Effects Of Exercise-based Cardiac Rehabilitation Research Articles

What are the effects of exercise-based cardiac rehabilitation for adults with heart failure?

What are the effects of exercise-based cardiac rehabilitation for adults with heart failure?

Effects of Exercise-Based Cardiac Rehabilitation in Patients After Myocardial Infarction

Background: Myocardial infarction (MI) is a leading cause of mortality and physical disability worldwide, particularly among the elderly. Despite advancements in percutaneous coronary intervention (PCI) and pharmacotherapy, many MI patients continue to experience health deterioration. Exercise-based cardiac rehabilitation has shown potential in improving myocardial perfusion, endothelial function, and reducing thrombotic activity, thereby enhancing patient outcomes. Objective: This study aimed to determine the effects of a supervised exercise-based cardiac rehabilitation program on quality of life, heart rate, and blood pressure in patients’ post-myocardial infarction. Methods: A randomized controlled trial was conducted with 36 participants aged 40 to 60 who experienced an MI within the previous three weeks. Participants were randomly assigned to Group A (exercise program) or Group B (educational interventions). Group A engaged in a 6-week supervised exercise program, including warm-up exercises, aerobic activities, and cool-down sessions. Quality of life was assessed using the CDC HRQOL-14 questionnaire, while heart rate and blood pressure were measured pre- and post-intervention. Data analysis was performed using SPSS 25, employing independent and paired sample t-tests. Results: Group A showed significant improvements in HRQOL scores: Module 1 (p=0.04), Module 2 (p=0.04), and Module 3 (p=0.02). Heart rate improved by 12 bpm (p=0.03), and systolic blood pressure reduced by 8.81 mmHg (p=0.01) in Group A compared to Group B. Conclusion: Exercise-based cardiac rehabilitation significantly improves quality of life, heart rate, and blood pressure in post-MI patients.

Exercise-based cardiac rehabilitation effects on severity of angina, HRQoL and exercise capacity in patients with microvascular angina: systematic review and meta-analysis

Abstract Background Microvascular angina (MVA) is a clinical syndrome caused by coronary microvascular dysfunction in patients with angina symptoms and no flow limiting blockages in their main coronary arteries. Patients experience recurrent angina, low health related quality of life (HRQoL) and limited exercise tolerance, making them more likely to repeatedly present to healthcare services. Aim To establish the effects of exercise-based cardiac rehabilitation (CR) on the severity of angina, HRQoL and exercise capacity among adults with a diagnosis of MVA compared to a no-exercise group. Methods Searches were performed in 14 online databases. We included randomised controlled trials (RCTs) that assessed the independent effect of CR versus a no-exercise group in adults with a probable or definite diagnosis of MVA according to the COVADIS criteria. Risk of bias was assessed via the Cochrane RoB2 tool at outcome level and the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. Meta-analysis using random effects models were used to estimate mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals (CI). Results Of the 15,873 reports identified, five studies (n=222) were included. Reasons for RoB judgements varied between studies and outcomes, however all were scored at either ‘high risk’ or ‘some concerns’. Participants were mostly female (97%), average ages ranged from 51 to 64 years. The CR programmes utilised aerobic exercise and resistance training. Meta-analysis of the effect of CR on severity of angina (2 RCTs; n=85) was not possible due to the limited data presented in one of the reports. The narrative synthesis concluded that there is no evidence of an effect of CR on severity of angina symptoms. Meta-analysis of the effects of CR versus no-exercise on HRQoL were conducted at domain level of the Short Form-36 (SF-36) questionnaire (2 RCTs; n=75), and exercise capacity as measured by peak VO2 (3 RCTs; n=101). The evidence of the effect of CR versus no-exercise intervention of the SF-36 domains from the meta-analyses was classified as ‘very low certainty’, meaning we have very little confidence in the effect estimates calculated. CR versus no-exercise intervention was estimated to result in a SMD of 1.06 (95% CI -0.7 to 2.19, low certainty of evidence) for measurements of peak VO2 in favour of CR. A SMD of 1.06 is estimated to be equivalent to a 4.42 ml/kg/min change in peak VO2, which is believed to represent a clinically meaningful difference. Conclusions CR may improve exercise capacity outcomes in patients with MVA compared to controls, however our confidence in the effect estimate is limited. We remain uncertain as to the effect of CR on the severity of angina symptoms and HRQoL. High-quality, well-reported RCTs are needed to more rigorously assess the benefits and harms of exercise-based CR for adults with MVA.

