High-intensity intermittent aerobic exercise on exercise capacity and quality of life in patients with heart failure: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Min ¹ ,  SUN Guozhen ^1,2 , XING Shuangshuang ³ , GU Zejuan ³

1. The Nursing School, Nanjing Medical University, Nanjing, 210029, P.R.China;
2. Cardiology Department of the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, P.R.China;
3. Nursing Department of the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, P.R.China;

Corresponding author：

SUN Guozhen, Email: gzsun100@126.com

Keywords：

High intensity intermittent aerobic exercise; Exercise rehabilitation; Heart failure; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201906094

Video：

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Objectives To systematically review the efficacy of high-intensity intermittent exercise (HIIE) on cardiac function, exercise capacity, quality of life and depression in patients with heart failure.Methods PubMed, Web of Science, The Cochrane Library, EBSCOhost, EMbase, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on HIIE on cardiac function, exercise capacity, quality of life and depression in patients with heart failure from inception to April, 2019. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, RevMan 5.3 software and Stata 15.1 software were used for meta-analysis.Results A total of 16 RCTs involving 549 patients were included. The results of meta-analysis showed that, compared with the control group, HIIE could increase peak oxygen consumption (MD=2.04, 95%CI 0.74 to 3.33, P=0.002), peak work rate (MD=12.85, 95%CI 1.17 to 24.52, P=0.03), left ventricular ejection fraction (MD=4.24, 95% CI 1.40 to 7.07, P=0.003), quality of life (MD=7.32, 95%CI 1.41 to 13.22, P=0.02), and the six minute walk distance (MD=42.46, 95%CI 20.40 to 64.52, P=0.000 2). However, there was no significant difference between two groups in the depression score (SMD=0.39, 95%CI −0.52 to 1.31, P=0.40) and VE/VCO₂ Slope (MD=0.12, 95%CI −1.02 to 1.26, P=0.84).Conclusions Current evidence shows that compared with routine exercise or moderate intensity exercise, HIIE can improve exercise capacity, quality of life and cardiac function in patients with heart failure, but there is no significant difference in improving depression. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.

Citation： GAO Min, SUN Guozhen, XING Shuangshuang, GU Zejuan. High-intensity intermittent aerobic exercise on exercise capacity and quality of life in patients with heart failure: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(1): 53-62. doi: 10.7507/1672-2531.201906094 Copy

