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Cited by 254Cardiovascular and exercise physiologyCardiac Health and Mental HealthHeart Failure Treatment and Management

Exercise based rehabilitation for heart failure

Open access
Rees, Karen, Taylor, Rod RS, Singh, Sally, Coats, Andrew JS, Ebrahim, Shah·2004·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd003331.pub2PMC PMC4164468
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Abstract

BACKGROUND: The prevalence of chronic heart failure is increasing, and increases with increasing age. Major symptoms include breathlessness and restricted activities of daily living due to reduced functional capacity, which in turn affects quality of life. Exercise training has been shown to be effective in patients with coronary heart disease and has been proposed as an intervention to improve exercise tolerance in patients with heart failure. OBJECTIVES: To determine the effectiveness of exercise based interventions compared with usual medical care on the mortality, morbidity, exercise capacity and health related quality of life, of patients with heart failure. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (The Cochrane Library Issue 2, 2001), MEDLINE (2000 to March 2001), EMBASE (1998 to March 2001), CINAHL (1984 to March 2001) and reference lists of articles. We also sought advice from experts. SELECTION CRITERIA: RCTs of exercise based interventions. The comparison group was usual medical care as defined by the study, or placebo. Adults of all ages with chronic heart failure. Only those studies with criteria for diagnosis of heart failure (based on clinical findings or objective indices) have been included. DATA COLLECTION AND ANALYSIS: Studies were selected, and data were abstracted, independently by two reviewers. Authors were contacted where possible to obtain missing information. MAIN RESULTS: Twenty-nine studies met the inclusion criteria, with 1126 patients randomised. The majority of studies included both patients with primary and secondary heart failure, NYHA class II or III. None of the studies specifically examined the effect of exercise training on mortality and morbidity as most were of short duration. Exercise training significantly increased VO(2) max by (WMD random effects model) 2.16 ml/kg/min (95% CI 2.82 to 1.49), exercise duration increased by 2.38 minutes (95% CI 2.85 to 1.9), work capacity by 15.1 Watts (95% CI 17.7 to 12.6) and distance on the six minute walk by 40.9 metres (95% CI 64.7 to 17.1). Improvements in VO(2) max were greater for training programmes of greater intensity and duration. HRQoL improved in the seven of nine trials that measured this outcome. REVIEWERS' CONCLUSIONS: Exercise training improves exercise capacity and quality of life in patients mild to moderate heart failure in the short term. There is currently no information regarding the effect of exercise training on clinical outcomes. The findings are based on small-scale trials in patients who are unrepresentative of the total population of patients with heart failure. Other groups (more severe patients, the elderly, women) may also benefit. Large-scale pragmatic trials of exercise training of longer duration, recruiting a wider spectrum of patients are needed to address these issues.

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  • The rarity of major cardiovascular events during supervised aerobic exercise training also applies to patients with chronic heart failure and reduced left ventricular function, NYHA class II-IV, on optimal guideline-based therapy.

    “The same is also true for patients with chronic heart failure and reduced left ventricular function, New York Heart Association class II-IV symptoms, and treated with optimal, guideline-based background heart failure therapy.342”

    From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [342]

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Research works printed but not linked: 4

  1. Dziekan G Myers J Goebbels U Muller P Reinhart W Ratti R Effects of exercise training on limb blood flow in patients with reduced ventricular function American Heart Journal 1998 136 22 7 9665214
  2. Jolliffe JA Rees K Taylor RS Thompson D Oldridge N Ebrahim S Exercise based rehabilitation for coronary heart disease (Cochrane Review) The Cochrane Library 2001 2 11279730
  3. Lefebvre C McDonald S Development of a sensitive search strategy for reports of randomised controlled trials in EMBASE 20-24 10 Conference Abstracts for the Fourth International Cochrane Colloquium Adelaide, Australia 1996
  4. NHS Centre for Reviews and Dissemination Cardiac Rehabilitation Effective Health Care Bulletin 1998 4

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Authors
Rees, K., Taylor, R. R., Singh, S., Coats, A. J., & Ebrahim, S.
Affiliations
  • University of Bristol (GB)
  • University of Exeter (GB)
  • Glenfield Hospital (GB)
  • The University of Sydney (AU)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Rees, Karen
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
John Wiley & Sons, Ltd
Published
2004-07-19
Issue
3
Pages
CD003331-CD003331
ISSN
1361-6137 (ISSN-L)
DOI
10.1002/14651858.cd003331.pub2
PMC
PMC4164468
OpenAlex
W4248193413
Cited by
253
References
81
Citations by year
2026: 1 · 2025: 6 · 2024: 5 · 2023: 24 · 2022: 8 · 2021: 13 · 2020: 5 · 2019: 5 · 2018: 8 · 2017: 11 · 2016: 12 · 2015: 14 · 2014: 13 · 2013: 10 · 2012: 8
Type
reference entry
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Topics
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
heart failure, exercise training, cardiac rehabilitation, exercise capacity, VO2max, health-related quality of life, 6-minute walk distance, mortality, morbidity, training intensity and duration, NYHA functional class
MeSH terms
Cardiac Output, Low, Chronic Disease, Exercise Therapy, Heart Failure, Humans, Quality of Life, Randomized Controlled Trials as Topic

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