A Systematic Review and Meta-Analysis of Randomized Clinical Trials on the Benefits of Exercise in Heart Failure Patients

Objective: To update Sagar et al. systematic review and meta-analysis on exercise-based rehabilitation in heart failure.

Methods: MEDLINE, OVID and cross references were searched for randomized clinical trials published between February 2013 to August 2018 on exercised-based cardiac rehabilitation. Trials with at least 6 months follow up were included if with exercise training program alone or as a component of comprehensive cardiac rehabilitation program compared with groups without exercise prescription.

Results: A total of 43 randomized clinical trials involving 11,989 patients predominantly with reduced EF and NYHA class ll-lll were included in the study. Exercise training program prescription in heart failure patients was shown to reduced the all-cause mortality (RR=0.76; 95%CI= 0.66, 0.87; P= 0.001), all cause hospitalization after 12 months (RR=0.70; 95% CI= 0.52, 0.96; P= 0.02) rehospitalization due to heart failure (RR= 0.49; 95% CI= 0.44, 0.55; P= <0.0001) and improvement in quality-of-life scores (RR= -0.36; 95% CI= -0.58, -0.14; P= 0.002). All-cause mortality and hospitalization admission after 12 months follow up showed significant benefits with exercise therapy program, particularly on exercise setting(p=0.026) and exercise dose (p=0.013), respectively, as revealed by the univariate meta-regression results.

Conclusion: Exercise therapy either in center or home based has been shown to benefit heart failure patients in reducing the risk of all-cause mortality up to 12 months, hospital admission up 12 months, and gave better quality of life. The new studies included have further strengthened the findings of previous studies that an exercise therapy program provides benefit to heart failure patients, either as an “alone” intervention or together with a cardiac rehabilitation program; and that the setting and dose of an exercise therapy program provide significant impact in reducing the risk of all-cause mortality and hospitalization after 12 months follow up, respectively.