Effects of exercise training on left ventricular remodelling in heart failure patients: an updated meta-analysis of randomised controlled trials

Objectives: The purpose of this updated meta‐analysis was to determine whether exercise training reversed left ventricular remodelling in heart failure patients. Methods: Articles were searched in MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, EMBASE and PubMed (up until October, 2011). The anti‐remodelling benefit of exercise training was assessed by ejection fraction (EF), end‐diastolic volume (EDV) and end‐systolic volume (ESV). Standardised mean difference (SMD) together with 95% confidence intervals (CI) was calculated. Subgroup meta‐analysis with exercise duration was also conducted. Results: Fifteen randomised controlled trials with 813 patients were included. Aerobic exercise training improved EF (SMD = 0.44; 95% CI 0.28 to 0.61), EDV (SMD = ?0.33; 95% CI ?0.49 to ?0.16) and ESV (SMD = ?0.40; 95% CI ?0.57 to ?0.23). Subgroup analysis indicated that long‐term aerobic exercise (≥6 months) had a marked positive effect on EF (SMD = 0.5; 95% confidence interval 0.31 to 0.69), EDV (SMD = ?0.38; 95% CI ?0.57 to ?0.19) and ESV (SMD = ?0.48; 95% CI ?0.67 to ?0.29), but there was no evidence of benefit with short‐term aerobic exercise (<6 months): EF (SMD = 0.27; 95% CI ?0.08 to 0.61), EDV (SMD = ?0.14; 95% CI ?0.48 to 0.21) and ESV (SMD = ?0.08; 95% CI ?0.47 to 0.30). Strength training (alone or plus aerobic training) was not associated with improvements in EDV and ESV, with all confidence intervals including 0. Conclusions: Aerobic exercise training, especially long‐term duration (≥6 months) reverses left ventricular remodelling in clinically stable patients with heart failure. Strength training (alone or plus aerobic training) did not improve or worsen ventricular remodelling.     

A self-directed adherence management program for patients with heart failure completing combined aerobic and resistance exercise training

This study measured the impact of the Exercise Adherence Management Program (EAMP) provided to 20 patients with heart failure (HF) who participated in a combined resistance and aerobic exercise training program during two 12-week phases. The EAMP included strategies designed to support exercise self-efficacy and adherence. Results indicate that an improvement in exercise self-efficacy occurred during the study period, whereas exercise adherence declined during the unsupervised phase. The highest rated adherence strategy for helpfulness and self-efficacy was group sessions. The study supports the use of adherence strategies based on self-efficacy in exercise programs for patients with HF.     

Resistance exercise in chronic heart failure--landmark studies and implications for practice

In patients with chronic congestive heart failure (CHF), there is a need for complementary strength training to maintain and/or increase muscle mass and strength. The challenge is how to stress peripheral muscles intensively without creating cardiovascular overload. Since the late 1990s, an increasing number of research and clinical experiments have been conducted on resistance exercise in CHF. As a result, data are now available for both acute responses during resistance exercise as well as muscular and cardiovascular adaptation to resistance training programs, based on different training methods. Study results demonstrated that dynamic resistance exercise is well tolerated in chronic stable CHF when: 1) initial contraction intensity is low, 2) small muscle groups are involved, 3) work phases are kept short, 4) a small number of repetitions per set is performed, and 5) work/rest ratio is > or = 1:2. With tolerance, contraction intensity can be increased. With resistance training programs lasting 12 weeks, maximal strength could be improved by 15 to 50%. Improvements in maximum exercise time and peak VO2 were between 10 and 18%, in relation to baseline values. In terms of these results, no differences were reported between combined resistance/ aerobic training and resistance training alone. Thus, resistance exercise can be assumed as safe as aerobic exercise in clinically stable CHF.     

