title: Combined Exercise and Inspiratory Muscle Training in Patients With Heart Failure: A SYSTEMATIC REVIEW AND META-ANALYSIS.
abstract: OBJECTIVE
  Studies have reported the benefits of exercise and inspiratory muscle training (IMT) in patients with heart failure (HF); however, there is no meta-analysis on the effects of the combination of exercise and IMT in patients with HF. The objective of this study was to determine whether combined exercise/IMT was more effective than conventional exercise on exercise capacity, respiratory muscle strength, and quality of life in patients with HF.
  
  
  METHODS
  This is a systematic review and meta-analysis. We searched MEDLINE, LILACS, CINAHL, EMBASE, PEDro, and the Cochrane Central Register of Controlled Trials (from the earliest date available to April 2015) for randomized controlled trials, examining effects of combined exercise/IMT versus conventional exercise on exercise capacity, respiratory muscle strength, and quality of life measurements in patients with HF. Two reviewers selected studies independently. Weighted mean differences and 95% CIs were calculated.
  
  
  RESULTS
  Three studies met the study criteria. Combined exercise/IMT resulted in improvement in maximal inspiratory pressure weighted mean differences (20.89 cm H2O; 95% CI, 14.0-27.78) and Minnesota Living with Heart Failure Questionnaire weighted mean differences (4.43; 95% CI, 0.72-8.14). Nonsignificant difference was observed in peak (Equation is included in full-text article.)O2 for participants in the combined exercise/IMT group compared with the conventional exercise group. No serious adverse events were reported.
  
  
  CONCLUSIONS
  Combined exercise/IMT may improve maximal inspiratory pressure and quality of life in patients with HF and should be considered for inclusion in cardiac rehabilitation programs.
authors.affiliation: Departamento de Biofunção, Curso de Fisioterapia, Universidade Federal da Bahia, Salvador, Bahia, Brazil (Drs Neto and Conceição, and Mr Martinez); Programa de Pós-graduação em Medicina e Saúde da, Universidade Federal da Bahia, Salvador, Bahia, Brazil (Dr Neto); The GREAT Group (GRupo de Estudos em ATividade física), Aracaju, Brazil (Drs Neto and Carvalho); Programa de Pós-graduação em Educação Física, Universidade de Brasília, Brasília, Brazil (Mr Silva); and Departamento de Fisioterapia da Universidade Federal de Sergipe, Aracaju, Brazil (Dr Carvalho).
authors.forename: Mansueto Gomes
authors.initials: MG
authors.lastname: Neto
authors.forename: Bruno Prata
authors.initials: BP
authors.lastname: Martinez
authors.forename: Cristiano Sena
authors.initials: CS
authors.lastname: Conceição
authors.forename: Paulo Eugênio
authors.initials: PE
authors.lastname: Silva
authors.forename: Vitor Oliveira
authors.initials: VO
authors.lastname: Carvalho
mesh_terms: D001945:Breathing Exercises / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D006333:Heart Failure / Q000534:rehabilitation*; D006801:Humans; D053580:Muscle Strength / Q000502:physiology*; D012132:Respiratory Muscles / Q000502:physiology*; D016896:Treatment Outcome