Resistance exercise enhances oxygen uptake without worsening cardiac function in patients with systolic heart failure: a systematic review and meta-analysis

Abstract

Recent literature suggests that resistance training (RT) improves peak oxygen uptake ([Formula: see text] peak), similarly to aerobic exercise (AE) in patients with heart failure (HF), but its effect on cardiac remodeling is controversial. Thus, we examined the effects of RT and AE on [Formula: see text] peak and cardiac remodeling in patients with heart failure (HF) via a systematic review and meta-analysis. MEDLINE, EMBASE, Cochrane Library and CINAHL, AMEDEO and PEDro databases search were extracted study characteristics, exercise type, and ventricular outcomes. The main outcomes were [Formula: see text] peak (ml kg min), LVEF (%) and LVEDV (mL). Fifty-nine RCTs were included. RT produced a greater increase in [Formula: see text] peak (3.57 ml kg min, P < 0.00001, I = 0%) compared to AE (2.63 ml kg min, P < 0.00001, I = 58%) while combined RT and AE produced a 2.48 ml kg min increase in [Formula: see text]; I = 69%) compared to control group. Comparison among the three forms of exercise revealed similar effects on [Formula: see text] peak (P = 0.84 and 1.00, respectively; I = 0%). AE was associated with a greater gain in LVEF (3.15%; P < 0.00001, I = 17%) compared to RT alone or combined exercise which produced similar gains compared to control groups. Subgroup analysis revealed that AE reduced LVEDV (- 10.21 ml; P = 0.007, I = 0%), while RT and combined RT and AE had no effect on LVEDV compared with control participants. RT results in a greater gain in [Formula: see text] peak, and induces no deleterious effects on cardiac function in HF patients.

Effects of intradialytic resistance exercises on physical performance, nutrient intake and quality of life among haemodialysis people: A systematic review and meta‐analysis

“…The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommend that exercises should be one of the cornerstones of therapy for adults receiving dialysis (K/DOQI Workgroup, 2005). Intradialytic resistance exercises, namely various exercise programmes like upper extremity strengthening with free‐weight dumbbells implemented during dialysis, were considered as a strategy to prevent or even reverse people’ muscle wasting, are an important part of comprehensive management for HD people (Parker, 2016) and have been confirmed beneficial in the older population and some chronic diseases such as heart failure (Peterson, Rhea, Sen, & Gordon, 2010; Santos et al, 2018). The aim of this review was to provide an up‐to‐date synthesis of randomized controlled trials (RCT) comparing the effects of intradialytic resistance exercises versus usual care on physical performance, nutrient intake and quality of life in HD people.…”

Reported methods for handling missing change standard deviations in meta-analyses of exercise therapy interventions in patients with heart failure: A systematic review

“…However, this was specifically in regard to the pre and/or post SD required to calculate a change SD[ 21 ]. Two MAs [ 12 , 29 ] report the exclusion of studies if suitable data was not available, however, this appears to be only in the case where both mean and SD were missing. Only one MA[ 21 ], specifically reported excluding a study due to missing pre/post SD required to impute a change SD, and no other MA utilising change values for meta-analysis made reference to the possibility of missing pre or post SDs and how this would be handled.…”

“…Overall eleven [ 12 , 17 , 22 , 23 , 25 – 27 , 29 , 31 – 33 ] MAs failed to report anywhere within the publication any clear approach to deal with missing change SDs. Further examination of the 11 MAs revealed a range of methods were utilised in these analyses, including actual and approximate algebraic recalculations using actual or default p-values, post-intervention SDs and imputed SDs using correlation values ( Table 3 ).…”

“…Direct substitution was only reported in one MA[ 20 ], with the baseline SD utilised. Four MAs [ 17 , 24 , 28 , 29 ] noted the conversion of median and interquartile (IQR) to mean±SD. Of these, one[ 17 ] calculated the SD using IQR/1.35, one[ 24 ] stipulated using previously established methods, referencing Wan et al (2014)[ 34 ], one[ 29 ] utilised a formula provided in the paper ( S2 Table ), while one MA[ 28 ] notes using a formula, but provided no details.…”

“…The above two analyses highlight the issue of missing SDs and the issue of missing change SDs has continued. A recent large meta-analysis by Santos et al (2018)[ 29 ] included 46 data sets (from 41 studies) in the analysis of VO 2peak . However, a review of the studies included in the analysis indicated that only seven studies reported the change mean±SD (or SE) in the published paper, with all remaining studies only reporting pre and post intervention data.…”