Department of Cardiovascular Medicine, West China Hospital, Sichuan University.
Department of Cardiology, The First People's Hospital of Jintang County, Sichuan, China.
Medicine (Baltimore). 2021 Apr 2;100(13):e25128. doi: 10.1097/MD.0000000000025128.
Systematically review the current published literature on the impact of exercise training (ET) in chronic heart failure (CHF) patients who were conducted cardiac resynchronization therapy (CRT).
PubMed, EMBASE, and the Cochrane Library of Controlled Trails databases were searched for trials comparing the additional effects of ET in CHF patients after CRT implantation with no exercise or usual care control up until 2020.03.07. We independently screened the literature, extracted data, employed the tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) to evaluate study quality and risk of bias, and performed meta-analysis with Revman 5.3 software.
Eight trials were identified for qualitative analysis and 7 randomized controlled trails (RCTs) included 235 participants (120 ET; 115 controls) for quantitative analysis. The results showed that the maximal workload (mean difference [MD] 26.32 W, 95% CI 19.41-33.23; P < .00001, I2 = 0%) and the exercise duration (MD 68.95 seconds, 95% CI 15.41-122.48; P = .01, I2 = 76%) had significant improvement in the ET group versus control. Subgroup analysis showed that compared with control, the change in peak oxygen uptake (VO2) (MD 3.05 ml/kg/minute, 95% CI 2.53-3.56; P < .00001, I2 = 0%), left ventricular ejection fraction (LVEF) (MD 4.97%, 95% CI 1.44-8.49; P = .006, I2 = 59%), and health related quality of life (HRQoL) (the change in Minnesota living with heart failure questionnaire [MLHFQ]: MD -19.96, 95% CI -21.57 to -18.34; P < .00001, I2 = 0%) were significantly improved in the light to moderate intensity training (non-HIT) group, while there seemed no statistical difference of above endpoints in the high intensity training (HIT) group.
During the short term (up to 6 months), non-HIT could improve exercise capacity, cardiac function, and HRQoL in CHF patients with CRT. However, due to the small number of participants, a high-quality large-sample multicenter trial is demanded.
系统综述目前关于心脏再同步化治疗（CRT）后慢性心力衰竭（CHF）患者进行运动训练（ET）的影响的已发表文献。
检索 PubMed、EMBASE 和 Cochrane 对照试验图书馆，查找截至 2020 年 03 月 07 日比较 CRT 植入后 CHF 患者进行 ET 与无运动或常规护理对照的额外效果的试验。我们独立筛选文献，提取数据，使用评估运动研究质量和报告的工具（TESTEX）评估研究质量和偏倚风险，并使用 Revman 5.3 软件进行荟萃分析。
定性分析确定了 8 项试验，定量分析纳入了 7 项随机对照试验（RCT），共 235 名参与者（120 名 ET；115 名对照）。结果显示，与对照组相比，ET 组的最大工作量（均数差 [MD] 26.32 W，95%可信区间 19.41-33.23；P<0.00001，I2=0%）和运动时间（MD 68.95 秒，95%可信区间 15.41-122.48；P=0.01，I2=76%）有显著改善。亚组分析显示，与对照组相比，峰值摄氧量（VO2）（MD 3.05 ml/kg/min，95%可信区间 2.53-3.56；P<0.00001，I2=0%）、左心室射血分数（LVEF）（MD 4.97%，95%可信区间 1.44-8.49；P=0.006，I2=59%）和健康相关生活质量（HRQoL）（明尼苏达州心力衰竭生活质量问卷 [MLHFQ]的变化：MD -19.96，95%可信区间 -21.57 至-18.34；P<0.00001，I2=0%）在轻至中度强度训练（非 HIT）组中明显改善，而在高强度训练（HIT）组中上述终点似乎无统计学差异。
在短期（最长 6 个月）内，非 HIT 可改善 CRT 后 CHF 患者的运动能力、心功能和 HRQoL。然而，由于参与者数量较少，需要进行高质量的大样本多中心试验。
