrison C, Basen-Engquist K. Feasibility and outcomes of an exercise intervention for chemotherapy-induced heart failure. Journal of cardiopulmonary rehabilitation and prevention. 2019 May 1;39(3):199-203. Doi: https://doi.org/10.1097/HCR.0000000000000388 PMid:31022003 PMCid:PMC6492623
Jaureguizar KV, Vicente-Campos D, Bautista LR, de la Peña CH, Gómez MJ, Rueda MJ, Mahillo IF. Effect of high-intensity interval versus continuous exercise training on functional capacity and quality of life in patients with coronary artery disease: a randomized clinical trial. Journal of cardiopulmonary rehabilitation and prevention. 2016 Mar 1;36(2):96-105. Doi: https://doi.org/10.1097/HCR.0000000000000156 PMid:26872000
Sayegh AL, Dos Santos MR, Rondon E, de Oliveira P, de Souza FR, Salemi VM, de NN Alves MJ, Mady C. Exercise Rehabilitation Improves Cardiac Volumes and Functional Capacity in Patients with Endomyocardial Fibrosis: A RANDOMIZED CONTROLLED TRIAL. Journal of cardiopulmonary rehabilitation and prevention. 2019 Nov 1;39(6):373-80. Doi: https://doi.org/10.1097/HCR.0000000000000445 PMid:31397769
Rengo JL, Savage PD, Barrett T, Ades PA. Participation rates and outcomes for heart failure patients in cardiac rehabilitation. Journal of cardiopulmonary rehabilitation and prevention. 2018 Jan;38(1):38. Doi: https://doi.org/10.1097/HCR.0000000000000252 PMid:28671938 PMCid:PMC5741463
Besnier F, Labrunée M, Richard L, Faggianelli F, Kerros H, Soukarié L, Bousquet M, Garcia JL, Pathak A, Gales C, Guiraud T. Short-term effects of a 3-week interval training program on heart rate variability in chronic heart failure. A randomised controlled trial. Annals of physical and rehabilitation medicine. 2019 Sep 1;62(5):321-8. Doi: https://doi.org/10.1016/j.rehab.2019.06.013 PMid:31352063
Opotowsky AR, Rhodes J, Landzberg MJ, Bhatt AB, Shafer KM, Yeh DD, Crouter SE, Ubeda Tikkanen A. A randomized trial comparing cardiac rehabilitation to standard of care for adults with congenital heart disease. World Journal for Pediatric and Congenital Heart Surgery. 2018 Mar;9(2):185-93. Doi: https://doi.org/10.1177/2150135117752123 PMid:29544423
Chen YW, Wang CY, Lai YH, Liao YC, Wen YK, Chang ST, Huang JL, Wu TJ. Home-based cardiac rehabilitation improves quality of life, aerobic capacity, and readmission rates in patients with chronic heart failure. Medicine. 2018 Jan 1;97(4): e9629. Doi: https://doi.org/10.1097/MD.0000000000009629 PMid:29369178 PMCid:PMC5794362
Ellingsen Ø, Halle M, Conraads V, Støylen A, Dalen H, Delagardelle C, Larsen AI, Hole T, Mezzani A, Van Craenenbroeck EM, Videm V. High-intensity interval training in patients with heart failure with reduced ejection fraction. Circulation. 2017 Feb 28;135(9):839-49. Doi: https://doi.org/10.1161/CIRCULATIONAHA.116.022924 PMid:28082387 PMCid:PMC5325251
Acanfora D, Scicchitano P, Casucci G, Lanzillo B, Capuano N, Furgi G, Acanfora C, Longobardi M, Incalzi RA, Piscosquito G, Ciccone MM. Exercise training effects on elderly and middle-aged patients with chronic heart failure after acute decompensation: A randomized, controlled trial. International journal of cardiology. 2016 Dec 15; 225:313-23. Doi: https://doi.org/10.1016/j.ijcard.2016.10.026 PMid:27750131
