Fengying Wang, Yan Bai, Bin Hua, Wenqin Zhou, Xiaoyan Wang
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Study selection and data extraction were performed simultaneously by two independent reviewers, using the Physiotherapy Evidence Database Scale (PEDro) for quality assessment of the included literature. The weighted mean differences (WMD) or standardized mean difference (SMD) were calculated by employing a fixed or random effects model. Other statistical analyses included subgroup analysis and sensitivity analysis. Quality of evidence was evaluated by the Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) method.</p><p><strong>Results: </strong>Eight RCTs were included. Analyses reported no significant improvement in left ventricular ejection fractions (LVEF; WMD = 0.47, 95% CI [-4.10, 5.03], p = 0.841), peak oxygen uptake (peak VO<sub>2</sub>) (SMD = 0.38, 95% CI [-0.03, 0.80], p = 0.069) and 6‑min walking distance (6MWD) (WMD = 14.10, 95% CI [-9.51, 37.72], p = 0.242). Exercise interventions of varying intensity produced small-to-moderate beneficial effects on QoL (WMD = -4.99, 95% CI [-8.29, -1.68], p = 0.003), which appeared to be attenuated at long-term follow-up (WMD = 2.12, 95% CI [-2.91, 7.16], p = 0.409).</p><p><strong>Conclusion: </strong>High-intensity exercise does not have a significant advantage over moderate-intensity exercise in improving cardiopulmonary function and aerobic capacity in patients with CHF. 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引用次数: 0
摘要
背景：以运动为基础的心脏康复对慢性心力衰竭（CHF）患者有积极的益处，但运动强度的选择一直存在争议。本系统综述和荟萃分析旨在研究不同运动强度对 CHF 患者心肺功能和生活质量（QoL）的影响：方法：在 PubMed、Web of Science、Cochrane Library 和 Embase 数据库中检索了从开始到 2021 年 12 月针对 CHF 患者的不同运动强度的随机对照试验 (RCT)。研究选择和数据提取由两位独立审稿人同时进行，并使用物理治疗证据数据库量表（PEDro）对纳入的文献进行质量评估。采用固定或随机效应模型计算加权平均差（WMD）或标准化平均差（SMD）。其他统计分析包括亚组分析和敏感性分析。证据质量采用推荐、评估、发展和评价等级法（GRADE）进行评价：结果：共纳入 8 项研究性试验。分析表明，左心室射血分数（LVEF；WMD = 0.47，95% CI [-4.10，5.03]，p = 0.841）、峰值摄氧量（峰值 VO2）（SMD = 0.38，95% CI [-0.03，0.80]，p = 0.069）和 6 分钟步行距离（6MWD）（WMD = 14.10，95% CI [-9.51，37.72]，p = 0.242）均无明显改善。不同强度的运动干预对QoL产生了小到中等程度的有益影响（WMD = -4.99，95% CI [-8.29，-1.68]，p = 0.003），在长期随访中似乎有所减弱（WMD = 2.12，95% CI [-2.91，7.16]，p = 0.409）：结论：与中等强度运动相比，高强度运动在改善慢性阻塞性肺疾病患者的心肺功能和有氧能力方面没有明显优势。在长期随访过程中，高强度运动对患者生活质量的有益改变似乎也在减少，这表明高强度运动的疗效具有累积效应。
Effect of different intensity exercises on cardiopulmonary function and quality of life of patients with chronic heart failure : A systematic review and meta-analysis.
Background: Exercise-based cardiac rehabilitation has positive benefits for patients with chronic heart failure (CHF), but the choice of exercise intensity has been controversial. The aim of this systematic review and meta-analysis was to investigate the effects of different exercise intensities on cardiopulmonary function and quality of life (QoL) of patients with CHF.
Methods: Randomized controlled trials (RCTs) of different exercise intensities applied to patients with CHF were searched in PubMed, Web of Science, the Cochrane Library, and Embase databases from inception to December 2021. Study selection and data extraction were performed simultaneously by two independent reviewers, using the Physiotherapy Evidence Database Scale (PEDro) for quality assessment of the included literature. The weighted mean differences (WMD) or standardized mean difference (SMD) were calculated by employing a fixed or random effects model. Other statistical analyses included subgroup analysis and sensitivity analysis. Quality of evidence was evaluated by the Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) method.
Results: Eight RCTs were included. Analyses reported no significant improvement in left ventricular ejection fractions (LVEF; WMD = 0.47, 95% CI [-4.10, 5.03], p = 0.841), peak oxygen uptake (peak VO2) (SMD = 0.38, 95% CI [-0.03, 0.80], p = 0.069) and 6‑min walking distance (6MWD) (WMD = 14.10, 95% CI [-9.51, 37.72], p = 0.242). Exercise interventions of varying intensity produced small-to-moderate beneficial effects on QoL (WMD = -4.99, 95% CI [-8.29, -1.68], p = 0.003), which appeared to be attenuated at long-term follow-up (WMD = 2.12, 95% CI [-2.91, 7.16], p = 0.409).
Conclusion: High-intensity exercise does not have a significant advantage over moderate-intensity exercise in improving cardiopulmonary function and aerobic capacity in patients with CHF. Beneficial changes in QoL from high-intensity exercise also appeared to decrease during long-term follow-up, indicating a cumulative effect of the efficacy of high-intensity exercise.
期刊介绍：
Herz is the high-level journal for further education for all physicians interested in cardiology. The individual issues of the journal each deal with specific topics and comprise review articles in English and German written by competent and esteemed authors. They provide up-to-date and comprehensive information concerning the speciality dealt with in the issue. Due to the fact that all relevant aspects of the pertinent topic of an issue are considered, an overview of the current status and progress in cardiology is presented. Reviews and original articles round off the spectrum of information provided.
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