Effects of Exercise-Based Cardiac Rehabilitation on Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Objective: This study aims to systematically analyze the impact of exercise-based cardiac rehabilitation on patients undergoing percutaneous coronary intervention (PCI). Methods: We searched for original studies on the effect of exercise-based cardiac rehabilitation on patients undergoing PCI published in domestic and foreign databases such as PubMed, Web of Science, Embase, Cochrane Library, China Knowledge Network (CNKI), and VIP until December 2023. Studies retrieved were screened, and meta-analysis was extracted. The quality of the literature was evaluated; meta-analysis was carried out by RevMan5.4 software (Cochrane Collaboration, Oxford, UK). Results: A total of 1073 sufferers undergoing PCI were included in 11 literatures. Meta-analysis displayed that cardiogenic mortality [risk ratio (RR) = 0.23, 95% confidence interval (CI) (0.08, 0.64)], coronary restenosis rate [RR = 0.59, 95% CI (0.41, 0.87)], revascularization rate [RR = 0.58, 95% CI (0.43, 0.79)], incidence of recurrent angina pectoris [RR = 0.41, 95% CI (0.27, 0.62)], and late lumen loss [RR = –0.60, 95% CI (–0.98, –0.23)] in the trial group, were lower than those in the control group (p < 0.05). No significant difference was found in the recurrence rate of myocardial infarction between the test group and the control group [RR = 0.52, 95% CI (0.22, 1.25)]. Conclusion: Exercise-based cardiac rehabilitation therapy can effectively reduce the risk of major adverse cardio-cerebrovascular events, such as cardiogenic death and coronary restenosis after PCI; it reduces the late lumen loss of the stent coronary segment and has no obvious effect on the recurrence of myocardial infarction. However, this therapy tends to reduce the recurrence rate of myocardial infarction.

Impact of Exercise-Based Cardiac Rehabilitation on Metabolic Syndrome in Post-Acute Coronary Syndrome Patients

Abstract Background Metabolic syndrome (MetS) is characterized by a cluster of cardiovascular risk factors including hypertension (HTN), impaired fasting blood sugar (FBS), increased central obesity (WC) and dyslipidemia; hypertriglyceridemia (TG) and low high-density lipoprotein- cholesterol (HDL-C). The MetS adversely affects cardiovascular outcomes, individuals with at least 4 out of 5 features of MetS have a 3.7-fold increased risk of coronary artery diseases at a 5-year follow-up. Objective to determine the effectiveness of exercise based-cardiac rehabilitation (CR) program on MetS in post-Acute Coronary Syndrome (ACS) patients versus guideline directed medical therapy over a 12 weeks period. Patients and Methods The study included 62 patients who suffered from ACS with evidence of MetS. All patients were recruited from Ain Shams University Hospitals (ASUHs) from July 2021 to December 2021 and were assessed at baseline and after 12 weeks of follow up for MetS parameters. After approval by the local ethics committee all patients were provided voluntary informed consent. The study subjects were classified into two groups: Group A (case group): included 32 patients who completed at least 80% of 12 weeks of CR program in ASUHs. Group B (control group): included 30 patients who did not attend the CR program and completed 12 weeks of guideline directed medical therapy alone. Results The results revealed that -when compared group A at baseline and after 12 weeks of CR-program there was a significant reduction in WC, FBS and TG levels, while there was a significant rise in HDL-C level. However, there was no statistically significant difference found regarding BP in this group. Regarding group B there was no statistically significant difference between the baseline MetS parameters and at follow up after 12 weeks of guideline directed medical therapy alone. Conclusion The present study revealed that there was a statistically significant improvement regarding WC, FBS, TG and HDL after completion of 12 weeks of the CR Program, while there was no statistically significant difference found regarding BP in the study group. In the control group there was no statistically significant difference found at baseline and follow up after 12 weeks of guideline directed medical care alone. Thus, the exercise-based CR program is superior than the regular medical care alone in improving the WC, FBS, TG and HDL. Key words: Metabolic Syndrome, Cardiac Rehabilitation, Exercise Training, ACS. Abbreviations and Acronyms. Acronyms: ACS: Acute Coronary Syndrome ASUHs: Ain Shams University Hospitals BP: Blood Pressure CR: Cardiac Rehabilitation FBS: Fasting Blood Sugar HDL-C: High Density Lipoprotein-Cholesterol HTN: Hypertension MetS: Metabolic Syndrome TG: Triglyceridemia WC: Central Obesity

