{"title":"不同模式的心脏康复训练对心力衰竭患者的疗效：系统评价和网络荟萃分析","authors":"Yi-Tian Liu, Chang-Jiang Deng, Feng-Li Yang, Hao-Yue Yang, Zhi-Long Wang, Xin Yin, Ying Pan, Ting-Ting Wu, Xiang Xie","doi":"10.21037/cdt-2024-698","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) has been shown to be an effective treatment for patients with heart failure (HF). However, the effect of different modes of CR delivery on HF remains unclear. The purpose of this study is to perform a large-scale pairwise and network meta-analysis (NMA) on the impact of various exercise types on patients with HF using multiple indicators.</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) published between 2000 and October 2023 were systematically searched in PubMed (Medline), the Cochrane Library and Web of Science. Statistical analysis was performed by STATASE16 with the network pack. The primary outcomes focused on functional capacity and health-related quality of life (QoL), such as peak VO<sub>2</sub>, six-minute walk test (6MWT), maximum workload, left ventricular ejection fraction (LVEF), maximum heart rate (MHR), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores. All relevant studies reported well-defined or accessible exposures and presented clear data on any one or more of the six items above before and after exercise rehabilitation.</p><p><strong>Results: </strong>In total, 122 RCTs were ultimately included in the final analysis. Pairwise analyses revealed aerobic training (AT) can improve peak VO<sub>2</sub> (2.49 mL/kg/min) and LVEF (2.97%). High-intensity interval training (HIIT) was associated with an improvement in peak VO<sub>2</sub> (3.91 mL/kg/min), LVEF (6.68%), 6MWT (65.4 m) and MLHFQ score (-10.34). As shown in the NMA, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for peak VO<sub>2</sub>, was HIIT (SUCRA: 90.8%), strength training (ST) (74.7%), AT (64.4%), combined training (CT) (41.7%) and inspiratory muscle training (IMT) (18.3%). The order of effectiveness for LVEF based on SCURA values was HIIT (90.5%), AT (77.8%), CT (50.3%), ST (49.9%) and IMT (7.7%).</p><p><strong>Conclusions: </strong>Various types of exercise, especially HIIT, can improve QoL, cardiac function, LVEF, and exercise tolerance in patients with HF. The results of this analysis should inform future exercise guideline personalized recommendations and prescriptions for HF patients.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"15 3","pages":"526-538"},"PeriodicalIF":2.1000,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246986/pdf/","citationCount":"0","resultStr":"{\"title\":\"Efficacy of different modes of exercise-based cardiac rehabilitation delivery for patients with heart failure: a systematic review and network meta-analysis.\",\"authors\":\"Yi-Tian Liu, Chang-Jiang Deng, Feng-Li Yang, Hao-Yue Yang, Zhi-Long Wang, Xin Yin, Ying Pan, Ting-Ting Wu, Xiang Xie\",\"doi\":\"10.21037/cdt-2024-698\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Cardiac rehabilitation (CR) has been shown to be an effective treatment for patients with heart failure (HF). However, the effect of different modes of CR delivery on HF remains unclear. The purpose of this study is to perform a large-scale pairwise and network meta-analysis (NMA) on the impact of various exercise types on patients with HF using multiple indicators.</p><p><strong>Methods: </strong>Randomized controlled trials (RCTs) published between 2000 and October 2023 were systematically searched in PubMed (Medline), the Cochrane Library and Web of Science. Statistical analysis was performed by STATASE16 with the network pack. The primary outcomes focused on functional capacity and health-related quality of life (QoL), such as peak VO<sub>2</sub>, six-minute walk test (6MWT), maximum workload, left ventricular ejection fraction (LVEF), maximum heart rate (MHR), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores. All relevant studies reported well-defined or accessible exposures and presented clear data on any one or more of the six items above before and after exercise rehabilitation.</p><p><strong>Results: </strong>In total, 122 RCTs were ultimately included in the final analysis. Pairwise analyses revealed aerobic training (AT) can improve peak VO<sub>2</sub> (2.49 mL/kg/min) and LVEF (2.97%). High-intensity interval training (HIIT) was associated with an improvement in peak VO<sub>2</sub> (3.91 mL/kg/min), LVEF (6.68%), 6MWT (65.4 m) and MLHFQ score (-10.34). As shown in the NMA, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for peak VO<sub>2</sub>, was HIIT (SUCRA: 90.8%), strength training (ST) (74.7%), AT (64.4%), combined training (CT) (41.7%) and inspiratory muscle training (IMT) (18.3%). The order of effectiveness for LVEF based on SCURA values was HIIT (90.5%), AT (77.8%), CT (50.3%), ST (49.9%) and IMT (7.7%).</p><p><strong>Conclusions: </strong>Various types of exercise, especially HIIT, can improve QoL, cardiac function, LVEF, and exercise tolerance in patients with HF. The results of this analysis should inform future exercise guideline personalized recommendations and prescriptions for HF patients.</p>\",\"PeriodicalId\":9592,\"journal\":{\"name\":\"Cardiovascular diagnosis and therapy\",\"volume\":\"15 3\",\"pages\":\"526-538\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-06-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246986/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular diagnosis and therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/cdt-2024-698\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular diagnosis and therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/cdt-2024-698","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/26 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Efficacy of different modes of exercise-based cardiac rehabilitation delivery for patients with heart failure: a systematic review and network meta-analysis.
Background: Cardiac rehabilitation (CR) has been shown to be an effective treatment for patients with heart failure (HF). However, the effect of different modes of CR delivery on HF remains unclear. The purpose of this study is to perform a large-scale pairwise and network meta-analysis (NMA) on the impact of various exercise types on patients with HF using multiple indicators.
Methods: Randomized controlled trials (RCTs) published between 2000 and October 2023 were systematically searched in PubMed (Medline), the Cochrane Library and Web of Science. Statistical analysis was performed by STATASE16 with the network pack. The primary outcomes focused on functional capacity and health-related quality of life (QoL), such as peak VO2, six-minute walk test (6MWT), maximum workload, left ventricular ejection fraction (LVEF), maximum heart rate (MHR), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores. All relevant studies reported well-defined or accessible exposures and presented clear data on any one or more of the six items above before and after exercise rehabilitation.
Results: In total, 122 RCTs were ultimately included in the final analysis. Pairwise analyses revealed aerobic training (AT) can improve peak VO2 (2.49 mL/kg/min) and LVEF (2.97%). High-intensity interval training (HIIT) was associated with an improvement in peak VO2 (3.91 mL/kg/min), LVEF (6.68%), 6MWT (65.4 m) and MLHFQ score (-10.34). As shown in the NMA, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for peak VO2, was HIIT (SUCRA: 90.8%), strength training (ST) (74.7%), AT (64.4%), combined training (CT) (41.7%) and inspiratory muscle training (IMT) (18.3%). The order of effectiveness for LVEF based on SCURA values was HIIT (90.5%), AT (77.8%), CT (50.3%), ST (49.9%) and IMT (7.7%).
Conclusions: Various types of exercise, especially HIIT, can improve QoL, cardiac function, LVEF, and exercise tolerance in patients with HF. The results of this analysis should inform future exercise guideline personalized recommendations and prescriptions for HF patients.
期刊介绍：
The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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