慢性心力衰竭患者有氧运动方案的最佳证据总结

目的:检索并获取慢性心力衰竭(CHF)患者有氧运动的最佳证据,为临床制订科学、规范的CHF患者有氧运动方案提供依据。方法:检索BMJ Best Practice、Joanna Briggs Institute循证卫生保健中心数据库、国际指南协作网、UpToDate、美国指南网、英国国家临床医学研究所指南库、苏格兰学院间指南网、CINAHL、Embase、Cochrane Library、中国指南网、PubMed、中国生物医学文献数据库、WHO及心内科专业网站中有关CHF患者有氧运动的所有证据。检索时限为建库至2020年5月31日。结果:共纳入文献14篇,包括6篇指南,1篇专家共识和7篇系统评价。最终共总结有氧运动的必要性、有氧运动前准备、有氧运动的四要素、有氧运动模式4个方面的17条最佳证据。结论:有氧运动对射血分数下降的心力衰竭患者而言是安全有效的;运动强度的设定应基于症状限制性心肺运动试验结果;>6个月的运动对CHF患者有效;间歇有氧训练辅助抗阻运动能够改善患者峰值摄氧量,提高患者的心肺适应性、肌肉力量,改善心功能和提高生活质量,应被视为稳定期CHF患者运动锻炼的重要方式。     

Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis

OBJECTIVE: We sought to meta-analyze the effects of different modes of exercise training on measures of glucose control and other risk factors for complications of diabetes. RESEARCH DESIGN AND METHODS: The 27 qualifying studies were controlled trials providing, for each measure, 4-18 estimates for the effect of aerobic training, 2-7 for resistance training, and 1-5 for combined training, with 1,003 type 2 diabetic patients (age 55 +/- 7 years [mean +/- between-study SD]) over 5-104 weeks. The meta-analytic mixed model included main-effect covariates to control for between-study differences in disease severity, sex, total training time, training intensity, and dietary cointervention (13 studies). To interpret magnitudes, effects were standardized after meta-analysis using composite baseline between-subject SD. RESULTS: Differences among the effects of aerobic, resistance, and combined training on HbA(1c) (A1C) were trivial; for training lasting >/=12 weeks, the overall effect was a small beneficial reduction (A1C 0.8 +/- 0.3% [mean +/- 90% confidence limit]). There were generally small to moderate benefits for other measures of glucose control. For other risk factors, there were either small benefits or effects were trivial or unclear, although combined training was generally superior to aerobic and resistance training. Effects of covariates were generally trivial or unclear, but there were small additional benefits of exercise on glucose control with increased disease severity. CONCLUSIONS: All forms of exercise training produce small benefits in the main measure of glucose control: A1C. The effects are similar to those of dietary, drug, and insulin treatments. The clinical importance of combining these treatments needs further research.     

Body composition, physical fitness, functional performance, quality of life, and fatigue benefits of exercise for prostate cancer patients: a systematic review

ContextProstate cancer patients, especially those on androgen deprivation therapy (ADT), experience many symptoms that make it difficult to maintain their independence and quality of life. Because ADT acts by means of reducing testosterone production, exercise may offset many of the ADT side effects and those of the cancer itself.ObjectivesThis systematic review of the literature evaluates whether exercise could reduce symptoms and improve quality of life for prostate cancer patients.MethodsUsing relevant databases and key words, 12 training studies were found meeting the inclusion and exclusion criteria.ResultsGrade A level evidence was observed for the benefits of exercise in improving muscular endurance, aerobic endurance, and overall quality of life, as well as reducing fatigue in prostate cancer patients. Grade B evidence also suggested that exercise may improve prostate cancer patients’ muscle mass, muscular strength, functional performance (walking and sit to stand speed), as well as health-related, social and physical quality of life. These effects appeared greater for group—rather than home-based—exercise, especially if these programs included resistance training.ConclusionIt is recommended that most prostate cancer patients be encouraged to exercise regularly by their clinicians and significant others. Where possible, this exercise should be group-based and include some resistance training. Future research in this area should directly compare group- and home-based, as well as resistance, aerobic, and combined resistance and aerobic training to better elucidate the most effective forms of exercise for this population and what factors affect initiation and adherence to such programs.     