Effect of exercise based cardiac rehabilitation on LV systolic function & exercise stress parameters in patients with ischemic cardiomyopathy post anterior STEMI

Background: Cardiovascular diseases are a leading cause of death worldwide. Multiple meta-analysis have demonstrated the benefit of exercise based cardiac rehabilitation. However, the effect of exercise training on left ventricular (LV) systolic function in patients with ischemic cardiomyopathy has been controversial in the literature. Objective: To study the effect of exercise-based cardiac rehabilitation (EBCR) on left ventricular (LV) systolic function and exercise stress parameters (METs achieved, HR recovery and HR reserve) in post anterior STEMI patients with ischemic cardiomyopathy (EF≤45%). Patients and methods: The study included 50 patients with ischemic cardiomyopathy (Post anterior STEMI successfully treated by 1ry PCI) referred for cardiac rehabilitation unit at Ain Shams University Hospitals. The patients were subjected to 3 months of formal exercise based cardiac rehabilitation. Before the CR program, they were subjected to a symptom-limited exercise test (modified Bruce protocol) to exclude any remaining ischemia and calculate enrolment HR reserve, baseline heart rate recovery in 1st minute and 2nd minute (HRR1 and HRR2). Another symptom-limited exercise test was done post CR program to assess the forementioned exercise parameters after completion of the program. Echocardiography was done at baseline and after completion of the CR program for assessment of LV systolic function by ejection fraction (assessed by 2D Simpson’s method) and peak longitudinal strain of the left ventricle (measured using speckle tracking echocardiography). Results: Exercise-based cardiac rehabilitation was associated with significant improvement in LV systolic function as reflected by significant improvement in Global longitudinal strain (GLS) (P-value = 0.0001) in patients with ischemic heart failure. CR was also associated with improvement in the functional capacity as reflected by the improvement in METs as well as in the HRR and HR reserve (P-value = 0.0001). However, there was no significant change regarding EF before and after cardiac rehabilitation (P-value= 0.4582).

Effectiveness of exercise-based cardiac rehabilitation for patients with left ventricular assist device: A systematic review and meta-analysis.

Exercise-based cardiac rehabilitation (EBCR) improves functional capacity in heart failure (HF). However, data on the effect of EBCR in patients with advanced HF and left ventricular assist devices (LVADs) are limited. This meta-analysis aimed to evaluate the impact of EBCR on the functional ability of LVAD patients by comparing the corresponding outcome indicators between the EBCR and ST groups. PubMed, Embase, Clinical Trials, and Cochrane Library databases were searched for studies assessing and comparing the effects of EBCR and standard therapy (ST) in patients following LVAD implantation. Using pre-defined criteria, appropriate studies were identified and selected. Data from selected studies were extracted in a standardized fashion, and a meta-analysis was performed using a fixed-effects model. The protocol was registered on INPLASY (202340073). In total, 12 trials involving 477 patients were identified. The mean age of the participants was 52.9 years, and 78.6% were male. The initiation of EBCR varied from LVAD implantation during the index hospitalization to 11months post-LVAD implantation. The median rehabilitation period ranged from 2weeks to 18months. EBCR was associated with improved peak oxygen uptake (VO2) in all trials. Quantitative analysis was performed in six randomized studies involving 214 patients (EBCR: n = 130, ST: n = 84). EBCR was associated with a significantly high peak VO2 (weighted mean difference [WMD] = 1.64mL/kg/min; 95% confidence interval [CI], 0.20-3.08; p = .03). Similarly, 6-min walk distance (6MWD) showed significantly greater improvement in the EBCR group than in the ST group (WMD = 34.54m; 95% CI, 12.47-56.42; p = .002) in 266 patients (EBCR, n = 140; ST, n = 126). Heterogeneity was low among the included trials. None of the included studies reported serious adverse events related to EBCR, indicating the safety of EBCR after LVAD implantation. This study demonstrated that EBCR following LVAD implantation is associated with greater improvement in functional capacity compared with ST as reflected by the improved peak VO2 and 6MWD values. Considering the small number of patients in this analysis, further research on the clinical impact of EBCR in LVAD patients is warranted.

