Clinical Outcomes and Functional Change with Exercise Training in Heart Failure Patients

Abstract

Background: Published trials and reviews have identified benefits of exercise therapy or training for people with heart failure, including fewer hospitalizations, increased cardiorespiratory fitness, better quality of life, reduced brain natriuretic peptides, increased left ventricular ejection fraction (LVEF) and possibly improved survival. This body of work seeks to add to the evidence-base of safe and practical guidelines for the implementation of exercise training in chronic heart failure (CHF) patients. Methods: Meta-analyses were conducted using various methods. First, a systematic review and meta-analysis was conducted to compare the effect of exercise training in heart failure patients taking beta-blockers vs. those who do not. Second, an analysis of published exercise training programs was conducted in order to investigate if variation in aerobic exercise training intensity produced different effect sizes for fitness, adherence, cardiac events, mortality and hospitalization rates in heart failure patients. Third, an analysis of published exercise training programs was conducted to establish which training characteristics (frequency, duration etc.) produced the largest improvements in fitness, adherence, event, mortality and hospitalization rates in heart failure patients. Fourth, after difficulties assessing study quality and reporting for meta-analyses, a study quality and reporting assessment tool was designed specifically for use in exercise training studies. In light of the findings above a randomized controlled trial was designed based upon what we interpret as a natural progression of the published literature. A short editorial paper on current understanding of the exercise training literature for heart failure patients was also published.