School of Nursing, Nanjing Medical University, Nanjing, China.
Department of Nursing, Jiangyin People's Hospital of Jiangsu Province, Jiangyin, Jiangsu, China.
BMJ Open. 2021 Mar 16;11(3):e043160. doi: 10.1136/bmjopen-2020-043160.
Heart failure (HF) is an end-stage of numerous heart diseases including hypertension, coronary heart disease and arrhythmia, in which the heart is unable to perform its circulatory function with sufficient efficiency due to structural or functional dysfunction (systolic or diastolic alterations). Strategies such as exercise rehabilitation may improve cardiac function, exercise capacity and health-related quality of life and reduce anxiety and depression in patients with HF. However, the relative effectiveness as well as the hierarchy of exercise interventions have not been well established, although various exercise options are available. Therefore, this protocol proposes to conduct a network meta-analysis (NMA) aiming to compare the effectiveness of different types of exercise training in patients with HF.
PubMed, Embase and the Cochrane Library will be searched from inception to March 2021 for relevant randomised controlled trials. Other resources, such as Google Scholar and Clinical Trials.gov will also be considered. Studies assessing exercise rehabilitation in patients with HF will be selected. Two independent reviewers will identify eligible trials. The PEDro risk of bias assessment tool will be used to assess the quality of the included studies. Bayesian NMA will be used when possible to determine the comparative effectiveness of the different exercise interventions. The mean ranks and surface will estimate the ranking probabilities for the optimal intervention of various treatments under the cumulative ranking curve. Subgroup, sensitivity and meta-regression will be conducted to explain the included studies' heterogeneity if possible. We will also use the Grading of Recommendations, Assessment, Development, and Evaluation system to assess the strength of evidence.
This systematic review and NMA will synthesise evidence on the effectiveness of the different exercises in patients with HF. The results will be submitted to a peer-reviewed journal. No ethical approval will be required because the data used for the review will be exclusively extracted from published studies.
CRD42020165870.
心力衰竭（HF）是高血压、冠心病和心律失常等多种心脏病的终末期，由于结构或功能障碍（收缩或舒张改变），心脏无法有效地发挥其循环功能。运动康复等策略可以改善心脏功能、运动能力和健康相关生活质量，并减轻 HF 患者的焦虑和抑郁。然而，尽管有多种运动选择，不同运动干预的相对有效性及其等级尚未得到很好的确定。因此，本方案旨在进行网络荟萃分析（NMA），以比较 HF 患者不同类型运动训练的效果。
将从建库至 2021 年 3 月在 PubMed、Embase 和 Cochrane Library 中检索相关的随机对照试验。还将考虑其他资源，如 Google Scholar 和 ClinicalTrials.gov。将选择评估 HF 患者运动康复的研究。两名独立的审查员将确定合格的试验。将使用 PEDro 偏倚风险评估工具评估纳入研究的质量。如有可能，将使用贝叶斯 NMA 确定不同运动干预的相对效果。平均秩和曲面将估计在累积排序曲线上各种治疗方法的最佳干预的排序概率。如果可能，将进行亚组、敏感性和荟萃回归分析，以解释纳入研究的异质性。我们还将使用推荐、评估、制定和评估系统（Grading of Recommendations, Assessment, Development, and Evaluation system）来评估证据的强度。
本系统评价和 NMA 将综合 HF 患者不同运动效果的证据。结果将提交给同行评议的期刊。由于审查中使用的数据将完全从已发表的研究中提取，因此不需要伦理批准。
PROSPERO 注册号：CRD42020165870。