Impact of Long-Term Exercise-Based Cardiac Rehabilitation in Patients With Chronic Heart Failure - A Systematic Review and Meta-Analysis.

This study aimed to clarify the effects of exercise-based cardiac rehabilitation (CR) on patients with heart failure. Patients were divided into groups according to intervention duration (<6 and ≥6 months). We searched for studies published up to July 2023 in Embase, MEDLINE, PubMed, and the Cochrane Library, without limitations on data, language, or publication status. We included randomized controlled trials comparing the efficacy of CR and usual care on mortality, prehospitalization, peak oxygen uptake (V̇O2), and quality of life. Seventy-two studies involving 8,495 patients were included in this review. It was found that CR reduced the risk of rehospitalization for any cause (risk ratio [RR] 0.80; 95% confidence interval [CI] 0.70-0.92) and for heart failure (RR 0.88; 95% CI 0.78-1.00). Furthermore, CR was found to improve exercise tolerance (measured by peak V̇O2and the 6-min walk test) and quality of life. A subanalysis performed based on intervention duration (<6 and ≥6 months) revealed a similar trend. Our meta-analysis showed that although CR does not reduce mortality, it is effective in reducing rehospitalization rates and improving exercise tolerance and quality of life, regardless of the intervention duration.

Safety and Effectiveness of Exercise-Based Cardiac Rehabilitation for Patients With Atrial Fibrillation Following Radiofrequency Catheter Ablation Therapy: A Systematic Review and Meta-Analysis

Safety and Effectiveness of Exercise-Based Cardiac Rehabilitation for Patients With Atrial Fibrillation Following Radiofrequency Catheter Ablation Therapy: A Systematic Review and Meta-Analysis

Interindividual response variation to exercise-based cardiac rehabilitation on changes in cardiorespiratory fitness in heart transplant patients: A secondary meta-analysis of randomized controlled trials

PurposeDetermine whether true inter-individual exercise response differences (IIRD) occur in cardiorespiratory fitness (CRF) as a result of exercise-based cardiac rehabilitation in heart transplant patients. MethodsUsing data from a recent (2023) meta-analysis of nine RCTs representing 296 patients (163 exercise, 133 control), an aggregate data meta-analysis of treatment effects (change outcome differences between exercise and control groups) was conducted as well as an IIRD meta-analysis using the inverse variance heterogeneity (IVhet) model. The primary outcome was cardiorespiratory fitness (VO2max) in mL.kg-1.min-1. ResultsStatistically significant and clinically important increases equivalent to 14.5% were observed for VO2max in mL.kg-1.min-1 (X̅, 3.0, 95% CI, 2.4 to 3.7 mL.kg-1.min-1, p <0.001; Q=11.8, p=0.16; I2=32.0%, 95% CI, 0% to 68.8%; τ2=0.4). The 95% prediction interval (PI) was 1.2 to 4.7 mL.kg-1.min-1. However, no statistically significant IIRD were observed (X̅, 0.6, 95% CI, -1.1 to 1.4 mL.kg-1.min-1; τ2=2.9). The 95% PI was -2.7 to 2.8 mL.kg-1.min-1. ConclusionsWhile exercise-based cardiac rehabilitation increases VO2max in mL.kg-1.min-1 in heart transplant patients, a lack of true exercise-associated IIRD exist. A need exists for additional well-designed randomized controlled trials of longer duration to determine the long-term effects of exercise-based cardiac rehabilitation on VO2max in mL.kg-1.min-1 among heart transplant patients.

Which Components of The International Classification of Functioning, Disability and Health (ICF) are Covered by Cardiac Rehabilitation Assessment Tools among Individuals with Heart Failure?

