Skip to main content

Advertisement

SpringerLink
Log in

Effect of Aerobic Exercise on Peak Oxygen Consumption, VE/VCO2 Slope, and Health-Related Quality of Life in Patients with Heart Failure with Preserved Left Ventricular Ejection Fraction: a Systematic Review and Meta-Analysis

  • Evidence-Based Medicine, Clinical Trials and Their Interpretations (L. Roever, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The aim of this study was to determine the effects of aerobic exercise on peak oxygen uptake (peak VO2), minute ventilation/carbon dioxide production (VE/VCO2 slope), and health-related quality of life (HRQoL) among patients with heart failure (HF) and preserved ejection fraction (HFpEF).

Recent Findings

We conducted a Cochrane Library, MEDLINE/PubMed, Physiotherapy Evidence Database, and SciELO search (from 1985 to May 2019) for randomized controlled trials that evaluated the effects of aerobic exercise in HFpEF patients. We calculated the mean differences (MD) and 95% confidence interval (CI). Ten intervention studies were included providing a total of 399 patients. Compared with control, aerobic exercise resulted in improvement in peak VO2 MD 1.9 mL kg−1 min−1 (95% CI 1.3 to 2.5; N = 314) and HRQoL measured by Minnesota Living with Heart Failure MD 5.4 (95% CI − 10.5 to − 0.2; N = 256). No significant difference in VE/VCO2 slope was found between participants in the aerobic exercise group and the control group. The quality of evidence for peak VO2 and HRQoL was assessed as being moderate.

Summary

Aerobic exercise moderately improves peak VO2 and HRQoL and should be considered a strategy of rehabilitation of HFpEF individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Haykowsky M, Brubaker P, Kitzman D. Role of physical training in heart failure with preserved ejection fraction. Curr Heart Fail Rep. 2012;9(2):101–6.

    Article  Google Scholar 

  2. Tucker WJ, Lijauco CC, Hearon CM, et al. Mechanisms of the improvement in peak VO2 with exercise training in heart failure with reduced or preserved ejection fraction. Heart, Lung and Circulation. 2018;27:9–21.

    Article  Google Scholar 

  3. Montero D, Diaz-Cañestro C. Determinants of exercise intolerance in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Int J Cardiol. 2018;254:224–9.

    Article  Google Scholar 

  4. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18:891–975.

    Article  Google Scholar 

  5. Pandey A, Patel KV, Vaduganathan M, Sarma S, Haykowsky MJ, Berry JD, et al. Physical activity, fitness, and obesity in heart failure with preserved ejection fraction. JACC Heart Fail. 2018;6(12):975–82.

    Article  Google Scholar 

  6. Redfield MM. Heart failure with preserved ejection fraction. N Engl J Med. 2016;375(19):1868–77.

    Article  Google Scholar 

  7. Upadhya B, Haykowsky MJ, Eggebeen J, Kitzman DW. Exercise intolerance in heart failure with preserved ejection fraction: more than a heart problem. JGeriatrCardiol. 2015;12(3):294–304. https://doi.org/10.11909/j.issn.1671-5411.2015.03.013.

    Article  CAS  Google Scholar 

  8. Dickstein K, Cohen-Solal A, Filippatos G, JJ MM, Ponikowski P, Poole-Wilson PA, et al. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail. 2008;10:933–89.

    Article  Google Scholar 

  9. Gomes Neto M, Durães AR, Conceição LSR, Saquetto MB, Ellingsen Ø, Carvalho VO. High intensity interval training versus moderate intensity continuous training on exercise capacity and quality of life in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis. Int J Cardiol. 2018;261:134–41.

    Article  Google Scholar 

  10. Dieberg G, Ismail H, Giallauria F, Smart NA. Clinical outcomes and cardiovascular responses to exercise training in heart failure patients with preserved ejection fraction: a systematic review and meta-analysis. J Appl Physiol (1985). 2015;119(6):726–33.

    Article  CAS  Google Scholar 

  11. Nadruz W Jr, West E, Sengeløv M, Santos M, Groarke JD, Forman DE, et al. Prognostic value of cardiopulmonary exercise testing in heart failure with reduced, midrange, and preserved ejection fraction. J Am Heart Assoc. 2017;6(11):e006000.

    Article  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG, for the PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

    Article  Google Scholar 

  13. Higgins JPT, Green S. The Cochrane library. Issue 4. Chichester: John Wiley & Sons; 2006. Cochrane handbook for Systematic Reviews of Interventions 4.2.6 [update September 2006

    Google Scholar 

  14. Olivo SA, Macedo LG, Gadotti IN, Fuentes J, Stanton T, Magee DJ. Scales to assess the quality of randomized controlled trials: a systematic review. PhysTher. 2008;88(2):156–75.

