The Effect of Exercise Training Intensity on Quality of Life in Heart Failure Patients: A Systematic Review and Meta-Analysis

Cardiology ◽  
2016 ◽  
Vol 136 (2) ◽  
pp. 79-89 ◽  
Author(s):  
Cecilia Ostman ◽  
Daniel Jewiss ◽  
Neil A. Smart
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Resistance Training ◽  
Exercise Training ◽  
Left Ventricular ◽  
Moderate Intensity ◽  
Training Intensity ◽  
Medline Search ◽  
Intensity Training

Objectives: To establish if exercise training intensity produces different effect sizes for quality of life in heart failure. Background: Exercise intensity is the primary stimulus for physical and mental adaptation. Methods: We conducted a MEDLINE search (1985 to February 2016) for exercise-based rehabilitation trials in heart failure using the search terms ‘exercise training', ‘left ventricular dysfunction', ‘peak VO2', ‘cardiomyopathy', and ‘systolic heart dysfunction'. Results: Twenty-five studies were included; 4 (16%) comprised high-, 10 (40%) vigorous-, 9 (36%) moderate- and 0 (0%) low-intensity groups; two studies were unclassified. The 25 studies provided a total of 2,385 participants, 1,223 exercising and 1,162 controls (36,056 patient-hours of training). Analyses reported significant improvement in total Minnesota living with heart failure (MLWHF) total score [mean difference (MD) -8.24, 95% CI -11.55 to -4.92, p < 0.00001]. Physical MLWHF scorewas significantly improved in all studies (MD -2.89, 95% CI -4.27 to -1.50, p < 0.00001). MLWHF total score was significantly reduced after high- (MD -13.74, 95% CI -21.34 to -6.14, p = 0.0004) and vigorous-intensity training (MD -8.56, 95% CI -12.77 to -4.35, p < 0.0001) but not moderate-intensity training. A significant improvement in the total MLWHF score was seen after aerobic training (MD -3.87, 95% CI -6.97 to -0.78, p = 0.01), and combined aerobic and resistance training (MD -9.82, 95% CI -15.71 to -3.92, p = 0.001), but not resistance training. Conclusions: As exercise training intensity rises, so may the magnitude of improvement in quality of life in exercising patients. Aerobic-only or combined aerobic and resistance training may offer the greatest improvements in quality of life.

scholarly journals Exercise Training Improved Longitudinal Intrinsic Left Ventricle Function in Heart Failure with Preserved Ejection Fraction

2019 ◽  
Vol 28 (01) ◽  
pp. 044-049
Author(s):  
Sidhi Purwowiyoto ◽  
Budhi Purwowiyoto ◽  
Amiliana Soesanto ◽  
Anwar Santoso
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
World Health ◽  
Volume Index ◽  
Lv Function ◽  
Preserved Ejection Fraction

Exercise improves morbidity, fatality rate, and quality of life in heart failure with low ejection fraction, but fewer data available in heart failure with preserved ejection fraction (HFPEF).The purpose of this study is to test the hypothesis that exercise training might improve the longitudinal intrinsic left ventricular (LV) function in HFPEF patients.This quasi-experimental study had recruited 30 patients with HFPEF. Exercise training program had been performed for a month with a total of 20 times exercise sessions and evaluated every 2 weeks. Echocardiography was performed before sessions, second week and fourth week of exercise training. Six-minute walk tests (6MWTs) and quality-of-life variables using Minnesota living with HF scoring and the 5-item World Health Organization Well-Being Index scoring were measured before and after exercise as well.Left ventricular filling pressure, represented by the ratio of early diastolic mitral flow velocity/early diastolic annular velocity and left atrial volume index, improved during exercise. The longitudinal intrinsic LV function, represented by four-chamber longitudinal strain, augmented during exercise (p < 0.001). Aerobic capacity, measured by 6MWT, increased significantly (p = 0.001). Quality of life improved significantly during exercise (p < 0.001).Exercise training was suggested to improve the longitudinal intrinsic LV function and quality of life in HFPEF. Clinical Trial Registration: ACTRN12614001042639.