BackgroundThe therapeutic assessment of functioning in cardiac rehabilitation from the perspective of the International Classification of Functioning, Disability and Health (ICF) can provide a biopsychosocial approach to health care. However, it is unclear which components are reflected in the instruments used for cardiac rehabilitation in individuals with heart failure (HF). ObjectivesTo investigate which ICF components (body function, structures, activities, participation, environmental factors, and personal factors) are represented in the assessment instruments used in individuals with HF and to identify the most appropriate instrument to use based on the inclusion of these factors. MethodsForty-four clinical trials included in an updated Cochrane systematic review that investigated the effects of exercise-based cardiac rehabilitation in patients with HF were reviewed. The instruments were analyzed to extract significant concepts linked to the ICF codes. ResultsA total of 12 outcomes and 40 instruments were identified. The concepts were linked to 2466 codes in the following ICF components: body functions (41.8%), activities (29.7%), participation (8.4%), environmental factors (3.8%), personal factors (1.3%), and body structures (1.0%); other concepts (13.9%) were classified as not covered by ICF. None of the instruments presented concepts linked to all ICF components. The Minnesota Living with Heart Failure Questionnaire (MLHFQ), however, demonstrated comprehensive coverage of the ICF components, with the exception of body structure. ConclusionsBody function was the most frequently detected ICF component. Individual instruments did not provide a comprehensive perspective on the functioning level of individuals with HF. The MLHFQ provided the greatest coverage of ICF components.

Exercise-based cardiac rehabilitation programmers for patients after transcatheter aortic valve implantation: A systematic review and meta-analysis.

Currently, transcatheter aortic valve implantation (TAVI) is presently a recognized treatment modality for patients with severe aortic stenosis who are often old, disabled, frail, and have low exercise capacity (ExCap). It is further expected from this therapy to improve quality of life by improving of the cardio function performance. The aim of this study is to evaluate the effect of exercise-based cardiac rehabilitation (CR) on patients after TAVI. PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to December 10, 2022 for relevant studies that evaluated the effect of CR on patients after TAVI. The primary outcome was the improvement of 6-minute walked distance and Barthel index score after CR. The secondary outcomes included other parameters such as SF-12 scale, HADS score, Morse Fall Scale, Frailty-Index, ExCap, and FIM score. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2. A total of 12 observational studies were identified, with 2365 participants. Pooled data indicated that CR programmers significantly improved the 6-minute walked distance (SMD 0.65; 95% confidence intervals [CI] 0.51-0.79) and Barthel index score (SMD 0.83; 95% CI 0.61-1.06). In addition, compared with admission, patients experienced significant improvement in SF-12 scale at CR discharge, with a pooled mean differences (MD) of 2.74 (95% CI 0.86-4.61) in physical component score and 2.76 (95% CI 0.59-4.93) in mental component score. Similar results were also observed in ExCap (MD 8.10 W; 95% CI 1.57 W-14.63 W) and FIM score (MD 11.0; 95% CI 6.22-15.78). Our analysis indicated that exercise-based CR programmers had significant effect on patients after TAVI in improving exercise tolerance and functional independence.

일주일간의 입원 기간 동안 운동 기반 심장재활이 급성 심근경색 환자의 젖산 수치에 미치는 영향

Purpose: Few studies have been conducted to examine changes in lactate levels associated with the severity of myocardial infarction during cardiac rehabilitation. Thus, this study aimed to investigate the effects of exercise-based cardiac rehabilitation on lactate levels in patients with acute myocardial infarction. Methods: A total of eight patients (7 males and 1 female, aged 64.1 ± 12.8 years) who were diagnosed with acute myocardial infarction and participated in an inpatient cardiac rehabilitation program were included in this study. Lactate levels were measured using Lactate Plus (Nova Biomedical, Rodermark, Germany), which can measure lactate levels from 0.3 to 25.0 mmol/L. Exercise intensity during the inpatient cardiac rehabilitation period was set at 40%-60% of peak oxygen uptake (peak VO2), and cardiopulmonary exercise testing and lactate level measurements were conducted before and after exercise. Normally distributed data were analyzed using paired t-tests, and non-normally distributed data were analyzed using the Wilcoxon signed-rank test. Results: VO2peak and metabolic equivalents significantly increased, and minute ventilation per unit carbon dioxide production showed a decreasing trend but not a significant decrease (p=.014, p=.02). During the one-week inpatient rehabilitation period, lactate levels at rest before exercise on the first and last days of rehabilitation significantly decreased (p=.036). Lactate levels significantly increased immediately after exercise (p=.014), while lactate levels before exercise showed a decreasing trend in all eight patients. Conclusion: In patients with acute myocardial infarction, lactate levels increased immediately after exercise-based cardiac rehabilitation, while lactate levels at rest decreased during the one-week rehabilitation period as aerobic capacity improved.