Exercise parameters in the management of breast cancer: A systematic review of randomized controlled trials

Aim. Previous systematic reviews have examined the efficacy of exercise in improving the quality of life for patients with, and survivors of, breast cancer. This review sets out to determine the parameters of exercise programmes used in randomized controlled trials. Methods. A systematic review of randomized controlled trials was conducted. Only trials that reported significant improvement on the quality of life outcome were included. Data relating to the parameters of exercise (mode, duration, frequency and intensity and delivery method) were analyzed. Results. Nine randomized controlled trials were included in this review. Overall quality of the trials was average. Aerobic exercise was featured in eight of the nine trials and was used in combination with resistance training in four trials. All the trials were gym‐based, were under the supervision of a physiotherapist and included a warm‐up and cool‐down phase. Conclusions. This review concludes that aerobic exercise performed with or without weight training is a common feature of exercise programmes that report significant quality of life–related outcomes. The most commonly reported exercise parameters were three sessions per week, at moderate intensity being equivalent to 50% to 80% of the maximum heart rate for greater than 30 minutes. Copyright © 2010 John Wiley & Sons, Ltd.     

Do low-frequency electrical myostimulation and aerobic training similarly improve performance in chronic heart failure patients with different exercise capacities?

OBJECTIVE: To confirm that electrical myostimulation is a good alternative to conventional aerobic training in patients with chronic heart failure and to compare the effects of both training programmes in patients with different exercise capacities. PATIENTS AND METHODS: A total of 44 patients with stable chronic heart failure underwent 5 weeks of exercise training, with electrical myostimulation or conventional aerobic training programmes. At baseline and after the training period, patients performed a symptom-limited cardiopulmonary exercise test and a 6-min walk test. RESULTS: Oxygen uptake at the end of exercise (V.O2 peak) and at ventilatory threshold (V.O2 VT) increased after electrical myostimulation (p< 0.001) and conventional aerobic training (p< 0.001) training programmes. The slope of the relationship between V.O2 and workload was reduced after electrical myostimulation (p< 0.05), but not after conventional aerobic training. Recovery was improved after both training programmes (p< 0.05), and the distance walked in 6 min was increased (p< 0.001). These improvements were not statistically different between electrical myostimulation and conventional aerobic training. Moreover, electrical myostimulation induced greater improvements in patients with low exercise capacity, whereas conventional aerobic training induced improved performance in patients with average exercise capacity. CONCLUSION: Five weeks of electrical myostimulation and conventional aerobic training exercise training produced similar improvements in exercise capacity in patients with chronic heart failure. However, electrical myostimulation appears to be more effective in patients with low exercise capacity than in those with average exercise capacity.     

9种运动方式对提高血液透析患者透析充分性效果的网状Meta分析

目的 系统评价不同运动方式对提高血液透析患者透析充分性的效果。方法 系统检索PubMed、Cochrane Library、Embase、Web of Science和万方数据库、中国知网、维普数据库、中国生物医学文献数据库等中英文数据库中关于运动干预对改善血液透析患者透析充分性的文献,检索时限为建库至2022年1月1日。经文献筛选和资料提取,采用随机对照试验Cochrane偏倚评估工具2.0版本进行文献质量评价,采用RevMan 5.3和STATA 16.0软件进行统计分析。结果 最终纳入30项研究,共1 216例患者,9种运动方式。网状Meta分析结果显示,透析中有氧联合抗阻运动和透析中有氧运动对提高血液透析患者单室尿素清除指数的效果在9种运动中位于前2名;透析中有氧运动和透析中有氧联合抗阻运动对提高血液透析患者尿素减少率的效果在6种运动中位于前2名。结论 多种运动方式能够提高血液透析患者的透析充分性,尤其以透析中有氧联合抗阻运动、透析中有氧运动的效果最为明显。     

Combined aerobic and resistance exercise program improves task performance in patients with heart failure

Gary RA, Cress ME, Higgins MK, Smith AL, Dunbar SB. Combined aerobic and resistance exercise program improves task performance in patients with heart failure.

