Grosman-Rimon Liza, Hui Sarah, Santos Sara, Vadasz Brian, Foroutan Farid, Farrell Ashley, Lalonde Spencer, Ghashghai Arash, McDonald Michael, Alba Ana C
Cardiovascular Department and Research Center, Baruch Padeh Medical Center, Poriya, Tiberias, Israel.
The Academic College At Wingate, Wingate Institute, Netanya, Israel.
Heart Fail Rev. 2021 May;26(3):507-519. doi: 10.1007/s10741-020-10049-7. Epub 2020 Nov 17.
The benefit of exercise training in cardiac resynchronization therapy (CRT) recipients is not well established. We conducted a systematic review and meta-analysis to determine the effect of exercise training on clinical outcomes in CRT recipients.A comprehensive search until 2019 was conducted of MEDLINE, Epub, Embase, CINAHL and Cochrane databases as well as a bibliographic hand search to identify additional studies. We included all studies that compared aerobic exercise interventions in adults treated with CRT devices with adults treated with usual CRT care. These studies evaluated patient clinical characteristics, exercise testing measures, hemodynamic measures, echocardiography parameters, biomarkers and adverse events. Independent reviewers evaluated study eligibility, abstracted data and assessed risk of bias in duplicate. We used random-effect meta-analysis methods to estimate mean differences and odds ratios. Grades of Recommendation, Assessment, Development and Evaluation system were used to quantify absolute effects and quality of evidence. I was used to evaluate heterogeneity.We identified seven studies, six randomized control trials and one observational study, totaling 332 CRT patients in the exercise intervention and 534 patients receiving usual care. Peak VO was 2.4 ml/kg/min higher in the exercise group in comparison with the control group (pooled mean difference 2.26, 95% CI 1.38-3.13, I = 53%, high quality). AT-VO improved with exercise rehabilitation, and heterogeneity was considered low (pooled mean difference 3.96, 95% CI 2.68-5.24, I = 0.0%, moderate quality).Peak VO and AT-VO are increased with aerobic exercise in CRT recipients, demonstrating a significant improvement in functional capacity.
运动训练对接受心脏再同步治疗（CRT）患者的益处尚未明确。我们进行了一项系统评价和荟萃分析，以确定运动训练对CRT患者临床结局的影响。截至2019年，我们对MEDLINE、Epub、Embase、CINAHL和Cochrane数据库进行了全面检索，并进行了文献手工检索以识别其他研究。我们纳入了所有比较接受CRT设备治疗的成人与接受常规CRT治疗的成人进行有氧运动干预的研究。这些研究评估了患者的临床特征、运动测试指标、血流动力学指标、超声心动图参数、生物标志物和不良事件。独立评审员对研究的纳入资格进行评估、提取数据并重复评估偏倚风险。我们使用随机效应荟萃分析方法来估计平均差异和比值比。使用推荐分级、评估、制定和评价系统来量化绝对效应和证据质量。I用于评估异质性。我们识别出七项研究，六项随机对照试验和一项观察性研究，运动干预组共有332例CRT患者，接受常规治疗的有534例患者。运动组的峰值摄氧量比对照组高2.4 ml/kg/min（合并平均差异2.26，95%CI 1.38 - 3.13，I = 53%，高质量）。运动康复使无氧阈摄氧量得到改善，异质性被认为较低（合并平均差异3.96，95%CI 2.68 - 5.24，I = 0.0%，中等质量）。CRT患者进行有氧运动可提高峰值摄氧量和无氧阈摄氧量，表明功能能力有显著改善。