Exercise-based cardiac rehabilitation in women with heart failure: a review of enrollment, adherence, and outcomes.

Exercise-based cardiac rehabilitation (CR) is an evidence-based recommendation for patients with stable heart failure (HF). Less clear is how effective exercise-based CR is for women with HF. The aim of this review was to synthesize the evidence for the effects of exercise-based CR on mortality, hospitalizations, exercise capacity, and quality of life (QOL) among women with HF. We identified 18 studies comprising 4917 patients, of which 1714 were women. The interventions evaluated consisted of various combinations of supervised in-hospital and out-patient sessions as well as home-based programs that included aerobic (walking, treadmill, bicycle) and resistance training. The interventions ranged from 12 to 54weeks, with a frequency of 2-7 sessions per week, lasting from 30 to 105min per session. Because of a paucity of sex-specific analyses of the outcomes, it was not possible to draw conclusions for women. There was limited evidence for mortality benefit for men or women participating in exercise-based CR. There was more substantial evidence for reductions in hospitalizations for the participants. Generally, exercise training improved exercise capacity. The effects of exercise-based CR on QOL were mixed with most studies favoring CR at 3months but not at 4, 5, and 12months. Moreover, generally, the physical dimension of QOL but not the mental dimensions improved. Recommendations for future research to reduce the gap in knowledge about the effects of exercise-based CR for women are offered.

The Effect of Exercise-Based Cardiac Rehabilitation on Neutrophil to Lymphocyte Ratio in Patients with Coronary Artery Disease

Cíl: Vliv zátěžové kardiorehabilitace (cardiac rehabilitation, KR) na systémový zánět dosud nebyl u pacientů s ischemickou chorobou srdeční (ICHS) podrobněji zkoumán. Jako nový marker zánětu byl navržen poměr počtu neutrofilů a lymfocytů (N/L), přičemž se ukázalo, že jeho zvýšené hodnoty jsou u pacientů s ICHS spojeny s nepříznivějším výsledným klinickým stavem. Dalším nezávislým prediktorem morbidity a mortality je u pacientů s ICHS nízká kvalita života v souvislosti se zdravím (health-related quality of life, HRQL). Cílem této studie bylo zjistit vliv zátěžové KR na poměr N/L a na HRQL u pacientů s ICHS. Metody: Do studie jsme zařadili 200 ambulantních pacientů se stabilní ICHS indikovaných svými lékaři k absolvování III. fáze programu KR (skupina KR). Tuto skupinu jsme srovnali se skupinou 100 ambulantních pacientů se stabilní ICHS bez přístupu ke KR pro velkou dojezdovou vzdálenost nebo komorbidity omezující možnost zátěže (skupina bez KR). Výsledky: Nebyl nalezen žádný statisticky významný rozdíl mezi skupinami ve vstupních klinických a biochemických charakteristikách. I když poměr N/L a hodnoty CRP po programu KR byly nižší než poměr N/L a hodnoty CRP před absolvováním programu KR ve skupinách KR a bez KR (p &lt; 0,001 a p &lt; 0,007, resp. p &lt; 0,001 a p &lt; 0,001), byl poměr V/L a hodnoty CRP ve skupině KR po absolvování programu KR nižší než ve skupině bez KR (p &lt; 0,001 a p &lt; 0,001, resp. p &lt; 0,001 a p &lt; 0,001). Celková skóre HRQL v dotazníku MacNew byla po absolvování KR vyšší ve skupině bez KR (p &lt; 0,001). Závěry: Program zátěžové KR zlepšuje u pacientů se stabilní ICHS poměr N/L a zvyšuje HRQL. Protože léčba tlumící systémový zánět pozitivně ovlivňuje výsledný stav pacientů s ICHS, mohou být naše zjištění potenciálně významná pro klinickou praxi.

Effectiveness of Exercise-Based Cardiac Rehabilitation for Heart Transplant Recipients: A Systematic Review and Meta-Analysis.

