title: Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine the effect of exercise training on clinical events and health-related quality of life (HRQoL) of patients with systolic heart failure.
  
  
  RESULTS
  We searched electronic databases including Medline, EMBASE, and Cochrane Library up to January 2008 to identify randomized controlled trials (RCTs) comparing exercise training and usual care with a minimum follow-up of 6 months. Nineteen RCTs were included with a total of 3647 patients, the majority of whom were male, low-to-medium risk, and New York Heart Association class II-III with a left ventricular ejection fraction of <40%. There was no significant difference between exercise and control in short-term (<or=12 months) or longer-term all-cause mortality or overall hospital admissions. Heart failure-related hospitalizations were lower [relative risk: 0.72, 95% confidence interval (CI): 0.52-0.99] and HRQoL improved (standardized mean difference: -0.63, 95% CI: -0.80 to -0.37) with exercise therapy. Any effect of cardiac exercise training on total mortality and HRQoL was independent of degree of left ventricular dysfunction, type of cardiac rehabilitation, dose of exercise intervention, length of follow-up, trial quality, and trial publication date.
  
  
  CONCLUSIONS
  Compared with usual care, in selected heart failure patients, exercise training reduces heart failure-related hospitalizations and results in clinically important improvements in HRQoL. High-quality RCT and cost-effectiveness evidence is needed for the effect of exercise training in community-based settings and in more severe heart failure patients, elderly people, and women.
authors.affiliation: Cardiothoracic Department, Plymouth Hospitals NHS Trust, Terrance Lewis Building, 9th Floor, Derriford Hospital, Plymouth Hospitals NHS Trust, Derriford Road, Crownhill, Plymouth, Devon PL6 8DH, UK. dreddavies@gmail.com
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Davies
authors.forename: Tiffany
authors.initials: T
authors.lastname: Moxham
authors.forename: Karen
authors.initials: K
authors.lastname: Rees
authors.forename: Sally
authors.initials: S
authors.lastname: Singh
authors.forename: Andrew J S
authors.initials: AJ
authors.lastname: Coats
authors.forename: Shah
authors.initials: S
authors.lastname: Ebrahim
authors.forename: Fiona
authors.initials: F
authors.lastname: Lough
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D054143:Heart Failure, Systolic / Q000534:rehabilitation*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000534:rehabilitation