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Published online: 2021-09-01
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The effect of exercise training and physiotherapy on diastolic function, exercise capacity and quality of life in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

Chenchen Zhuang, Xufei Luo, Qiongying Wang, Wenjuan Wang, Runmin Sun, Xiaofang Zhang, Jing Yu
DOI: 10.33963/KP.a2021.0101
·
Pubmed: 34472077

open access

Online first
Original article
Published online: 2021-09-01

Abstract

Background: Exercise and physiotherapy is accepted as an important contribution to the rehabilitation of patients with heart failure with preserved ejection fraction (HFpEF). But the previous results are unclear partly because of limited power with small sample sizes.
Aims: We aimed to better understand the effects of 2 exercise training interventions and two modalities of physiotherapies on exercise capacity, quality of life (QoL) and diastolic dysfunction in HFpEF patients.
Methods: Cochrane Library, EMBASE and MEDLINE via PubMed for randomized controlled trials were searched from their inception to May 2021. The effect size was estimated as mean differences (MD) with 95% confidence intervals (CI).
Results: A total of 14 articles on 13 trials were included in this meta-analysis with 673 HFpEF patients. The pooling revealed that peak oxygen uptake was improved by endurance training, functional electrical stimulation (FES) and inspiratory muscle training (IMT). Similar results were observed for 6-minute walk test and QoL. A combination of endurance and resistance training (combined exercise) was beneficial to the ratio of peak early to late diastolic mitral inflow velocities (MD [95% CI]: –2.90 [–4.97, –0.83]; P = 0.006) and the early diastolic mitral annual velocity (MD [95% CI]: 1.40 [0.68, 2.12]; P = 0.006]. IMT improved ventilation/carbon dioxide ratio slope (MD [95% CI]: –3.36 ml/kg-1/min-1 [–6.17, –0.54]; P = 0.019].
Conclusions: FES and IMT improve functional capacity and QoLwithout a change in diastolic function in HFpEF patients, and the outcomes are similar to endurance training. Notably, combined exercise may improve diastolic function.

Abstract

Background: Exercise and physiotherapy is accepted as an important contribution to the rehabilitation of patients with heart failure with preserved ejection fraction (HFpEF). But the previous results are unclear partly because of limited power with small sample sizes.
Aims: We aimed to better understand the effects of 2 exercise training interventions and two modalities of physiotherapies on exercise capacity, quality of life (QoL) and diastolic dysfunction in HFpEF patients.
Methods: Cochrane Library, EMBASE and MEDLINE via PubMed for randomized controlled trials were searched from their inception to May 2021. The effect size was estimated as mean differences (MD) with 95% confidence intervals (CI).
Results: A total of 14 articles on 13 trials were included in this meta-analysis with 673 HFpEF patients. The pooling revealed that peak oxygen uptake was improved by endurance training, functional electrical stimulation (FES) and inspiratory muscle training (IMT). Similar results were observed for 6-minute walk test and QoL. A combination of endurance and resistance training (combined exercise) was beneficial to the ratio of peak early to late diastolic mitral inflow velocities (MD [95% CI]: –2.90 [–4.97, –0.83]; P = 0.006) and the early diastolic mitral annual velocity (MD [95% CI]: 1.40 [0.68, 2.12]; P = 0.006]. IMT improved ventilation/carbon dioxide ratio slope (MD [95% CI]: –3.36 ml/kg-1/min-1 [–6.17, –0.54]; P = 0.019].
Conclusions: FES and IMT improve functional capacity and QoLwithout a change in diastolic function in HFpEF patients, and the outcomes are similar to endurance training. Notably, combined exercise may improve diastolic function.

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Keywords

diastolic function, exercise training, functional electrical stimulation, heart failure with preserved ejection fraction, inspiratory muscle training

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About this article
Title

The effect of exercise training and physiotherapy on diastolic function, exercise capacity and quality of life in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2021-09-01

DOI

10.33963/KP.a2021.0101

Pubmed

34472077

Keywords

diastolic function
exercise training
functional electrical stimulation
heart failure with preserved ejection fraction
inspiratory muscle training

Authors

Chenchen Zhuang
Xufei Luo
Qiongying Wang
Wenjuan Wang
Runmin Sun
Xiaofang Zhang
Jing Yu

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