Effect of outpatient exercise training programmes in patients with chronic heart failure: a systematic review

2011 ◽  
Vol 19 (4) ◽  
pp. 795-803 ◽  
Author(s):  
Suzan van der Meer ◽  
Marlies Zwerink ◽  
Marco van Brussel ◽  
Paul van der Valk ◽  
Elly Wajon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Systematic Review ◽  
Chronic Heart Failure ◽  
Exercise Training ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Training Programmes

Background: Advantages of outpatient exercise training are reduced waiting lists, better compliance, reduced time investment by the patient with reduced travel expenses, and less dependence on other people to participate. Therefore, this systematic review studies the effects of outpatient exercise training programmes compared with usual care on exercise capacity, exercise performance, quality of life, and safety in patients with chronic heart failure. Design: Systematic review with meta-analysis. Methods: Randomized controlled trials concerning patients with chronic heart failure, with a left ventricular ejection fraction ≤40%, were included. A meta-analysis was performed. Results: Twenty-two studies were included. VO2max, 6-min walking test, and quality of life showed significant differences in favour of the intervention group of 1.85 ml/kg/min, 47.9 m, and 6.9 points, respectively. In none of the studies, a significant relationship was found between exercise training and adverse events. Conclusion: This meta-analysis illustrates the efficacy and safety of outpatient training programmes for patients with chronic heart failure.

scholarly journals Exercise training in patients with chronic heart failure: A new challenge for Cardiac Rehabilitation Community

2018 ◽  
Vol 88 (3) ◽  
Author(s):  
Francesco Giallauria ◽  
Lucrezia Piccioli ◽  
Giuseppe Vitale ◽  
Filippo M. Sarullo
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Inspiratory Muscle ◽  
Moderate Intensity ◽  
Frailty Status ◽  
Training Modality

Exercise training (ET) is strongly recommended in patients with chronic stable heart failure (HF). Moderate-intensity aerobic continuous ET is the best established training modality in HF patients. In the last decade, however, high-intensity interval exercise training (HIIT) has aroused considerable interest in cardiac rehabilitation community. In HF patients, HIIT exerts larger improvements in exercise  capacity compared to moderate-continuous ET. Since better functional capacity translates into symptoms relief and improvement in quality of life in patients with HF, this training modality is collecting growing interest and consensus, not revealing major safety issues. HIIT should not replace other training modalities in HF but should rather complement them. Inspiratory muscle training, another promising training modality in patients with HF, exerts beneficial effect on inspiratory muscle strength and inspiratory endurance, on exercise capacity and quality of life. In conclusion, taking into consideration the complecity of HF syndrome, combining and tailoring different ET modalities according to each patient’s baseline clinical characteristics (i.e. exercise capacity, comorbidity, frailty status, personal needs, preferences and goals) seem the most wily approach for exercise prescription.

Exercise training increases arterial compliance in patients with congestive heart failure

2001 ◽  
Vol 102 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Melinda M. PARNELL ◽  
Diane P. HOLST ◽  
David M. KAYE
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Exercise Training ◽  
Arterial Compliance ◽  
Training Programme ◽  
Left Ventricular ◽  
Control Group ◽  
Exercise Training Programme

Systemic arterial compliance (SAC) makes an important contribution to cardiac afterload, and thus is a significant determinant of left ventricular work. Previous studies have suggested that arterial compliance may be reduced in patients with congestive heart failure (CHF), and that SAC is increased after a 4-week exercise training programme in healthy, sedentary individuals. The present study aimed to investigate the effects of an 8-week exercise training programme on arterial mechanical properties, left ventricular performance and quality of life in CHF patients. A total of 21 patients with NYHA class II or III CHF (mean±S.D. age 55±13 years) were randomly allocated to either an 8-week exercise training group or a ‘usual lifestyle’ control group. SAC, as determined non-invasively using applanation tonometry and Doppler aortic velocimetry, increased from 0.57±0.11 to 0.77±0.14 arbitrary compliance units (mean±S.E.M.; P = 0.01) in the exercise group, while no change occurred in the control group. Left ventricular structure and function was assessed by echocardiography, and these parameters were unchanged over the 8-week study period. Exercise training significantly increased exercise capacity, measured by a 6-min walking test (474±27 to 547±34 m; P = 0.008). Quality of life, as assessed using the Minnesota Living with Heart Failure Evaluation, demonstrated a decrease in heart failure symptoms from 46±7 to 24±5units (P = 0.01) following the exercise training programme. These data show that exercise training improves SAC in patients with CHF. The accompanying improvement in exercise capacity may be due, in part, to an improvement in arterial function.

