title: Effect of exercise on diastolic function in heart failure patients: a systematic review and meta-analysis.
abstract: Diastolic dysfunction contributes to the development and progression of heart failure. Conventional echocardiography and tissue Doppler imaging are widely utilised in clinical research providing a number of indices of diastolic function valuable in the diagnosis and prognosis of heart failure patients. The aim of this meta-analysis was to quantify the effect of exercise training on diastolic function in patients with heart failure. Exercise training studies that investigate different indices of diastolic function in patients with heart failure have reported that exercise training improves diastolic function in these patients. We sought to add to the current literature by quantifying, where possible, the effect of exercise training on diastolic function. We conducted database searches (PubMed, EBSCO, EMBASE, and Cochrane Trials Register to 31 July 2016) for exercise based rehabilitation trials in heart failure, using the search terms 'exercise training, diastolic function and diastolic dysfunction'. Data from six studies, with a total of 266 heart failure with reduced ejection fraction (HFrEF) participants, 144 in intervention groups and 122 in control groups, indicated a significant reduction in the ratio of early diastolic transmitral velocity (E) to early diastolic tissue velocity (E') (E/E' ratio) with exercise training, exercise vs. control mean difference (MD) of -2.85 (95% CI -3.66 to -2.04, p < 0.00001). Data from five studies in heart failure with preserved ejection fraction (HFpEF) patients, with a total of 204 participants, 115 in intervention groups and 89 in control groups, also demonstrated a significant improvement in E/E' in exercise vs. control MD of -2.38 (95% CI -3.47 to -1.28, p < 0.0001).
authors.affiliation: School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Pearson
authors.affiliation: Westmead Private Physiotherapy Services and The Clinical Research Institute, Sydney, Australia.|Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
authors.forename: S F
authors.initials: SF
authors.lastname: Mungovan
authors.affiliation: School of Science and Technology, University of New England, Armidale, NSW, 2351, Australia. nsmart2@une.edu.au.
authors.forename: N A
authors.initials: NA
authors.lastname: Smart
mesh_terms: D003971:Diastole; D004452:Echocardiography; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D054144:Heart Failure, Diastolic / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Cardiac function; Diastolic function; Exercise; Heart failure