Piepoli M F, Davos C, Francis D P, Coats A J S
Cardiac Medicine, Royal Brompton Hospital, Imperial College of Science Technology and Medicine, London.
BMJ. 2004 Jan 24;328(7433):189. doi: 10.1136/bmj.37938.645220.EE. Epub 2004 Jan 16.
To determine the effect of exercise training on survival in patients with heart failure due to left ventricular systolic dysfunction.
Collaborative meta-analysis. Inclusion criteria Randomised parallel group controlled trials of exercise training for at least eight weeks with individual patient data on survival for at least three months. Studies reviewed Nine datasets, totalling 801 patients: 395 received exercise training and 406 were controls.
Death from all causes.
During a mean (SD) follow up of 705 (729) days there were 88 (22%) deaths in the exercise arm and 105 (26%) in the control arm. Exercise training significantly reduced mortality (hazard ratio 0.65, 95% confidence interval, 0.46 to 0.92; log rank chi(2) = 5.9; P = 0.015). The secondary end point of death or admission to hospital was also reduced (0.72, 0.56 to 0.93; log rank chi(2) = 6.4; P = 0.011). No statistically significant subgroup specific treatment effect was observed.
Meta-analysis of randomised trials to date gives no evidence that properly supervised medical training programmes for patients with heart failure might be dangerous, and indeed there is clear evidence of an overall reduction in mortality. Further research should focus on optimising exercise programmes and identifying appropriate patient groups to target.
确定运动训练对左心室收缩功能障碍所致心力衰竭患者生存率的影响。
协作性荟萃分析。纳入标准：至少为期八周的运动训练随机平行组对照试验，且有个体患者至少三个月的生存数据。所回顾的研究：九个数据集，共801例患者，其中395例接受运动训练，406例为对照组。
各种原因导致的死亡。
在平均（标准差）705（729）天的随访期内，运动训练组有88例（22%）死亡，对照组有105例（26%）死亡。运动训练显著降低了死亡率（风险比0.65，95%置信区间0.46至0.92；对数秩检验χ² = 5.9；P = 0.015）。死亡或住院这一次要终点也有所降低（0.72，0.56至0.93；对数秩检验χ² = 6.4；P = 0.011）。未观察到有统计学意义的亚组特异性治疗效果。
对迄今随机试验的荟萃分析没有证据表明，为心力衰竭患者提供的适当监督下的医学训练计划可能存在危险，而且确实有明确证据表明总体死亡率有所降低。进一步的研究应侧重于优化运动计划并确定合适的目标患者群体。
