A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling
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BACKGROUND: The effects of variations in exercise training on left ventricular (LV) remodeling in patients shortly after myocardial infarction (MI) are important but poorly understood. METHODS: Systematic review incorporating meta-analysis using meta-regression. Studies were identified via systematic searches of: OVID MEDLINE (1950 to 2009), Cochrane Central Register of Controlled Trials (1991 to 2009), AMED (1985 to 2009), EMBASE (1988 to 2009), PUBMED (1966 to 2009), SPORT DISCUS (1975 to 2009), SCOPUS (1950 to 2009) and WEB OF SCIENCE (1950 to 2009) using the medical subject headings: myocardial infarction, post myocardial infarction, post infarction, heart attack, ventricular remodeling, ventricular volumes, ejection fraction, left ventricular function, exercise, exercise therapy, kinesiotherapy, exercise training. Reference lists of all identified studies were also manually searched for further relevant studies. Studies selected were randomized controlled trials of exercise training interventions reporting ejection fraction (EF) and/or ventricular volumes in patients following recent MI (≤ 3 months) post-MI patients involving control groups. Studies were excluded if they were not randomized, did not have a 'usual-care' control (involving no exercise), evaluated a non-exercise intervention, or did not involve human subjects. Non-English studies were also excluded. RESULTS: After screening of 1029 trials, trials were identified that reported EF (12 trials, n = 647), End Systolic Volumes (ESV) (9 trials, n = 475) and End Diastolic Volumes (EDV) (10 trials, n = 512). Meta-regression identified that changes in EF effect size difference decreased as the time between MI and initiation of the exercise program lengthened, and increased as the duration of the program increased (Q = 25.48, df = 2, p < 0.01, R2 = 0.76). Greater reductions in ESV and EDV (as indicated by effect size decreases) occurred with earlier initiation of exercise training and with longer training durations (ESV: Q = 23.89, df = 2, p < 0.05, R2 = 0.79; EDV: Q = 27.42, df = 2, p < 0.01, R2 = 0.83). Differences remained following sensitivity analysis. Each week that exercise was delayed required an additional month of training to achieve the same level of benefit on LV remodeling. CONCLUSIONS: Exercise training has beneficial effects on LV remodeling in clinically stable post-MI patients with greatest benefits occurring when training starts earlier following MI (from one week) and lasts longer than 3 months.
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Exercise training best improves left ventricular remodeling in clinically stable post-MI patients when started one week after MI.
“A 2011 meta-analysis concludes that exercise training has greatest beneficial effects on left ventricular remodeling in clinically stable post-MI patients when training starts one week following the MI (227).”
From Lack of Exercise Is a Major Cause of Chronic Diseases (2012) · cites this paper as [227]
The benefits of exercise training following MI on LV remodelling are maximized if exercise implementation starts early (~1 week) after the event.
“A previous meta-analysis 162 found that exercise training following MI can improve LV remodelling, notably by reducing LV end-systolic volume (LVESV)-a strong predictor of mortality after MI-with these benefits maximized if exercise implementation starts early (∼1 week) after the event.”
From Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation (2023) · cites this paper as [162]
A previous meta-analysis found that exercise training following MI can improve LV remodelling, notably by reducing LV end-systolic volume (LVESV).
“A previous meta-analysis 162 found that exercise training following MI can improve LV remodelling, notably by reducing LV end-systolic volume (LVESV)-a strong predictor of mortality after MI-with these benefits maximized if exercise implementation starts early (∼1 week) after the event.”
From Exercise benefits in cardiovascular diseases: From mechanisms to clinical implementation (2023) · cites this paper as [162]
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- Authors
- Haykowsky, M., Scott, J., Esch, B., Schopflocher, D., Myers, J., Paterson, I., Warburton, D., Jones, L., & Clark, A. M.
- Affiliations
- University of Alberta (CA)
- University of British Columbia (CA)
- VA Palo Alto Health Care System (US)
- Duke Medical Center (US)
- Corresponding author
- Haykowsky, Mark
- Venue
- Trials
- Published
- 2011-04-04
- Volume
- 12
- Issue
- 1
- Pages
- 92-92
- ISSN
- 1745-6215 (ISSN-L)
- PMC
- PMC3083361
- OpenAlex
- W2132363115
- Cited by
- 228
- References
- 40
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 23 · 2023: 17 · 2022: 18 · 2021: 22 · 2020: 17 · 2019: 18 · 2018: 15 · 2017: 13 · 2016: 19 · 2015: 12 · 2014: 13 · 2013: 8 · 2012: 14
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Trials (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- cIRcle (University of British Columbia) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs (IK6 RX002477)
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Keywords
- exercise training, left ventricular remodeling, myocardial infarction, ejection fraction, end-systolic volume, end-diastolic volume, training duration, cardiac rehabilitation, left ventricular function, ventricular volume
- MeSH terms
- Exercise Therapy, Humans, Myocardial Infarction, Stroke Volume, Time Factors, Ventricular Function, Left, Treatment Outcome, Evidence-Based Medicine, Ventricular Remodeling
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