Interval training early after heart failure decompensation is safe and improves exercise tolerance and quality of life in selected patients

2017 ◽  
Vol 25 (1) ◽  
pp. 9-18 ◽  
Author(s):  
Artem Doletsky ◽  
Denis Andreev ◽  
Ilya Giverts ◽  
Alexey Svet ◽  
Anna Brand ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Exercise Tolerance ◽  
Interval Training ◽  
Training Group ◽  
Moderate Intensity ◽  
Interval Exercise ◽  
Heart Failure Decompensation

Aims To evaluate safety and efficacy of moderate intensity interval exercise training early after heart failure decompensation on exercise tolerance and health-related quality of life (HRQoL). Methods and results This is a prospective randomized controlled study. We screened 234 consecutive patients admitted with decompensated heart failure; 46 patients (42 men/4 women; 61 ± 12 years of age) were randomized to a moderate intensity aerobic interval training ( n = 24) or to a control group ( n = 22). Patients underwent cardiopulmonary exercise testing, echocardiography and Minnesota Living with Heart Failure questionnaire (MLHFQ) at baseline, after three weeks and after three months. After three weeks, peak-VO2 increased by 17% in the training group ( p = 0.003) with further increase by 10% after three months ( p < 0.001) but did not change significantly in controls. MLHFQ score improved after three weeks, with better results in the training group (from 64.6 ± 15.6 to 30.8 ± 12.9, p < 0.001). After three months, MLHFQ further improved in the exercise training group, but not in controls. Left ventricular ejection fraction was not significantly different between the two groups at baseline and after three months. No serious adverse events related to exercise testing or training were observed. Conclusions Interval exercise training early after an episode of heart failure decompensation is safe and effective in improving exercise tolerance and health-related quality of life in selected patients after achievement of clinical stability. Positive effects remained sustained after three months. Further studies are needed to define role and indications for interval exercise training early after heart failure decompensation.

Controlled study of myocardial recovery after interval training in heart failure: SMARTEX-HF – rationale and design

2011 ◽  
Vol 19 (4) ◽  
pp. 813-821 ◽  
Author(s):  
Asbjørn Støylen ◽  
Viviane Conraads ◽  
Martin Halle ◽  
Axel Linke ◽  
Eva Prescott ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Oxygen Uptake ◽  
Primary Endpoint ◽  
Interval Training ◽  
Peak Oxygen Uptake ◽  
Left Ventricular ◽  
Regular Exercise

Background: The large randomized controlled multicentre clinical trial, HF-ACTION, recently demonstrated that a programme of recommendation of regular exercise training at moderate intensity is safe, improves quality of life, and reduces the combined endpoint of all-cause death and hospitalization in patients with chronic heart failure. However, the size of beneficial effects was modest compared to results published in smaller single studies and meta-analyses. Objective: Based on results of a pilot study, the objective of the present investigation is to test the hypothesis that a programme comprising interval training at high relative intensity would yield significantly larger effects in terms of left ventricular remodelling compared to moderate continuous exercise training. Study design: In a three-armed randomized multicentre study of stable heart failure patients with left ventricular ejection fraction ≤35%, the effects of a 12-week programme of high-intensity interval training (HIT; 85–90% of peak oxygen uptake, VO2peak) will be compared to actual practice in Europe, represented by either an isocaloric programme of moderate continuous training (MCT; 50–60% of VO2peak) and a recommendation of regular exercise (RE) of the individual patients’ own preference based on clinical practice at the local centre. The primary endpoint is reverse remodelling, defined as change in left ventricular end-diastolic diameter assessed by echocardiography. Secondary endpoints include peak oxygen uptake (VO2peak), biomarkers, quality of life, and level of physical activity assessed by questionnaires. In addition, long-term maintenance of effects after the supervised training period will be determined. Assessments will be made at baseline, after the 12-week intervention programme, and at 1-year follow up. A total number of 200 patients on treatment per protocol, randomized to the three groups in a 1 : 1 : 1 manner, is estimated to detect clinically relevant differences in effect with HIT vs. MCT and RE ( p < 0.05; statistical power 0.90) for the primary endpoint. Inclusion of patients started May 2009 and will run until total number has been reached.

