A Cochrane review [Abstract] 1 included 44 studies with a total of 5 783 subjects with heart failure (HF), predominantly with HF due to reduced ejection fraction (HFREF) and NYHA classes II and III. Programmes were typically based on aerobic exercise training with or without a resistance exercise element. All studies included a no formal exercise training intervention comparator; a wide range of comparators were seen across studies that included active intervention (i.e. education, psychological intervention), or usual medical care alone.
There was no difference in mortality between exercise-based rehabilitation versus no exercise control in studies with up to one-year follow-up. However, there was trend towards a reduction in mortality with exercise in studies with more than one year of follow-up (table T1). Compared with control, exercise training reduced the rate of overall and HF specific hospitalisation. Exercise also resulted in a clinically important improvement in the Minnesota Living with Heart Failure questionnaire - a disease specific health-related quality of life measure. However, levels of statistical heterogeneity across studies in this outcome were substantial (I2 =82%).
| Outcome | Relative effect (95% CI) | Participants (studies) |
|---|---|---|
| *I2 = 66%; **I2 = 82% | ||
| All-cause mortality up to 12 months' follow-up | RR 0.89 (0.66 to 1.21) | 2 596 (27 studies) |
| All-cause mortality more than 12 months' follow-up | RR 0.88 (0.75 to 1.02) | 2 845 (6 studies) |
| All hospital admissions up to 12 months' follow-up | RR 0.70 (0.60 to 0.83) | 2 182 (21 studies) |
| All hospital admissions more than 12 months' follow-up | RR 0.70 (0.47 to 1.05)* | 2 691 (6 studies) |
| Hospital admissions due to heart failure | RR 0.59 (0.42 to 0.84) | 1 114 (14 studies) |
| Health-related quality of life (Minnesota Living with Heart Failure questionnaire) up to 12 months' follow-up | MD -7.11 points (-10.49 to -3.73 points)** | 1 995(17 studies) |
Univariate meta-regression analysis showed that the benefits were independent of the type of rehabilitation (exercise only vs comprehensive), type of exercise (aerobic training alone vs aerobic plus resistance training), exercise dose, and exercise setting (hospital only, home only, both hospital and home).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding).
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