    Google Scholar 

  15. Verhagen AP, de Vet HCW, de Bie RA, Kessels AGH, Boers M, Bouter LM, et al. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998;51(12):1235–41.

    Article  CAS  Google Scholar 

  16. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating of quality randomized controlled trials. Phys Ther. 2003;83(8):713–21.

    PubMed  Google Scholar 

  17. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 2014;14:135. https://doi.org/10.1186/1471-2288-14-135.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  Google Scholar 

  19. Collaboration TC. Available at: www.cochrane.org. [Accessed 3 Feb 2008].

  20. • Maldonado-Martín S, Brubaker PH, Eggebeen J, Stewart KP, Kitzman DW. Association between 6-minute walk test distance and objective variables of functional capacity after exercise training in elderly heart failure patients with preserved ejection fraction: a randomized exercise trial. Arch Phys Med Rehabil. 2017;98(3):600–3 This study demonstrated Peak VO2 improved in the AE.

    Article  Google Scholar 

  21. Kitzman DW, Brubaker P, Morgan T, Haykowsky M, Hundley G, Kraus WE, et al. Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical trial. JAMA. 2016;315(1):36–46.

    Article  CAS  Google Scholar 

  22. • Angadi SS, Mookadam F, Lee CD, Tucker WJ, Haykowsky MJ, Gaesser GA. High-intensity interval training vs. moderate-intensity continuous exercise training in heart failure with preserved ejection fraction: a pilot study. J Appl Physiol (1985). 2015;119(6):753–8 This study demonstrated the HIIT improved VO 2 peak and left ventricular diastolic dysfunction grade.

    Article  CAS  Google Scholar 

  23. • Kitzman DW, Brubaker PH, Herrington DM, Morgan TM, Stewart KP, Hundley WG, et al. Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. J Am Coll Cardiol. 2013;62(7):584–92. https://doi.org/10.1016/j.jacc.2013.04.033 Exercise training increased peak VO 2 and quality of life.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Yeh GY, Wood MJ, Wayne PM, Quilty MT, Stevenson LW, Davis RB, et al. Tai chi in patients with heart failure with preserved ejection fraction. Congest Heart Fail. 2013;19(2):77–84.

    Article  Google Scholar 

  25. • Alves AJ, Ribeiro F, Goldhammer E, Rivlin Y, Rosenschein U, Viana JL, et al. Exercise training improves diastolic function in heart failure patients. Med Sci Sports Exerc. 2012;44(5):776–85 Exercise training increased the mean ratio of early to late mitral inflow velocities (E/A ratio) and decreased deceleration time (DT) of early filling in patients with mild and preserved LVEF.

    Article  Google Scholar 

  26. Haykowsky MJ, Brubaker PH, Stewart KP, Morgan TM, Eggebeen J, Kitzman DW. Effect of endurance training on the determinants of peak exercise oxygen consumption in elderly patients with stable compensated heart failure and preserved ejection fraction. J Am Coll Cardiol. 2012;60(2):120–8.

    Article  Google Scholar 

  27. • Smart NA, Haluska B, Jeffriess L, Leung D. Exercise training in heart failure with preserved systolic function: a randomized controlled trial of the effects on cardiac function and functional capacity. Congest Heart Fail. 2012;18(6):295–301 After exercise training, the increment in peak VO 2.

    Article  Google Scholar 

  28. Kitzman DW, Brubaker PH, Morgan TM, Stewart KP, Little WC. Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. Circ Heart Fail. 2010;3(6):659–67.

    Article  Google Scholar 

  29. • Gary RA, Sueta CA, Dougherty M, Rosenberg B, Cheek D, Preisser J, etal. Home-based exercise improves functional performance and quality of life in women with diastolic heart failure. Heart Lung 2004;33(4):210–218. Exercise improved in the 6-min walk test.

    Article  Google Scholar 

  30. Agostoni P, Corrà U, Cattadori G, Veglia F, La Gioia R, Scardovi AB, et al. Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: a multi parametric approach to heart failure prognosis. Int J Cardiol. 2013;167:2710–8.

    Article  Google Scholar 

  31. Faller H, Störk S, Schowalter M, Steinbüchel T, Wollner V, Ertl G, et al. Is health-related quality of life an independent predictor of survival in patients with chronic heart failure? J Psychosom Res. 2007;63(5):533–8.

    Article  Google Scholar 

  32. Frankenstein L, Nelles M, Hallerbach M, Dukic D, Fluegel A, Schellberg D, et al. Prognostic impact of peak VO2-changes in stable CHF on chronic beta-blocker treatment. Int J Cardiol. 2007;122(2):125–30.

