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CLINICAL RESEARCH: HEART FAILURE

A Meta-Analysis of the Effect of Exercise Training on Left Ventricular Remodeling in Heart Failure Patients

The Benefit Depends on the Type of Training Performed

Mark J. Haykowsky, PhD^_*,1,_*, Yuanyuan Liang, PhD, David Pechter, BA^_*, Lee W. Jones, PhD, Finlay A. McAlister, MD, MSc^||,2,3 and Alexander M. Clark, PhD^,2

^_* Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
Alberta Research Centre for Child Health Evidence, University of Alberta, Edmonton, Alberta, Canada
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
Department of Surgery, Duke University Medical Center, Durham, North Carolina
^|| Division of General Internal Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada.

Manuscript received December 14, 2006; revised manuscript received February 16, 2007, accepted February 20, 2007.

^_* Reprint requests and correspondence: Dr. Mark J. Haykowsky, 2-50, Corbett Hall, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta T6G 2G4, Canada. (Email: mark.haykowsky{at}ualberta.ca).

Objectives: The aim of this study was to determine the effect of exercise training and type of exercise (aerobic vs. strength vs. combined training) on left ventricular (LV) remodeling in heart failure (HF).

Background: A number of randomized controlled trials have examined the effect of exercise training on LV remodeling in individuals with HF. However, the results of these trials have been inconclusive.

Methods: The authors searched MEDLINE (1966 to 2006), Cochrane Central Register of Controlled Trials (issue #3, 2006), CINAHL (1982 to 2006), EMBASE (1988 to 2006), PubMed (1966 to 2006), and reference lists of identified studies for randomized controlled trials examining the effects of exercise training on ejection fraction (EF), end-diastolic volume (EDV), and end-systolic volume (ESV) in clinically stable patients with HF. Primary study authors were also contacted if appropriate. Studies were selected and data were extracted independently by 2 reviewers. Weighted mean differences (WMD) were calculated using a random effects model.

Results: Fourteen trials reported EF data (n = 812 patients). Seven trials reported both EDV and ESV data (n = 569). Aerobic training significantly improved EF (9 trials, 538 patients, WMD = 2.59%; 95% confidence interval [CI] 1.44% to 3.74%), EDV (371 patients; WMD = –11.49 ml; 95% CI –19.95 to –3.02 ml) and ESV (371 patients; WMD = –12.87 ml; 95% CI –17.80 to –7.93 ml). Combined aerobic and strength training was not associated with significant improvements in EF, EDV, or ESV.

Conclusions: Aerobic training reverses LV remodeling in clinically stable individuals with HF. This benefit was not confirmed with combined aerobic and strength training.

Abbreviations and Acronyms   CI = confidence interval   EDV = end-diastolic volume   EF = ejection fraction   ESV = end-systolic volume   HF = heart failure   LV = left ventricle/ventricular   SMD = standardized mean difference   VO 2peak = peak oxygen consumption   WMD = weighted mean difference

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