Heart Transplant (HTx) is the ultimate chance of life for end stage Heart Failure (HF). Exercise training has consistently shown the potential to improve functional capacity in various chronic heart diseases. Still, the evidence in HTx recipients is scarcer. This study aims to systematically review the literature to evaluate the effectiveness and safety of Exercise-based Cardiac Rehabilitation (EBCR) in HTx recipients and to identify possible moderators of success. We conducted a systematic review and meta-analysis of randomized controlled trials on the effect and safety of EBCR in adult HTx recipients. The primary outcome was functional capacity, measured by Peak Oxygen Uptake (pVO2). We searched CENTRAL, MEDLINE, Embase, Scopus, and Web of Knowledge databases until December 2020, reviewed references of relevant articles and contacted experts. Usual care (UC), the different dosages of exercise regimens and alternative settings were allowed as comparators. A quantitative synthesis of evidence was performed using random-effects meta-analyses. A total of 11 studies with 404 patients were included. Nine studies comprising 306 patients compared EBCR with usual care. They showed that EBCR improved pVO2 compared to usual care (Mean Difference [MD] 3.03 mL/kg/min, 95% CI [2.28-3.77]; I 2 = 32%). In the subgroup analysis, including length of intervention and timing of enrollment after HTx, no significant moderator was found. Two trials, with 98 patients total, compared High Intensity Interval Training (HIIT) and Moderate Intensity Continuous Training (MICT). HIIT attained a significant edge over MICT (MD 2.23 mL/kg/min, 95% CI [1.79-2.67]; I 2 = 0%). No major adverse events associated with EBCR were reported. We found moderate quality evidence suggesting EBCR has a significant benefit on functional capacity improvement HTx recipients at the short-term. HIIT showed superiority when compared to MICT. Research focusing long term outcomes and standardized protocols are needed to improve evidence on EBCR effectiveness.

Exercise and the Brain in Cardiovascular Disease: A Narrative Review

Patients with cardiovascular diseases (CVDs) (including heart failure) are at increased risk of cognitive impairment and dementia. Vascular risk factors contribute to cognitive decline through cerebral small vessel diseases, pathological brain changes, and hypoperfusion. Habitual exercise and increased cardiorespiratory fitness are associated with higher cognitive function, greater cerebral blood flow, and attenuation of the decline in gray matter volume and white matter integrity. Furthermore, moderate-vigorous exercise training has been shown to improve cognitive function in healthy middle-aged and older adults. Cardiac rehabilitation (CR) is a class 1A recommendation for patients with CVD, which involves exercise training and intensive risk factor modification. This article reviews the current evidence for the effect of exercise-based CR on cognitive function, cerebrovascular function, and brain structure in patients with CVDs. Overall, exercise-based CR appears to improve global cognitive function and attention-psychomotor functions but not language processes. Furthermore, the effect of exercise-based CR on executive function and memory is less clear and there is limited research into the effect of exercise-based CR on cerebrovascular function and brain structure.

Does Exercise-Based Cardiac Rehabilitation Reduce Mortality and Hospitalization Rates After Heart Valve Surgery?: A Cochrane Review Summary With Commentary.

Does Exercise-Based Cardiac Rehabilitation Reduce Mortality and Hospitalization Rates After Heart Valve Surgery?: A Cochrane Review Summary With Commentary.

Comparative effectiveness of exercise-based cardiac rehabilitation for heart failure: a Bayesian network analysis of 44 randomized trials and 5896 patients

