运动训练可提高射血分数保留型心力衰竭患者的运动能力和生活质量:随机对照试验的系统回顾和荟萃分析。

European heart journal open Pub Date : 2024-06-26 eCollection Date: 2024-07-01 DOI:10.1093/ehjopen/oeae033
Ranu Baral, Jamie Sin Ying Ho, Ayesha Nur Soroya, Melissa Hanger, Rosemary Elizabeth Clarke, Sara Fatima Memon, Hannah Glatzel, Mahmood Ahmad, Rui Providencia, Jonathan James Hyett Bray, Fabrizio D'Ascenzo
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引用次数: 0

摘要

目的:射血分数保留型心力衰竭(HFpEF)与高发病率和高死亡率有关,目前已证实的治疗策略有限。多项研究表明,运动对患者有益。我们旨在评估运动对功能、生理和生活质量的影响:我们对 Medline 和 Embase 进行了全面检索。方法:我们对 Medline 和 Embase 进行了全面检索,纳入了针对成人高频低氧血症患者的随机对照试验(RCT),其中包含运动干预的数据。通过荟萃分析,我们利用Review Manager(RevMan)软件得出了峰值摄氧量(VO2)、明尼苏达心力衰竭患者生活质量(MLWHF)和其他舒张功能障碍评分的集合平均差(MD)估计值及95%置信区间(CI)。共纳入了 14 项研究,涉及 629 名高频心衰患者(63.2% 为女性),平均年龄为 68.1 岁。运动可显著改善 HFpEF 患者的峰值 VO2(MD 1.96 mL/kg/min,95% CI 1.25-2.68;P < 0.00001)和 MLWHF 评分(MD -12.06,95% CI -17.11 至 -7.01;P < 0.00001)。亚组分析显示,高强度间歇训练(HIIT)与中等强度持续运动(MCT;MD 1.25 mL/kg/min,95% CI 0.41-2.08,P = 0.003)相比,VO2峰值有小幅但显著的改善:运动可提高高房颤患者的运动能力和生活质量,与中等强度运动相比,高强度运动对运动能力的提高幅度较小,但在统计学上有显著意义。为了证实这些研究结果并阐明高强度运动与中等强度运动之间的潜在差异,还需要对更大的参与人群和更长时间的随访进行进一步研究。
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Exercise training improves exercise capacity and quality of life in heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials.

Aims: Heart failure with preserved ejection fraction (HFpEF) is associated with high morbidity and mortality, and there are limited proven therapeutic strategies. Exercise has been shown to be beneficial in several studies. We aimed to evaluate the efficacy of exercise on functional, physiological, and quality-of-life measures.

Methods and results: A comprehensive search of Medline and Embase was performed. Randomized controlled trials (RCTs) of adult HFpEF patients with data on exercise intervention were included. Using meta-analysis, we produced pooled mean difference (MD) estimates with 95% confidence intervals (CIs) with Review Manager (RevMan) software for the peak oxygen uptake (VO2), Minnesota living with heart failure (MLWHF) and, other diastolic dysfunction scores. A total of 14 studies on 629 HFpEF patients were included (63.2% female) with a mean age of 68.1 years. Exercise was associated with a significant improvement in the peak VO2 (MD 1.96 mL/kg/min, 95% CI 1.25-2.68; P < 0.00001) and MLWHF score (MD -12.06, 95% CI -17.11 to -7.01; P < 0.00001) in HFpEF. Subgroup analysis showed a small but significant improvement in peak VO2 with high-intensity interval training (HIIT) vs. medium-intensity continuous exercise (MCT; MD 1.25 mL/kg/min, 95% CI 0.41-2.08, P = 0.003).

Conclusion: Exercise increases the exercise capacity and quality of life in HFpEF patients, and high-intensity exercise is associated with a small but statistically significant improvement in exercise capacity than moderate intensity. Further studies with larger participant populations and longer follow-up are needed to confirm these findings and elucidate potential differences between high- and medium-intensity exercise.

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