Abstract：
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) represents a prevalent and increasingly common condition. Recognized for its high incidence, there is a growing interest in exploring effective interventions, with exercise emerging as a critical component in the rehabilitation of HFpEF patients. We aim to update evidence on the impact of supervised exercise training on exercise capacity, diastolic function, arterial stiffness, and health-related quality of life (QoL) of individuals diagnosed with HFpEF.
METHODS: We systematically reviewed the literature, searching from inception to December 2023, utilizing databases such as MEDLINE (via PubMed), Google Scholar, the Cochrane Library, ClinicalTrials.gov, and the ScienceDirect portal. Statistical analyses utilized RevMan 5.4 with a random-effects model. Outcomes were presented as the weighted mean difference (WMD) alongside corresponding 95 % confidence intervals (CI), and heterogeneity was assessed using the I2 test.
RESULTS: Our final analysis included 7 randomized controlled trials (RCTs) of 346 participants, with an exercise follow-up duration of 12 to 48 weeks. In our pooled analysis, diastolic function, measured by E/A (WMD 0.01, 95 % CI: -0.04 to 0.05, p = 0.79; I2 = 0 %) and E/e\' (WMD 0.87, 95 % CI: -11.09 to 12.83, p = 0.89; I2 = 69 %), showed no significant change post-exercise training. However, exercise capacity, measured by peak V̇o2 significantly improved (WMD 2.57, 95 % CI: 1.38 to 3.75, p < 0.0001; I2= 14 %). The QoL assessed by the Minnesota Living with Heart Failure (MLWHF) score remained unchanged (WMD -3.12, 95 % CI: -8.73 to 2.50, p = 0.28; I2 = 0 %), but the SF-36 physical functioning scale indicated significant improvement (WMD 9.84, 95 % CI: 2.94 to 16.73, p < 0.005; I2 = 0 %). Arterial stiffness and vascular function remained unaffected, as evidenced by arterial elastance (WMD -0.13, 95 % CI: -0.36 to 0.10, p = 0.26; I2 = 0 %) and total arterial compliance (WMD 0.12, 95 % CI: -0.26 to 0.49, p = 0.54; I2 = 0 %).
CONCLUSIONS: Exercise training is safe and significantly enhances exercise capacity and QoL in HFpEF, with no significant impact on diastolic function, arterial stiffness, or vascular function.
METHODS: We systematically reviewed the literature, searching from inception to December 2023, utilizing databases such as MEDLINE (via PubMed), Google Scholar, the Cochrane Library, ClinicalTrials.gov, and the ScienceDirect portal. Statistical analyses utilized RevMan 5.4 with a random-effects model. Outcomes were presented as the weighted mean difference (WMD) alongside corresponding 95 % confidence intervals (CI), and heterogeneity was assessed using the I2 test.
RESULTS: Our final analysis included 7 randomized controlled trials (RCTs) of 346 participants, with an exercise follow-up duration of 12 to 48 weeks. In our pooled analysis, diastolic function, measured by E/A (WMD 0.01, 95 % CI: -0.04 to 0.05, p = 0.79; I2 = 0 %) and E/e\' (WMD 0.87, 95 % CI: -11.09 to 12.83, p = 0.89; I2 = 69 %), showed no significant change post-exercise training. However, exercise capacity, measured by peak V̇o2 significantly improved (WMD 2.57, 95 % CI: 1.38 to 3.75, p < 0.0001; I2= 14 %). The QoL assessed by the Minnesota Living with Heart Failure (MLWHF) score remained unchanged (WMD -3.12, 95 % CI: -8.73 to 2.50, p = 0.28; I2 = 0 %), but the SF-36 physical functioning scale indicated significant improvement (WMD 9.84, 95 % CI: 2.94 to 16.73, p < 0.005; I2 = 0 %). Arterial stiffness and vascular function remained unaffected, as evidenced by arterial elastance (WMD -0.13, 95 % CI: -0.36 to 0.10, p = 0.26; I2 = 0 %) and total arterial compliance (WMD 0.12, 95 % CI: -0.26 to 0.49, p = 0.54; I2 = 0 %).
CONCLUSIONS: Exercise training is safe and significantly enhances exercise capacity and QoL in HFpEF, with no significant impact on diastolic function, arterial stiffness, or vascular function.
摘要：
背景：射血分数保留的心力衰竭（HFpEF）是一种普遍且日益普遍的疾病。以其高发病率而闻名，人们对探索有效的干预措施越来越感兴趣，随着运动成为HFpEF患者康复的重要组成部分。我们旨在更新有监督的运动训练对运动能力影响的证据，舒张功能,动脉僵硬度,以及诊断为HFpEF的个体的健康相关生活质量（QoL）。
方法：我们系统回顾了文献，从开始到2023年12月的搜索，利用MEDLINE(通过PubMed)等数据库，谷歌学者，Cochrane图书馆,ClinicalTrials.gov,和ScienceDirect门户。统计分析使用RevMan5.4和随机效应模型。结果以加权平均差(WMD)和相应的95%置信区间(CI)表示，使用I2检验评估异质性。
结果：我们的最终分析包括346名参与者的7项随机对照试验（RCT），运动随访时间为12至48周。在我们的汇总分析中，舒张功能,通过E/A（WMD0.01，95％CI：-0.04至0.05，p=0.79；I2=0％）和E/e'（WMD0.87，95％CI：-11.09至12.83，p=0.89；I2=69％），运动训练后无明显变化。然而,锻炼能力,通过峰值测量Vo2显着改善（WMD2.57，95％CI：1.38至3.75，p<0.0001；I2=14％）。明尼苏达州心力衰竭（MLWHF）评分评估的QoL保持不变（WMD-3.12，95％CI：-8.73至2.50，p=0.28；I2=0％），但SF-36身体功能量表显示显着改善（WMD9.84，95％CI：2.94至16.73，p<0.005；I2=0％）。动脉僵硬度和血管功能未受影响，表现为动脉弹性(WMD-0.13,95%CI:-0.36~0.10,p=0.26;I2=0%)和总动脉顺应性(WMD0.12,95%CI:-0.26~0.49,p=0.54;I2=0%)。
结论：运动训练是安全的，并且可以显着提高HFpEF的运动能力和QoL，对舒张功能没有显著影响，动脉僵硬度,或血管功能。
方法：我们系统回顾了文献，从开始到2023年12月的搜索，利用MEDLINE(通过PubMed)等数据库，谷歌学者，Cochrane图书馆,ClinicalTrials.gov,和ScienceDirect门户。统计分析使用RevMan5.4和随机效应模型。结果以加权平均差(WMD)和相应的95%置信区间(CI)表示，使用I2检验评估异质性。
结果：我们的最终分析包括346名参与者的7项随机对照试验（RCT），运动随访时间为12至48周。在我们的汇总分析中，舒张功能,通过E/A（WMD0.01，95％CI：-0.04至0.05，p=0.79；I2=0％）和E/e'（WMD0.87，95％CI：-11.09至12.83，p=0.89；I2=69％），运动训练后无明显变化。然而,锻炼能力,通过峰值测量V
结论：运动训练是安全的，并且可以显着提高HFpEF的运动能力和QoL，对舒张功能没有显著影响，动脉僵硬度,或血管功能。
