Efficacy of different modes of exercise-based cardiac rehabilitation delivery for patients with heart failure: a systematic review and network meta-analysis.

BACKGROUND

Cardiac rehabilitation (CR) has been shown to be an effective treatment for patients with heart failure (HF). However, the effect of different modes of CR delivery on HF remains unclear. The purpose of this study is to perform a large-scale pairwise and network meta-analysis (NMA) on the impact of various exercise types on patients with HF using multiple indicators.

METHODS

Randomized controlled trials (RCTs) published between 2000 and October 2023 were systematically searched in PubMed (Medline), the Cochrane Library and Web of Science. Statistical analysis was performed by STATASE16 with the network pack. The primary outcomes focused on functional capacity and health-related quality of life (QoL), such as peak VO, six-minute walk test (6MWT), maximum workload, left ventricular ejection fraction (LVEF), maximum heart rate (MHR), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores. All relevant studies reported well-defined or accessible exposures and presented clear data on any one or more of the six items above before and after exercise rehabilitation.

RESULTS

In total, 122 RCTs were ultimately included in the final analysis. Pairwise analyses revealed aerobic training (AT) can improve peak VO (2.49 mL/kg/min) and LVEF (2.97%). High-intensity interval training (HIIT) was associated with an improvement in peak VO (3.91 mL/kg/min), LVEF (6.68%), 6MWT (65.4 m) and MLHFQ score (-10.34). As shown in the NMA, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for peak VO, was HIIT (SUCRA: 90.8%), strength training (ST) (74.7%), AT (64.4%), combined training (CT) (41.7%) and inspiratory muscle training (IMT) (18.3%). The order of effectiveness for LVEF based on SCURA values was HIIT (90.5%), AT (77.8%), CT (50.3%), ST (49.9%) and IMT (7.7%).

CONCLUSIONS

Various types of exercise, especially HIIT, can improve QoL, cardiac function, LVEF, and exercise tolerance in patients with HF. The results of this analysis should inform future exercise guideline personalized recommendations and prescriptions for HF patients.