Exercise Capacity in Chronic Heart Failure

2012 ◽  
Vol 9 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Gina G Mentzer ◽  
Alex J Auseon
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Exercise Training ◽  
Exercise Capacity ◽  
Positive Impact ◽  
Pharmacologic Therapy ◽  
The Past ◽  
Diagnosis And Prognosis ◽  
Future Therapy

Heart failure (HF) affects more than 5 million people and has an increasing incidence and cost burden. Patients note symptoms of dyspnea and fatigue that result in a decreased quality of life, which has not drastically improved over the past decades despite advances in therapies. The assessment of exercise capacity can provide information regarding patient diagnosis and prognosis, while doubling as a potential future therapy. clinically, there is acceptance that exercise is safe in hf and can have a positive impact on morbidity and quality of life, although evidence for improvement in mortality is still lacking. specific prescriptions for exercise training have not been developed because many variables and confounding factors have prevented research trials from demonstrating an ideal regimen. Physicians are becoming more aware of the indices and goals for hf patients in exercise testing and therapy to provide comprehensive cardiac care. it is further postulated that a combination of exercise training and pharmacologic therapy may eventually provide the most benefits to those suffering from hf.

Abstract 15830: Elevated Resting Heart Rate is Associated With Impaired Quality of Life and Worse NYHA Functional Capacity in Patients With Chronic Heart Failure: Results From REALITY HF Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yuksel Cavusoglu ◽  
Omer Kozan ◽  
Ahmet Temizhan ◽  
Serdar Kucukoglu
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Heart Rate ◽  
Functional Capacity ◽  
Real Life ◽  
Left Ventricular ◽  
Summary Score ◽  
Treatment Modalities ◽  
Resting Heart Rate

Purpose: Resting heart rate (HR), health related quality of life (HQoL) and NYHA functional capacity are referred as important determinants of prognosis and targets of therapy in heart failure (HF). REALITY HF (Resting Heart Rate and Real Life Treatment Modality in Outpatients with Left Ventricular Systolic Dysfunction) study data were analyzed for the evaluation of any relationship of resting HR with HQoL assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ) and NYHA functional class. Methods: REALITY HF was a multicenter, prospective registry designed to evaluate HF patients’ characteristics and effects of treatment modalities on resting HR and enrolled 1057 patients (age 61±12 years) with LVEF <40%. 781 (74%) patients in sinus rhythm were included in this analysis. Patients were classified into 4 groups according to the quartiles of HR: Q1:<68 bpm (n=234), Q2:69-75 bpm (n=189), Q3:76-87 bpm (n=194) and Q4:>87 bpm (n=164). KCCQ was completed in a random sample of 320 (Q1:n=27, Q2:n=99, Q3:n=125, Q4:n=69) patients, in which higher scores show better patient’s health status. Results: During enrollment, 82% of patients were receiving ≥2 drugs including ACE[[Unable to Display Character: &#304;]]/ARB, beta blocker, aldosterone blocker, diuretic or digoxin. Resting HR was 76±14 bpm and 68% of patients had a resting HR ≥70 bpm. KCCQ overall summary score (OSC) was found to be 75.7±13.2 in those in Q1, 65.5±20.8 in Q2, 64.4±20.6 in Q3 and 58.3±21.2 in Q4 (p=0.004) and KCCQ clinical summary score (CSS) was 80.4±15.7 in those in Q1, 70.0±22.4 in Q2, 69.9±21.9 in Q3 and 63.8±23.3 in Q4 (p=0.016). Also, there was a significant negative correlation between resting HR and OSC (p=0.008) or CSS (p=0.031). The distribution of NYHA-I patients for Q1, Q2, Q3 and Q4 were 40.7%, 22.8%, 23.8% and 12.7%, NYHA-II patients-30.8%, 23.1%, 27.2% and 18.9%, NYHA-III patients-21.2%, 23.9%, 24.3% and 30.6% and NYHA-IV patients-22.7%, 34.1%, 22.7% and 20.5%, respectively (p<0.001). Also, resting HR were found to gradually and significantly increase across NYHA categories (72.8±12 bpm in NYHA-I, 76.1±13 bpm in NYHA-II, 80.2±15 bpm in NYHA-III and 78.9±16 bpm in NYHA-IV, p<0.001). Conclusions: These results suggest that elevated resting HR in HF patients is associated with impaired HQoL and worse NYHA functional capacity.

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