Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital, Rome, Italy.
IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
Heart Fail Rev. 2020 Sep;25(5):703-711. doi: 10.1007/s10741-019-09841-x.
Physical activity is associated with a lower risk of adverse cardiovascular outcomes, including heart failure (HF). Exercise training is a class IA level recommendation in patients with stable HF, but its impact is less clear in heart failure with preserved ejection fraction (HFpEF). The aim of this study was to analyze the effects of the exercise training on cardiovascular outcomes in patients with HFpEF. A systematic literature search was conducted on the main electronic databases, proceedings of major meetings, and reference lists of the identified studies, using specific terms for only English language studies published between 2000 and 2018. We followed the PRISMA to perform our review. Quality of studies was also assessed. The systematic review identified 9 studies on 348 patients, of moderate (n = 2) to good (n = 7) quality. The training consisted of a combination of supervised in-hospital and home-based outpatient programs, including aerobic exercise, endurance and resistance training, walking, and treadmill and bicycle ergometer. Most of the protocols ranged 12-16 weeks, with a frequency of 2-3 sessions weekly, lasting 20-60 min per session. There were significant improvements in peak oxygen uptake, 6-min walking test distance, and ventilatory threshold, whereas quality of life and echocardiographic parameters improved only in some studies. Endothelial function/arterial stiffness remained unchanged. No adverse events were reported. Appropriate exercise programs are able to get a favorable cardiovascular outcome in patients with HFpEF. This could also benefit in terms of quality of life, even if more controversial. Further researches are necessary.
身体活动与不良心血管结局（包括心力衰竭）的风险降低相关。运动训练是稳定心力衰竭患者的 IA 类推荐，但在射血分数保留的心力衰竭（HFpEF）中其影响不太明确。本研究旨在分析运动训练对 HFpEF 患者心血管结局的影响。我们仅对 2000 年至 2018 年期间发表的英文研究进行了主要电子数据库、主要会议论文集和已确定研究参考文献的系统文献检索，使用了特定术语。我们按照 PRISMA 进行了综述。还评估了研究的质量。系统综述确定了 9 项涉及 348 例患者的研究，这些研究的质量为中等（n = 2）至良好（n = 7）。训练包括住院期间和家庭门诊的联合监督计划，包括有氧运动、耐力和阻力训练、散步以及跑步机和自行车测功计。大多数方案持续 12-16 周，每周 2-3 次，每次 20-60 分钟。峰值摄氧量、6 分钟步行试验距离和通气阈都有显著改善，而生活质量和超声心动图参数仅在一些研究中得到改善。内皮功能/动脉僵硬度没有变化。没有报告不良事件。适当的运动方案可以使 HFpEF 患者获得良好的心血管结局。这也可能有益于生活质量，尽管更具争议性。还需要进一步的研究。
