Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis
Open accessAbstract
Aims: To determine the effect of exercise training on clinical events and health-related quality of life (HRQoL) of patients with systolic heart failure. Methods and results: We searched electronic databases including Medline, EMBASE, and Cochrane Library up to January 2008 to identify randomized controlled trials (RCTs) comparing exercise training and usual care with a minimum follow-up of 6 months. Nineteen RCTs were included with a total of 3647 patients, the majority of whom were male, low-to-medium risk, and New York Heart Association class II–III with a left ventricular ejection fraction of <40%. There was no significant difference between exercise and control in short-term (≤12 months) or longer-term all-cause mortality or overall hospital admissions. Heart failure-related hospitalizations were lower [relative risk: 0.72, 95% confidence interval (CI): 0.52–0.99] and HRQoL improved (standardized mean difference: −0.63, 95% CI: −0.80 to −0.37) with exercise therapy. Any effect of cardiac exercise training on total mortality and HRQoL was independent of degree of left ventricular dysfunction, type of cardiac rehabilitation, dose of exercise intervention, length of follow-up, trial quality, and trial publication date. Conclusion: Compared with usual care, in selected heart failure patients, exercise training reduces heart failure-related hospitalizations and results in clinically important improvements in HRQoL. High-quality RCT and cost-effectiveness evidence is needed for the effect of exercise training in community-based settings and in more severe heart failure patients, elderly people, and women.
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In a pooled analysis of randomized controlled trials, exercise training was associated with improvement in exercise capacity and quality of life among patients with heart failure with preserved ejection fraction.
“In a pooled analysis of RCTs evaluating the effect of exercise on adverse outcomes among patients with HFpEF, exercise training was associated with improvement in exercise capacity and QOL [122] .”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [122]
The Abstract reports improved health-related quality of life in a pooled analysis of exercise-training RCTs, but the Inclusion and exclusion criteria explicitly exclude patients with normal systolic function; the review concerns systolic heart failure, not HFpEF. The paper attributes improved exercise capacity to an earlier review in the Introduction rather than reporting it as an outcome of its own pooled analysis. (LLM, conf=0.90)
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“In a pooled analysis of RCTs evaluating the effect of exercise on adverse outcomes among patients with HFpEF, exercise training was associated with improvement in exercise capacity and QOL [122].”
- Authors
- Davies, E. J., Moxham, T., Rees, K., Singh, S., Coats, A. J. S., Ebrahim, S., Lough, F., & Taylor, R. S.
- Affiliations
- Derriford Hospital (GB)
- University of Exeter (GB)
- University of Warwick (GB)
- Glenfield Hospital (GB)
- The University of Sydney (AU)
- London School of Hygiene & Tropical Medicine (GB)
- University College Hospital (GB)
- Corresponding author
- Davies, Edward J.
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-07-01
- Volume
- 12
- Issue
- 7
- Pages
- 706-715
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- PMC
- PMC2891490
- OpenAlex
- W2014154069
- Cited by
- 318
- References
- 44
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 9 · 2023: 7 · 2022: 22 · 2021: 16 · 2020: 16 · 2019: 15 · 2018: 21 · 2017: 21 · 2016: 20 · 2015: 36 · 2014: 29 · 2013: 43 · 2012: 23
- FWCI
- 6.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Heart Failure (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure (Coventry University) (submittedVersion, other-oa)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Coventry University Open Collections (Coventry university) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- The Open Collections (Coventry University) (submittedVersion)
- 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
- exercise training, heart failure with reduced ejection fraction, heart failure rehabilitation, health-related quality of life, heart failure hospitalization, all-cause mortality, left ventricular ejection fraction, cardiac rehabilitation
- MeSH terms
- Adult, Aged, Exercise Therapy, Female, Hospitalization, Humans, Male, Middle Aged, Quality of Life, Randomized Controlled Trials as Topic, Exercise Tolerance, Ventricular Dysfunction, Left, Heart Failure, Systolic
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