Abstract Introduction The prevalence of heart failure (HF) is increasing nowadays. Exercise-based cardiac rehabilitation (CR) reduces mortality and further improves the outcome of patients with HF. However, the effect of different types of CR on HF remains unclear. Data comparing these CR have not been synthesized. Thus, the purpose of this study is to determine the relative efficacy of different types of exercise-based CR for individuals with HF using a Bayesian network meta-analysis. Methods We followed a pre-specified protocol (PROSPERO: CRD42021278351). We conducted a systematic literature review of any randomized controlled trials which evaluated exercise-based CR for patients with HF. Databases including Embase, Medline, the Cochrane Central Register of Controlled Trials, and Web of Science were screened up to 31 December 2021. The primary outcomes focus on functional capacity (peak oxygen uptake and 6-minute walk distance) and health-related quality of life (hr-QOL). The main analysis was complemented by network subanalysis, standard pairwise comparisons, and subgroup and sensitivity analyses. The pooled estimates were quantified as mean differences (MD) or standardized mean difference (SMD)where appropriate, at 95% confidence intervals (CI). Results We identified 44 randomized controlled trials with a total of 5896 HF participants. Among 23 studies that compared exercise-based CR and usual care, participants in center-based CR (CBCR) had improvement of peak oxygen uptake (MD: 2.30 mL/kg per minute; 95% CI, 0.43–4.40) and 6-minute walk distance (MD: 33 meters; 95% CI, 11.00–58.00).18 studies that compared exercise-based CR with usual care showed that CBCR and cardiac telerehabilitation (CTR) had greater improvements in hr-QOL (SMD: −0.38; 95% CI, −0.49 to −0.15 and SMD: −0.18,95% CI, −0.36 to −0.00 respectively). Treatment ranking indicated CTR has the highest probability (46.0%, 50.2%) of being the most effective CR for peak oxygen uptake and hr-QOL elevation respectively. CBCR was similarly indicated as the most effective treatment for 6-min walk distance (38.7%). Conclusion Exercise-based CR programs provide broader cardiovascular benefits compared with UC. CBCR significantly improved functional capacity. CBCR and CTR have favorable effects on hr-QOL. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): China Scholarship Council

Effect of exercise-based cardiac rehabilitation on the ischemic threshold in patients with high-risk ischemic heart disease

Abstract Introduction Coronary artery disease is a complex condition and is not always resolved after an interventional or surgical procedure, due to the remaining obstructions in the coronary tree or the severity of the atherosclerosis, leaving anginal symptoms, ischemic threshold (IU) in the exercise, decreased cardiorespiratory fitness, and poor quality of life (QoL). Exercise-based cardiac rehabilitation programs (Ex-CRP) usually develop ischemic preconditioning mechanisms thanks to their direct anti-inflammatory, antioxidant, antithrombotic and coronary neovascularization effects, thus improving coronary reserve flow. We hypothesize that an Ex-CRP is capable of favorably impacting the UI in these patients. Therefore, the objective of this study is to evaluate the effects of an Ex-CRP on the UI in patients with high-risk ischemic heart disease. Methods Quasi-experimental study with 121 patients with ischemic threshold due to high-risk ischemic heart disease (with perfusion defects in nuclear medicine, complex coronary anatomy or partially revascularized) and presence of ischemic threshold in the exercise test. An Ex-CRP of 4–6 weeks duration was performed, consisting of supervised and monitored training concurrent with 30-minute aerobic exercise sessions at 70% of heart rate reserve, 3 times per week, supplemented with resistance exercise. and an educational understanding program for the control of risk factors and nutritional and psycho-emotional care. At the end of the program, a stress test was performed to compare the post-intervention effects and ischemic threshold was defined as the presence of angina or electrocardiographic changes of ischemia with negative ST-segment depression in 2 consecutive beats more than 80 ms from the J point. and in more than two contiguous leads. Results The 121 patients with ischemic threshold were 61±10 years old and 75% were male. On the other hand, 29.7% had a diagnosis of heart failure and an average LVEF of 53.1±12.9%. After Ex-CRP, an improvement was found in calculated VO2p (24.7±7.8 vs 34.23±7.5; p=0.000), METs at maximum effort from 7.06±2.15 to 9.78±1.14 (p&amp;lt;0.0001) and submaximal load in watts from 44±21.32 to 61±24.49; p&amp;lt;0.0001. 40.5% of the patients who were admitted with UI resolved it (absence of post-intervention ischemic diagnosis) after Ex-CRP and the remaining percentage with UI (59.5%) displaced it by 2.62 METs (p&amp;lt;0.0001). With this, the cardiovascular risk calculated by the Duke Score also decreased from −7 to −2 (p&amp;lt;0.0001), and the myocardial efficiency index improved from 8 to 6 (p&amp;lt;0.0001), strength (79±15 to 92±8%; p&amp;lt;0.0001) and QoL (65±17 vs 82±12; p&amp;lt;0.0001). Conclusions Ex-CRP had a significant effect on the resolution or displacement of the UI in patients with high-risk ischemic heart disease. In addition, it improved muscle strength, quality of life, myocardial efficiency, and reduced the cardiovascular risk index calculated by the Duke score. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Centro de Estudios e Investigaciόn FISICOL. Cúcuta, ColombiaCardioFit. CDMX, México