    Article  CAS  Google Scholar 

  33. Ades PA, Keteyian SJ, Balady GJ, et al. Cardiac rehabilitation exercise and self-care for chronic heart failure. JACC Heart Fail. 2013;1(6):540–7.

    Article  Google Scholar 

  34. Arnold M, Rajda M, Ignaszewski A, Howlett J, Leblanc M-H. Changes in the Minnesota living with heart failure questionnaire score and clinical outcomes in a large contemporary population of ambulatory heart failure patients in the Canadian heart failure network. J Card Fail. 2012;18(8 Supplement):S79.

    Article  Google Scholar 

  35. Poggio R, Arazi HC, Giorgi M, Miriuka SG. Prediction of severe cardiovascular events by VE/VCO2 slope versus peak VO2 in systolic heart failure: a meta-analysis of the published literature. Am Heart J. 2010;160(6):1004–14.

    Article  Google Scholar 

  36. Sato T, Yoshihisa A, Kanno Y, Suzuki S, Yamaki T, Sugimoto K, et al. Cardiopulmonary exercise testing as prognostic indicators: comparisons among heart failure patients with reduced, mid-range and preserved ejection fraction. Eur J Prev Cardiol. 2017;24(18):1979–87. https://doi.org/10.1177/2047487317739079.

    Article  PubMed  Google Scholar 

  37. Ingle L. Prognostic value and diagnostic potential of cardiopulmonary exercise testing in patients with chronic heart failure. Euro J Heart Fail. 2008;10:112–8.

    Article  Google Scholar 

  38. Pozehl BJ, Duncan K, Hertzog M, McGuire R, Norman JF, Artinian NT, et al. Study of adherence to exercise in heart failure: the HEART camp trial protocol. BMC Cardiovasc Disord. 2014;14:172.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Physical Therapy Department, Instituto de Ciências da Saúde, Federal University of Bahia – UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela Salvador, Salvador, Bahia, CEP 40.110-100, Brazil

    Mansueto Gomes-Neto & Ana Lucia Barbosa Goes

  2. Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brazil

    Mansueto Gomes-Neto & André Rodrigues Durães

  3. Physiotherapy Research Group, UFBA, Salvador, Brazil

    Mansueto Gomes-Neto, Ana Lucia Barbosa Goes & Iura Gonzalez Nogueira Alves

  4. The GREAT Group (GRupo de Estudos em ATividade física), São Paulo, Brazil

    Mansueto Gomes-Neto, Lino Sergio Rocha Conceição & Vitor Oliveira Carvalho

  5. Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil

    Leonardo Roever

  6. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China

    Tong Liu

  7. Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China

    Tong Liu

  8. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy

    Gary Tse

  9. Mediterranea Cardiocentro, Naples, Italy

    Giuseppe Biondi-Zoccai

  10. K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway

    Øyvind Ellingsen

  11. Department of Cardiology, Trondheim University Hospital, St. Olavs Hospital, Trondheim, Norway

    Øyvind Ellingsen

  12. Physical Therapy Department, Federal University of Sergipe – UFS, Aracaju, SE, Brazil

    Lino Sergio Rocha Conceição & Vitor Oliveira Carvalho

Authors
  1. Mansueto Gomes-Neto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. André Rodrigues Durães
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lino Sergio Rocha Conceição
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leonardo Roever
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tong Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gary Tse
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giuseppe Biondi-Zoccai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ana Lucia Barbosa Goes
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Iura Gonzalez Nogueira Alves
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Øyvind Ellingsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Vitor Oliveira Carvalho
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mansueto Gomes-Neto.

Ethics declarations

Conflict of Interest

Mansueto Gomes Neto, André Rodrigues Durães, Lino Sergio Rocha Conceição, Leonardo Roever, Tong Liu7 Gary Tse, Giuseppe Biondi-Zoccai, Ana Lucia Barbosa Goes, Lura Gonzalez Nogueira Alves, Øyvind Ellingsen, and Vitor Oliveira Carvalho declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Evidence-Based Medicine, Clinical Trials and Their Interpretations

Electronic supplementary material

ESM 1

(DOCX 16 kb)

ESM 2

(DOCX 16 kb)

ESM 3

(DOCX 20 kb)

ESM 4

(DOCX 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gomes-Neto, M., Durães, A.R., Conceição, L.S.R. et al. Effect of Aerobic Exercise on Peak Oxygen Consumption, VE/VCO2 Slope, and Health-Related Quality of Life in Patients with Heart Failure with Preserved Left Ventricular Ejection Fraction: a Systematic Review and Meta-Analysis. Curr Atheroscler Rep 21, 45 (2019). https://doi.org/10.1007/s11883-019-0806-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11883-019-0806-6

Keywords

Search

Navigation