Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis

Rod S Taylor; Sarah Walker; Neil A Smart; Massimo F Piepoli; Fiona C Warren; Oriana Ciani; David Whellan; Christopher O'Connor; Steven J Keteyian; Andrew Coats; Constantinos H Davos; Hasnain M Dalal; Kathleen Dracup; Lorraine S Evangelista; Kate Jolly; Jonathan Myers; Birgitta B Nilsson; Claudio Passino; Miles D Witham; Gloria Y Yeh; ExTraMATCH II Collaboration

doi:10.1016/j.jacc.2018.12.072

Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis

J Am Coll Cardiol. 2019 Apr 2;73(12):1430-1443. doi: 10.1016/j.jacc.2018.12.072.

Authors

Rod S Taylor¹, Sarah Walker², Neil A Smart³, Massimo F Piepoli⁴, Fiona C Warren⁵, Oriana Ciani⁶, David Whellan⁷, Christopher O'Connor⁸, Steven J Keteyian⁹, Andrew Coats¹⁰, Constantinos H Davos¹¹, Hasnain M Dalal¹², Kathleen Dracup¹³, Lorraine S Evangelista¹⁴, Kate Jolly¹⁵, Jonathan Myers¹⁶, Birgitta B Nilsson¹⁷, Claudio Passino¹⁸, Miles D Witham¹⁹, Gloria Y Yeh²⁰; ExTraMATCH II Collaboration

Affiliations

¹ Institute of Health Research, College of Medicine and Health, University of Exeter and Institute of Health and Well Being, University of Glasgow, Glasgow, United Kingdom. Electronic address: r.taylor@exeter.ac.uk.
² Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom. Electronic address: https://twitter.com/Sarah1003Walker.
³ University of New England, Armidale, New South Wales, Australia.
⁴ Cardiology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy.
⁵ Exeter Collaboration for Academic Primary Care, Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom.
⁶ Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom; Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy.
⁷ Department of Medicine, Sidney Kimmel Medical College, Philadelphia, Pennsylvania.
⁸ Duke Clinical Research Institute, Durham, North Carolina.
⁹ Department of Medicine, Henry Ford Hospital, Detroit, Michigan.
¹⁰ IRCCS, San Raffaele, Pisana, Italy.
¹¹ Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece.
¹² Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom; Research, Development & Innovation, Royal Cornwall Hospital, Truro, United Kingdom.
¹³ School of Nursing, University of California San Francisco, San Francisco, California.
¹⁴ University of California Irvine, Irvine, California.
¹⁵ Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
¹⁶ VA Palo Alto Health Care System/Stanford University, Stanford, California.
¹⁷ Division of Medicine, Oslo University Hospital and Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
¹⁸ Fondazione G. Monasterio and Scuola Superiore Sant'Anna, Pisa, Italy.
¹⁹ NIHR Newcastle Biomedical Research Centre, Institute of Neuroscience, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom.
²⁰ Beth Israel Deaconess Medical Center, Department of Medicine, Boston, Massachusetts.

Abstract

Background: Previous systematic reviews have indicated that exercise-based cardiac rehabilitation (ExCR) for patients with heart failure (HF) has a beneficial effect on health-related quality-of-life (HRQoL) and exercise capacity. However, there is uncertainty regarding potential differential effects of ExCR across HF patient subgroups.

Objectives: The authors sought to undertake an individual participant data (IPD) meta-analysis to: 1) assess the impact of ExCR on HRQoL and exercise capacity in patients with HF; and 2) investigate differential effects of ExCR according to a range of patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischemic etiology, ejection fraction, and exercise capacity.

Methods: A single dataset was produced, comprising randomized trials where ExCR (delivered for 3 weeks or more) was compared with a no exercise control group. Each trial provided IPD on HRQoL or exercise capacity (or both), with follow-up of 6 months or more. One- and 2-stage meta-analysis models were used to investigate the effect of ExCR overall and the interactions between ExCR and participant characteristics.

Results: IPD was obtained from 13 trials for 3,990 patients, predominantly (97%) with reduced ejection fraction HF. Compared with the control group, there was a statistically significant difference in favor of ExCR for HRQoL and exercise capacity. At 12-month follow-up, improvements were seen in 6-min walk test (mean 21.0 m; 95% confidence interval: 1.57 to 40.4 m; p = 0.034) and Minnesota Living With HF score (mean improvement 5.9; 95% confidence interval: 1.0 to 10.9; p = 0.018). No consistent evidence was found of differential intervention effects across patient subgroups.

Conclusions: These results, based on an IPD meta-analysis of randomized trials, confirm the benefit of ExCR on HRQoL and exercise capacity and support the Class I recommendation of current international clinical guidelines that ExCR should be offered to all HF patients. (Exercise Training for Chronic Heart Failure [ExTraMATCH II]: protocol for an individual participant data meta-analysis; PROSPERO: international database of systematic reviews CRD42014007170).

Keywords: MLHFQ; QoL; exercise capacity; heart failure; quality-of-life; rehabilitation.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Cardiac Rehabilitation* / methods
Cardiac Rehabilitation* / psychology
Exercise Therapy / methods
Exercise Tolerance*
Heart Failure* / physiopathology
Heart Failure* / psychology
Heart Failure* / rehabilitation
Humans
Quality of Life*
Randomized Controlled Trials as Topic

Abstract

Publication types

MeSH terms

Grants and funding