Objectives

To assess the effects of a home-based aerobic and resistance training program on the physical function of adults with New York Heart Association (NYHA) class II and III patients and systolic heart failure (HF).

Design

Randomized controlled trial.

Setting

Home based.

Participants

Stable patients (N=24; mean age, 60±10y; left ventricular ejection fraction, 25%±9%; 50% white; 50% women) with New York Heart Association (NYHA) classes II and III (NYHA class III, 58%) systolic heart failure (HF).

Intervention

A 12-week progressive home-based program of moderate-intensity aerobic and resistance exercise. Attention control wait list participants performed light stretching and flexibility exercises.

Main Outcome Measures

A 10-item performance-based physical function measure, the Continuous Scale Physical Functional Performance test (CS-PFP10), was the major outcome variable and included specific physical activities measured in time to complete a task, weight carried during a task, and distance walked. Other measures included muscle strength, HRQOL (Minnesota Living With Heart Failure Questionnaire, Epworth Sleepiness Scale), functional capacity (Duke Activity Status Index), and disease severity (brain natriuretic peptide) levels.

Results

After the exercise intervention, 9 of 10 specific task activities were performed more rapidly, with increased weight carried by exercise participants compared with the attention control wait list group. Exercise participants also showed significant improvements in CS-PFP10 total score (P<.025), upper and lower muscle strength, and HRQOL (P<.001) compared with the attention control wait list group. Adherence rates were 83% and 99% for the aerobic and resistance training, respectively.

Conclusions

Patients with stable HF who participate in a moderate-intensity combined aerobic and resistance exercise program may improve performance of routine physical activities of daily living by using a home-based exercise approach. Performance-based measures such as the CS-PFP10 may provide additional insights into physical function in patients with HF that more commonly used exercise tests may not identify. Early detection of subtle changes that may signal declining physical function that are amenable to intervention potentially may slow further loss of function in this patient population.     

Research Article: Correlating heart rate and perceived exertion during aerobic exercise in Alzheimer's disease

Older adults reap many health benefits from aerobic exercise training; however, little is known about how to monitor the training responses in older adults with Alzheimer's disease. The purpose of this pilot study was to examine the correlation of objectively measured heart rate and subjectively reported perceived exertion during aerobic exercise training in four older men with advanced Alzheimer's disease from a pilot study that used a one‐group pre‐ and post‐test design. During training (three times per week for 8 weeks), the participants' heart rate and perceived exertion were assessed by a trained exercise trainer every 5 min by using the Polar heart rate monitor and the Borg's Rating of Perceived Exertion Scale, respectively. There were 596 heart rate–perceived exertion data pairs. The results show that the Pearson's r for the heart rate and perceived exertion was 0.457 (significant at 0.01, two‐tailed), controlling for age, education, exercise session, and cognition. We conclude that the Borg's Rating of Perceived Exertion Scale itself might be insufficient for monitoring the exercise responses in older men with advanced Alzheimer's disease. Future studies are needed to further examine the utility of this scale in this population.     

Efficacy of aerobic exercise on aerobic capacity in slowly progressive neuromuscular diseases: A systematic review and meta-analysis

