Abstract
Objective. Flow-mediated dilation (FMD) is widely utilised to assess endothelial function and aerobic exercise improves FMD in heart failure patients. The aim of this meta-analysis is to quantify the effect of aerobic training intensity on FMD in patients with heart failure. Background. A large number of studies now exist that examine endothelial function in patients with heart failure. We sought to add to the current literature by quantifying the effect of the aerobic training intensity on endothelial function. Methods. We conducted database searches (PubMed, Embase, ProQuest, and Cochrane Trials Register to June 30, 2016) for exercise based rehabilitation trials in heart failure, using search terms exercise training, endothelial function, and flow-mediated dilation (FMD). Results. The 13 included studies provided a total of 458 participants, 264 in intervention groups, and 194 in nonexercising control groups. Both vigorous and moderate intensity aerobic training significantly improved FMD. Conclusion. Overall both vigorous and moderate aerobic exercise training improved FMD in patients with heart failure.
Highlights
Results of numerous studies and meta-analyses have shown that exercise training is safe but is associated with a range of physiological, functional, and clinical benefits in patients with heart failure (HF) [1,2,3]
Endothelial dysfunction is associated with the pathogenesis and progression of HF [6] and flow-mediated dilation (FMD), a noninvasive assessment of endothelial function, has been shown to be predictive of deterioration and death [7] in HF patients
Searches included a mix of MeSH and free text terms related to the key concepts of heart failure, exercise training, endothelial function, and flow-mediated dilation
Summary
Results of numerous studies and meta-analyses have shown that exercise training is safe but is associated with a range of physiological, functional, and clinical benefits in patients with heart failure (HF) [1,2,3]. While exercise interventions in HF patients have utilised a range of training modalities, aerobic or endurance training is the most investigated and has been shown to improve a range of parameters in HF patients [1, 4], including endothelial function [5]. While aerobic exercise is a feature of cardiac rehabilitation guidelines around the world, training program characteristics still vary considerably and the focus of current and emerging research is on identifying the exercise modality, dose, and intensity that will deliver optimal benefits [10,11,12,13]. As the pattern of blood flow and amount of shear stress [8] that occur during exercise may be related to the specific training characteristics, including training intensity, ascertaining an optimal training protocol is important
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