Effects and Optimal Dose of Exercise on Endothelial Function in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Background Exercise-based cardiac rehabilitation (CR) is considered an effective treatment for enhancing endothelial function in patients with heart failure (HF). However, recent studies have been published and the optimal “dose” of exercise required to increase the benefits of exercise-based CR pro...

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Published in:Sports medicine - open 2023-02, Vol.9 (1), p.8-18, Article 8
Main Authors: Fuertes-Kenneally, Laura, Manresa-Rocamora, Agustín, Blasco-Peris, Carles, Ribeiro, Fernando, Sempere-Ruiz, Noemí, Sarabia, José Manuel, Climent-Paya, Vicente
Format: Article
Language:English
Subjects:
Aerobic exercise
Aerobics
Cardiovascular disease
CRD
CRD42022304687
Ejection fraction
Endothelial-dependent dilation
Exercise
Exercise modality
Flow-mediated dilation
Heart failure
HIIT
Medicine
Medicine & Public Health
Meta-analysis
Physical fitness
Rehabilitation
Sports Medicine
Systematic Review
Vascular smooth muscle function
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Summary:Background Exercise-based cardiac rehabilitation (CR) is considered an effective treatment for enhancing endothelial function in patients with heart failure (HF). However, recent studies have been published and the optimal “dose” of exercise required to increase the benefits of exercise-based CR programmes on endothelial function is still unknown. Objectives (a) To estimate the effect of exercise-based CR on endothelial function, assessed by flow-mediated dilation (FMD), in patients with HF; (b) to determine whether high-intensity interval training (HIIT) is better than moderate-intensity training (MIT) for improving FMD; and (c) to investigate the influence of exercise modality (i.e. resistance exercise vs. aerobic exercise and combined exercise vs. aerobic exercise) on the improvement of endothelial function. Methods Electronic searches were carried out in PubMed, Embase, and Scopus up to February 2022. Random-effects models of between-group mean differences were estimated. Heterogeneity analyses were performed by means of the chi-square test and I 2 index. Subgroup analyses and meta-regressions were used to test the influence of potential moderator variables on the effect of exercise. Results We found a FMD increase of 3.09% (95% confidence interval [CI] = 2.01, 4.17) in favour of aerobic-based CR programmes compared with control groups in patients with HF and reduced ejection fraction (HFrEF). However, the results of included studies were inconsistent ( p  
ISSN:2198-9761
2199-1170
2198-9761
DOI:10.1186/s40798-023-00553-z