BackgroundAerobic exercise aims to improve aerobic capacity.ObjectiveTo summarize the evidence on the efficacy of aerobic exercise on aerobic capacity in slowly progressive neuromuscular diseases (NMDs).MethodsWe searched the electronic databases MEDLINE, EMBASE, SPORTDiscus and Web of Science Conference Proceedings Index for articles published up to June 17, 2021, selecting randomized controlled trials that included adults with slowly progressive NMDs and compared aerobic exercise to no aerobic exercise. The primary outcome was peak oxygen uptake (VO₂peak) directly post-intervention. Secondary outcomes included other peak test parameters, submaximal test parameters, long-term outcomes ≥8 weeks post-intervention, adherence and adverse events. Meta-analyses were performed for the primary outcome and for secondary outcomes when reported in more than 2 studies. Risk of bias was assessed with the Cochrane Risk of Bias tool and quality of evidence according to GRADE.ResultsNine studies were included (195 participants with 8 different NMDs). Eight studies were rated at high risk of bias and 1 study was rated at some concerns. Duration of exercise programs ranged from 6 to 26 weeks, with 3 weekly training sessions of 20 to 40 min, based on maximal capacity. Meta-analyses revealed short-term moderate beneficial effects of aerobic exercise on VO₂peak (standardized mean difference [SMD] 0.55, 95% CI 0.23; 0.86) and peak workload (SMD 0.61, 95% CI 0.24; 0.99). Long-term effects were not assessed. Most training sessions (83–97%) were completed, but time spent in target intensity zones was not reported. Included studies lacked detailed adverse event reporting.ConclusionsThere is low-quality evidence that aerobic exercise is safe and leads to moderate improvement of aerobic capacity directly post-intervention in slowly progressive NMDs, but the long-term efficacy remains unclear. Detailed information about the time spent in target intensity zones and adverse events is lacking.Prospero: CRD42020200083     

Quality of life, psychological and physiological changes following exercise training in patients with chronic heart failure.

OBJECTIVE: To assess the physiological and psychosocial effects of exercise training in chronic heart failure. SUBJECTS/PATIENTS: Twenty-six men with heart failure (New York Heart Association functional classes II and III) aged 52.5 (SD 9.8) years, were studied. METHODS: The subjects were randomized either to rehabilitation group (Group A: 16 patients), participating in a 6-month exercise training program, or to control group (Group B: 10 patients). A psychosocial assessment, which included affective (Beck Depression Inventory and Hospital Anxiety and Depression Scale), quality of life (Quality of Life Index, Minnesota Living with Heart Failure Questionnaire and the Scale of Life Satisfaction) and personality (Eysenck Personality Questionnaire) parameters, was performed at the beginning and the end of the study. RESULTS: After training VO2 peak increased by 36% and exercise time by 35%, p < 0.05. A significant decrease in anxiety and depression was also observed. Moreover, trained patients demonstrated a significant improvement in quality of life. No significant correlations were found between deltaVO2 peak and all psychosocial parameter gains. However, the more depressed patients showed the largest physiological responses. CONCLUSION: An exercise rehabilitation program in patients with chronic heart failure is useful for improving their work capacity and psychosocial status. Improvements in psychological status seem to be independent of the aerobic gains.     

Exercise and functional tasks among adults who are functionally limited

This study compared the efficacy of 16 weeks of either resistance training, aerobic walking, or combined resistance training and aerobic walking on the performance of functional tasks among adults age 65 years and older with limited functional ability. One hundred thirty-one older adult individuals were randomized into four groups: resistance training, aerobic walking, combined resistance and aerobic walking groups, or a nonexercise control group. Each of the exercise groups documented 70% compliance with their respective exercise intervention, which included three weekly exercise sessions. At baseline, and 8 and 16 weeks following baseline, all participants completed six assessments of their functional ability. Analysis of covariance indicated that all three exercise intervention groups significantly improved measures of functional ability, with the resistance group demonstrating the most consistent gains over the six measures. These findings indicate that older adults who are functionally limited can improve their functional ability through a variety of types of exercise.     