Tang A, Eng JJ, Krassioukov AV, Madden KM, Mohammadi A, Tsang MY, Tsang TS. Exercise-induced changes in cardiovascular function after stroke: a randomized controlled trial. International Journal of Stroke. 2014 Oct;9(7):883-9. Doi: https://doi.org/10.1111/ijs.12156 PMid:24148695 PMCid:PMC4486377
Belardinelli R, Georgiou D, Cianci G, Purcaro A. 10-year exercise training in chronic heart failure: a randomized controlled trial. Journal of the American College of Cardiology. 2012 Oct 16;60(16):1521-8. Doi: https://doi.org/10.1016/j.jacc.2012.06.036 PMid:22999730
Osbak PS, Mourier M, Kjaer A, Henriksen JH, Kofoed KF, Jensen GB. A randomized study of the effects of exercise training on patients with atrial fibrillation. American Heart Journal. 2011 Dec 1;162(6):1080-7. Doi: https://doi.org/10.1016/j.ahj.2011.09.013 PMid:22137082
Smith KM, Arthur HM, McKelvie RS, Kodis J. Differences in the sustainability of exercise and health-related quality of life outcomes following home or hospital-based cardiac rehabilitation. European Journal of Preventive Cardiology. 2004 Aug 1;11(4):313-9. Doi: https://doi.org/10.1097/01.hjr.0000136414.40017.10 PMid:15292765
Oldridge NB, Guyatt GH, Fischer ME, et al. Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials. JAMA 1988; 260:945-50. Doi: https://doi.org/10.1001/jama.1988.03410070073031 PMid:3398199
O'Connor GT, Buring JE, Yusuf S, et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 1989; 80:234-44. Doi: https://doi.org/10.1161/01.CIR.80.2.234 PMid:2665973
Lanza GA, Golino M, Villano A, Lanza O, Lamendola P, Fusco A, Leggio M. Cardiac Rehabilitation and Endothelial Function. J Clin Med. 2020 Aug 3;9(8):2487. doi: 10.3390/jcm9082487. PMID: 32756306; PMCID: PMC7463659. Doi: https://doi.org/10.3390/jcm9082487 PMid:32756306 PMCid:PMC7463659
Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, Taylor RS. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol. 2016 Jan 5;67(1):1-12. doi: 10.1016/j.jacc.2015.10.044. PMID: 26764059. Doi: https://doi.org/10.1016/j.jacc.2015.10.044 PMid:26764059
Sibilitz KL, Berg SK, Rasmussen TB, Risom SS, Thygesen LC, Tang L, Hansen TB, Johansen PP, Gluud C, Lindschou J, Schmid JP. Cardiac rehabilitation increases physical capacity but not mental health after heart valve surgery: a randomised clinical trial. Heart. 2016 Dec 15;102(24):1995-2003. Doi: https://doi.org/10.1136/heartjnl-2016-309414 PMid:27492941
Risom SS, Zwisler AD, Johansen PP, Sibilitz KL, Lindschou J, Gluud C, Taylor RS, Svendsen JH, Berg SK. Exercise‐based cardiac rehabilitation for adults with atrial fibrillation. Cochrane Database of Systematic Reviews. 2017(2). Doi: https://doi.org/10.1002/14651858.CD011197.pub2 PMid:28181684 PMCid:PMC6464537
Taylor, R.S., Walker, S., Smart, N.A., Piepoli, M.F., Warren, F.C., Ciani, O., O'Connor, C., Whellan, D., Keteyian, S.J., Coats, A. and Davos, C.H., 2018. Impact of exercise‐based cardiac rehabilitation in patients with heart failure (ExTraMATCH II) on mortality and hospitalisation: an individual patient data meta‐analysis of randomised trials. European journal of heart failure, 20(12), pp.1735-1743. Doi: https://doi.org/10.1002/ejhf.1311 PMid:30255969 PMCid:PMC7262555
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Bhupesh Gupta, Kirtika Gupta, Ramita Goel, Anshu Mittal
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The authors retain the copyright of their article, with first publication rights granted to Medsci Publications.