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Effects of exercise training in heart failure with preserved ejection fraction: an updated systematic literature review

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Abstract

Physical activity is associated with a lower risk of adverse cardiovascular outcomes, including heart failure (HF). Exercise training is a class IA level recommendation in patients with stable HF, but its impact is less clear in heart failure with preserved ejection fraction (HFpEF). The aim of this study was to analyze the effects of the exercise training on cardiovascular outcomes in patients with HFpEF. A systematic literature search was conducted on the main electronic databases, proceedings of major meetings, and reference lists of the identified studies, using specific terms for only English language studies published between 2000 and 2018. We followed the PRISMA to perform our review. Quality of studies was also assessed. The systematic review identified 9 studies on 348 patients, of moderate (n = 2) to good (n = 7) quality. The training consisted of a combination of supervised in-hospital and home-based outpatient programs, including aerobic exercise, endurance and resistance training, walking, and treadmill and bicycle ergometer. Most of the protocols ranged 12–16 weeks, with a frequency of 2–3 sessions weekly, lasting 20–60 min per session. There were significant improvements in peak oxygen uptake, 6-min walking test distance, and ventilatory threshold, whereas quality of life and echocardiographic parameters improved only in some studies. Endothelial function/arterial stiffness remained unchanged. No adverse events were reported. Appropriate exercise programs are able to get a favorable cardiovascular outcome in patients with HFpEF. This could also benefit in terms of quality of life, even if more controversial. Further researches are necessary.

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Abbreviations

CINAHL:

cumulative Index to Nursing and Allied Health

HF:

heart failure

HFpEF:

heart failure with preserved ejection fraction

HFrEF:

heart failure with reduced ejection fraction

MeSH:

Medical Subject Heading

PRISMA:

Preferred Reporting Items for Systematic reviews and Meta-Analyses

QI:

Quality Index

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Author notes

  1. Massimo Leggio and Augusto Fusco contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital, Rome, Italy

    Massimo Leggio & Giorgio Limongelli

  2. IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy

    Augusto Fusco & Claudia Loreti

  3. Cardiology Division, Santa Maria della Stella Hospital, Orvieto, Italy

    Maria Grazia Bendini & Andrea Mazza

  4. Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go F. Vito, 1, 00168, Rome, Italy

    Daniele Coraci & Luca Padua

  5. Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy

    Luca Padua

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  1. Massimo Leggio
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  2. Augusto Fusco
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Correspondence to Daniele Coraci.

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Leggio, M., Fusco, A., Loreti, C. et al. Effects of exercise training in heart failure with preserved ejection fraction: an updated systematic literature review. Heart Fail Rev 25, 703–711 (2020). https://doi.org/10.1007/s10741-019-09841-x

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