University of Washington, School of Nursing, Seattle.
J Cardiopulm Rehabil Prev. 2018 Mar;38(2):70-84. doi: 10.1097/HCR.0000000000000289.
This systematic review identified exercise-based intervention studies in patients with cardiac implantable devices (CIDs): implantable cardioverter defibrillator (ICD), cardiac resynchronization pacemaker or defibrillator (cardiac resynchronization therapy [CRT]), or ventricular assist device (VAD) and assessed evidence for the safety and efficacy of exercise-based interventions alone or in combination with psychoeducational components.
PubMed, EMBASE, CINAHL Plus, Web of Science, Cochrane, and PEDro databases were searched from database inception to September 2016. Data were extracted and validity was assessed by 2 reviewers. Study quality was evaluated using the JADAD scale for randomized controlled trials. A total of 3991 articles for all CIDs (ICD: 1015; pacemaker: 1630; and VAD: 1346) were screened for relevance. Subsequently, 24 full-text articles (ICD: 14; CRT: 4; and VAD: 6) were deemed eligible for this review.
Studies of aerobic exercise training demonstrated an average increase in peak oxygen uptake of 2.61 mL/kg/min, (ICD = 2.43, VAD = 2.2, and CRT = 3.2 mL/kg/min). These incremental increases were statistically significant when compared with the usual care or other comparison groups. Adverse event rates were very low at 1.1% to 2.2% for all CIDs.
Exercise interventions tested to date in the CID population (ICD, CRT, and VAD) indicate that exercise training at moderate to high intensity is safe and effective in improving cardiopulmonary outcomes without adverse events. Future investigations should include a more diverse sample of participants, designs that include translation of exercise to routine practice, the destination therapy VAD population, and measurement of costs and patient-centered outcomes.
本系统评价确定了患有心脏植入式设备（CIDs）的患者的基于运动的干预研究：植入式心脏复律除颤器（ICD）、心脏再同步起搏除颤器或起搏器（心脏再同步治疗[CRT]）或心室辅助装置（VAD），并评估了单独或结合心理教育成分的基于运动的干预的安全性和有效性的证据。
从数据库建立到 2016 年 9 月，在 PubMed、EMBASE、CINAHL Plus、Web of Science、Cochrane 和 PEDro 数据库中进行了搜索。由两名评审员提取数据并评估有效性。使用 JADAD 量表对随机对照试验进行了研究质量评估。对所有 CIDs（ICD：1015；起搏器：1630；VAD：1346）的 3991 篇文章进行了相关性筛选。随后，24 篇全文文章（ICD：14；CRT：4；VAD：6）被认为符合本综述的条件。
有氧运动训练研究显示，峰值摄氧量平均增加 2.61 mL/kg/min，（ICD = 2.43，VAD = 2.2，CRT = 3.2 mL/kg/min）。与常规护理或其他对照组相比，这些增量增加具有统计学意义。所有 CIDs 的不良事件发生率非常低，为 1.1%至 2.2%。
迄今为止在 CID 人群（ICD、CRT 和 VAD）中测试的运动干预表明，中等至高强度的运动训练是安全有效的，可改善心肺结局，而无不良事件。未来的研究应包括更具多样性的参与者样本、包括将运动转化为常规实践的设计、目的地治疗 VAD 人群以及测量成本和以患者为中心的结果。