The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis

OBJECTIVE: To determine whether aerobic exercise improves aerobic capacity in individuals with stroke. DESIGN: A systematic review of randomized controlled trials. DATABASES SEARCHED: MEDLINE, CINAHL, EMBASE, Cochrane Database of Systematic Reviews and Physiotherapy Evidence Database were searched. INCLUSION CRITERIA: Design: randomized controlled trials (RCTs). Participants: individuals with stroke. Interventions: aerobic exercise training aimed at improving aerobic capacity. OUTCOMES: Primary outcomes: aerobic capacity (peak oxygen consumption (VO2), peak workload). Secondary outcomes: walking velocity, walking endurance. DATA ANALYSIS: The methodological quality was assessed by the PEDro scale. Meta-analyses were performed for all primary and secondary outcomes. RESULTS: Nine articles (seven RCTs) were identified. The exercise intensity ranged from 50% to 80% heart rate reserve. Exercise duration was 20-40 min for 3-5 days a week. The total number of subjects included in the studies was 480. All studies reported positive effects on aerobic capacity, regardless of the stage of stroke recovery. Meta-analysis revealed a significant homogeneous standardized effect size (SES) in favour of aerobic exercise to improve peak VO2 (SES 0.42; 95% confidence interval (CI) 0.15-0.69; P=0.001) and peak workload (SES 0.50; 95% CI 0.26-0.73; P<0.001). There was also a significant homogeneous SES in favour of aerobic training to improve walking velocity (SES 0.26; 95% CI 0.05-0.48; P= 0.008) and walking endurance (SES 0.30; 95% CI 0.06-0.55; P= 0.008). CONCLUSIONS: There is good evidence that aerobic exercise is beneficial for improving aerobic capacity in people with mild and moderate stroke. Aerobic exercise should be an important component of stroke rehabilitation.     

Effect of combined interval training on the cardiorespiratory fitness in heart failure patients: a systematic review and meta-analysis

BackgroundThe combination of interval training and resistance training has showed interesting results in chronic heart failure patients, corroborating the benefits of physiological adaptations of both protocols.ObjectiveTo evaluate the effect of the combination of interval training and resistance training program when compared to interval training alone and/or without intervention group on cardiorespiratory fitness in patients with chronic heart failure.MethodsWe search MEDLINE via PubMed, ScienceDirect, Sportdiscus, BIREME and Scielo, from their inception to December 2018. Were included both randomized and non-randomized controlled trials comparing the effect of combined training, interval training alone and/or WI group on VO_2peak (expressed in ml/kg/min), in people with chronic heart failure patients. The meta-analysis was conducted via Review Manager v 5.3 software, using random effect model.ResultsTen articles were selected (nine randomized controlled trial), involving 401 participants. Six studies compared combined training with interval training and six studies compared combined training with the without intervention group. Eighty percent of the trials presented moderate risk of bias and twenty percent low risk of bias. Data showed significant difference and major increase in VO_2peak in favor to combined training group compared to interval training group (SMD = 0.25; CI = 0.04–0.46) and without intervention group (SMD = 0.46; CI = 0.29–0.64), respectively.ConclusionThe combination of interval training and resistance training showed more effective in increasing cardiorespiratory fitness in patients with heart failure than interval training alone and non-exercise therapy. However, further studies should be conducted to increase the understanding of this combined training method.     

运动干预在肺移植患者康复中应用的范围综述

目的 系统分析运动干预在肺移植患者康复中应用的相关研究,识别运动干预的具体内容、结局指标和应用效果,以期为医护人员开展相关干预提供参考。方法 根据范围综述的研究方法,计算机检索中国知网、万方数据库、中国生物医学文献数据库、Cochrane Library、PubMed、Embase等国内外数据库,检索时限为建库至2021年6月28日。对纳入文献进行筛选、汇总和分析。结果 共纳入25篇文献,其中9篇随机对照试验,16篇类实验研究。运动类型包括有氧运动、抗阻力运动和柔韧性运动;运动强度多为轻中度,频率多为3~5次/周,30~60 min/次。运动干预对肺移植患者的呼吸功能、活动能力、生活质量、心理状态具有积极意义。结论 运动干预具有整体性、动态性和综合性,对肺移植患者有积极的应用效果。未来研究应注重探究最佳的运动干预策略、制订规范统一的评价标准,依据肺移植患者的病情和身体功能状态,制订科学、适用和规范的肺移植患者运动干预方案。