title: Comparing exercise training modalities in heart failure: A systematic review and meta-analysis.
abstract: Exercise training (ET) is suggested to improve exercise capacity, prognosis, quality of life (QOL) and functional modifications of the heart in patients with heart failure (HF). However, it is not clear which modality is best. In order to assess the effectiveness of different ET modalities on prognostic cardiopulmonary exercise test (CPET) parameters, QOL and left ventricular remodeling, a systematic review and meta-analysis was performed. Randomized clinical trials (RCTs) were selected in three databases. The primary outcome data were peak oxygen uptake, ventilation over carbon dioxide slope, oxygen uptake efficiency slope, exercise oscillatory ventilation, rest and peak pulmonary end-tidal CO2. Secondary variables were QOL, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD). Twenty RCTs (n=811) met the a priori stated inclusion criteria. Studies were categorized into four different groups: "interval training (IT1) versus combined interval and strength training (IT1S)" (n=156), "continuous training (CT1) versus combined continuous and strength training (CT1S)" (n=130), "interval training (IT2) versus continuous training (CT2)" (n=501) and "continuous training (CT3) versus strength training (S3)" (n=24). No significant random effects of exercise modality were revealed assessing the CPET parameters. There was a significant improvement in QOL applying CT1S (P<0.001). Comparing IT2 with CT2, LVEDD and LVEF were significantly improved favoring IT2 (P<0.001). There is some evidence to support that interval training is more effective to improve LVEF and LVEDD. The fact that patients with HF are actively involved in any kind of ET program seems sufficient to improve the prognosis, QOL and anatomic function.
authors.affiliation: University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium. Electronic address: Justien.Cornelis@uantwerpen.be.
authors.forename: Justien
authors.initials: J
authors.lastname: Cornelis
authors.affiliation: University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium; Antwerp University Hospital, Department of Cardiology, Wilrijkstraat 10, B-2650 Edegem, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Department of Medicine, Universiteitsplein 1, B-2610 Wilrijk, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Beckers
authors.affiliation: University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium; Vrije Universiteit Brussel, Faculty of Physical Education and Physical Therapy, Pleinlaan 2, B-1050 Elsene, Belgium; Bern University of Applied Sciences (Health), Murtenstrasse 10, CH-3008 Bern, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Taeymans
authors.affiliation: Antwerp University Hospital, Department of Cardiology, Wilrijkstraat 10, B-2650 Edegem, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Department of Medicine, Universiteitsplein 1, B-2610 Wilrijk, Belgium.
authors.forename: Christiaan
authors.initials: C
authors.lastname: Vrints
authors.affiliation: University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Vissers
mesh_terms: D015444:Exercise / Q000502:physiology*; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D055070:Resistance Training / Q000379:methods*
keywords: Exercise; Heart failure; Meta-analysis; Training