1.	Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol, 2016, 13(6): 368-378.
2.	Gomes NM, Durães AR, Conceição LSR, et al. 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: 134-141.
3.	NHFA CSANZ Heart Failure Guidelines Working Group, Atherton JJ, Sindone A, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart Lung Circ, 2018, 27(10): 1123-1208.
4.	Kim MS, Lee JH, Kim EJ, et al. Korean guidelines for diagnosis and management of chronic heart failure. Korean Circ J, 2017, 47(5): 555-643.
5.	O’Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA, 2009, 301(14): 1439-1450.
6.	中国康复医学会心血管病专业委员会中国老年学学会心脑血管病专业委员会. 慢性稳定性心力衰竭运动康复中国专家共识. 中华心血管病杂志, 2014, 42(9): 714-720.
7.	Gibala MJ, Little JP, Macdonald MJ, et al. Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol, 2012, 590(5): 1077-1084.
8.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
9.	刘海宁, 吴昊, 姚灿, 等. Meta 分析中连续性数据的深度提取方法. 中国循证医学杂志, 2017, 17(1): 117-121.
10.	王红雨, 岳建兴. 强化间歇训练对慢性心衰患者心肺耐力及自主神经功能的影响. 中国应用生理学杂志, 2017, 33(5): 402-404, 409.
11.	Chrysohoou C, Angelis A, Tsitsinakis G, et al. Cardiovascular effects of high-intensity interval aerobic training combined with strength exercise in patients with chronic heart failure. A randomized phase III clinical trial. Int J Cardiol, 2015, 179: 269-274.
12.	Spee RF, Niemeijer VM, Wijn PF, et al. Effects of high-intensity interval training on central haemodynamics and skeletal muscle oxygenation during exercise in patients with chronic heart failure. Eur J Prev Cardiol, 2016, 23(18): 1943-1952.
13.	Chou CH, Fu TC, Tsai HH, et al. High-intensity interval training enhances mitochondrial bioenergetics of platelets in patients with heart failure. Int J Cardiol, 2019, 274: 214-220.
14.	Benda NM, Seeger JP, Stevens GG, et al. Effects of high-intensity interval training versus continuous training on physical fitness, cardiovascular function and quality of life in heart failure patients. PLoS One, 2015, 10(10): e0141256.
15.	Ellingsen Ø, Halle M, Conraads V, et al. High intensity interval training in heart failure patients with reduced ejection fraction. Circulation, 2017, 135(9): 839-849.
16.	Iellamo F, Caminiti G, Sposato B, et al. Effect of High-Intensity interval training versus moderate continuous training on 24-h blood pressure profile and insulin resistance in patients with chronic heart failure. Intern Emerg Med, 2014, 9(5): 547-552.
17.	Koufaki P, Mercer TH, George KP, et al. Low-volume high-intensity interval training vs. continuous aerobic cycling in patients with chronic heart failure: a pragmatic randomised clinical trial of feasibility and effectiveness. J Rehabil Med, 2014, 46(4): 348-356.
18.	Ulbrich AZ, Angarten VG, Schmitt NA, et al. Comparative effects of high intensity interval training versus moderate intensity continuous training on quality of life in patients with heart failure: study protocol for a randomized controlled trial. Clin Trials Regul Sci Cardiol, 2016, 13: 21-28.
19.	Iellamo F, Manzi V, Caminiti G, et al. Matched dose interval and continuous exercise training induce similar cardiorespiratory and metabolic adaptations in patients with heart failure. Int J Cardiol, 2013, 167(6): 2561-2565.
20.	Freyssin C, Verkindt C, Prieur F, et al. Cardiac rehabilitation in chronic heart failure: effect of an 8-week, high-intensity interval training versus continuous training. Arch Phys Med Rehabil, 2012, 93(8): 1359-1364.
21.	Dimopoulos S, Anastasiou-Nana M, Sakellariou D, et al. Effects of exercise rehabilitation program on heart rate recovery in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil, 2006, 13(1): 67-73.
22.	Fu TC, Wang CH, Lin PS, et al. Aerobic interval training improves oxygen uptake efficiency by enhancing cerebral and muscular hemodynamics in patients with heart failure. Int J Cardiol, 2013, 167(1): 41-50.
23.	Smart NA, Steele M. A comparison of 16 weeks of continuous vs intermittent exercise training in chronic heart failure patients. Congest Heart Fail, 2012, 18(4): 205-211.
24.	Roditis P, Dimopoulos S, Sakellariou D, et al. The effects of exercise training on the kinetics of oxygen uptake in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil, 2007, 14(2): 304-311.
25.	Wisløff U, Støylen A, Loennechen JP, et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation, 2007, 115(24): 3086-3094.
26.	许娜. 高强度间歇有氧运动治疗慢性心衰患者研究的进展. 心血管康复医学杂志, 2017, 26(5): 578-580.
27.	Crozier J, Roig M, Eng JJ, et al. High-intensity interval training after stroke: an opportunity to promote functional recovery, cardiovascular health, and neuroplasticity. Neurorehabil Neural Repair, 2018, 32(6-7): 543-556.
28.	Maillard F, Pereira B, Boisseau N. Effect of high-intensity interval training on total, abdominal and visceral fat mass: a meta-analysis. Sports Med, 2018, 48(2): 269-288.
29.	Mugele H, Freitag N, Wilhelmi J, et al. High-intensity interval training in the therapy and aftercare of cancer patients: a systematic review with meta-analysis. J Cancer Surviv, 2019, 13(2): 205-223.
30.	Ross LM, Porter RR, Durstine JL. High-intensity interval training (HIIT) for patients with chronic diseases. J Sport Health Sci, 2016, 5(2): 139-144.
31.	黄凯, 彭朋, 王大宁, 等. 一次不同方式运动对青少年克罗恩病患者炎症反应和生长因子的影响. 武警后勤学院学报 (医学版), 2018, 27(5): 392-397.
32.	巫治文, 谢广渊. 不同运动方式在缓解期溃疡性结肠炎患者康复治疗中的作用分析. 中医临床研究, 2017, 9(15): 81-82.
33.	Perrier-Melo RJ, Figueira FAMDS, Guimarães GV, et al. High-intensity interval training in heart transplant recipients: a systematic review with meta-analysis. Arq Bras Cardiol, 2018, 110(2): 188-194.
34.	孙景权, 苏浩, 严翊, 等. 高强度间歇运动改善心肺耐力的线粒体合成机制. 中国运动医学杂志, 2015, 34(10): 1022-1027.
35.	Oliveira BRR, Santos TM, Kilpatrick M, et al. Affective and enjoyment responses in high intensity interval training and continuous training: a systematic review and meta-analysis. PLoS One, 2018, 13(6): e0197124.
36.	刘锦铭, 刘海舰. 心肺运动试验的基本概念及其临床意义. 中华结核和呼吸杂志, 2012, 35(12): 954-956.
37.	阎炜, 余静. 六分钟步行试验:评估慢性心衰患者心功能的一种简单客观方法. 心血管病学进展, 2002, (2): 86-88.
38.	魏洪悦, 靳英辉, 谷晓玲, 等. 太极拳对心力衰竭患者作用效果的系统评价. 中国循证医学杂志, 2017, 17(6): 677-684.
39.	施龙永. 抑郁对心力衰竭患者因心因及全因死亡风险影响的 Meta 分析. 护理学报, 2016, 23(14): 60-64.
40.	喻芳, 齐晓燕. 住院慢性心力衰竭患者焦虑和抑郁症状分析. 中国心血管病研究, 2018, 16(8): 724-726, 748.
41.	朱训明, 吴强强. 放松疗法应用于老年慢性充血性心衰患者焦虑、抑郁情绪改善效果分析. 中国健康心理学杂志, 2018, 26(9): 1419-1422.
42.	沈彩云, 狄嘉伟, 王铁成. 运动康复对慢性心力衰竭患者抑郁焦虑状态及生活质量的影响. 中华行为医学与脑科学杂志, 2018, 27(7): 628-632.
43.	Meyer FA, Hugentobler E, Stauber S, et al. Depressive symptoms at discharge from rehabilitation predict future cardiovascular-related hospitalizations. Cardiology, 2015, 131(2): 80-85.

1. Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nat Rev Cardiol, 2016, 13(6): 368-378.
2. Gomes NM, Durães AR, Conceição LSR, et al. 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: 134-141.
3. NHFA CSANZ Heart Failure Guidelines Working Group, Atherton JJ, Sindone A, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart Lung Circ, 2018, 27(10): 1123-1208.
4. Kim MS, Lee JH, Kim EJ, et al. Korean guidelines for diagnosis and management of chronic heart failure. Korean Circ J, 2017, 47(5): 555-643.
5. O’Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA, 2009, 301(14): 1439-1450.
6. 中国康复医学会心血管病专业委员会中国老年学学会心脑血管病专业委员会. 慢性稳定性心力衰竭运动康复中国专家共识. 中华心血管病杂志, 2014, 42(9): 714-720.
7. Gibala MJ, Little JP, Macdonald MJ, et al. Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol, 2012, 590(5): 1077-1084.
8. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
9. 刘海宁, 吴昊, 姚灿, 等. Meta 分析中连续性数据的深度提取方法. 中国循证医学杂志, 2017, 17(1): 117-121.
10. 王红雨, 岳建兴. 强化间歇训练对慢性心衰患者心肺耐力及自主神经功能的影响. 中国应用生理学杂志, 2017, 33(5): 402-404, 409.
11. Chrysohoou C, Angelis A, Tsitsinakis G, et al. Cardiovascular effects of high-intensity interval aerobic training combined with strength exercise in patients with chronic heart failure. A randomized phase III clinical trial. Int J Cardiol, 2015, 179: 269-274.
12. Spee RF, Niemeijer VM, Wijn PF, et al. Effects of high-intensity interval training on central haemodynamics and skeletal muscle oxygenation during exercise in patients with chronic heart failure. Eur J Prev Cardiol, 2016, 23(18): 1943-1952.
13. Chou CH, Fu TC, Tsai HH, et al. High-intensity interval training enhances mitochondrial bioenergetics of platelets in patients with heart failure. Int J Cardiol, 2019, 274: 214-220.
14. Benda NM, Seeger JP, Stevens GG, et al. Effects of high-intensity interval training versus continuous training on physical fitness, cardiovascular function and quality of life in heart failure patients. PLoS One, 2015, 10(10): e0141256.
15. Ellingsen Ø, Halle M, Conraads V, et al. High intensity interval training in heart failure patients with reduced ejection fraction. Circulation, 2017, 135(9): 839-849.
16. Iellamo F, Caminiti G, Sposato B, et al. Effect of High-Intensity interval training versus moderate continuous training on 24-h blood pressure profile and insulin resistance in patients with chronic heart failure. Intern Emerg Med, 2014, 9(5): 547-552.
17. Koufaki P, Mercer TH, George KP, et al. Low-volume high-intensity interval training vs. continuous aerobic cycling in patients with chronic heart failure: a pragmatic randomised clinical trial of feasibility and effectiveness. J Rehabil Med, 2014, 46(4): 348-356.
18. Ulbrich AZ, Angarten VG, Schmitt NA, et al. Comparative effects of high intensity interval training versus moderate intensity continuous training on quality of life in patients with heart failure: study protocol for a randomized controlled trial. Clin Trials Regul Sci Cardiol, 2016, 13: 21-28.
19. Iellamo F, Manzi V, Caminiti G, et al. Matched dose interval and continuous exercise training induce similar cardiorespiratory and metabolic adaptations in patients with heart failure. Int J Cardiol, 2013, 167(6): 2561-2565.
20. Freyssin C, Verkindt C, Prieur F, et al. Cardiac rehabilitation in chronic heart failure: effect of an 8-week, high-intensity interval training versus continuous training. Arch Phys Med Rehabil, 2012, 93(8): 1359-1364.
21. Dimopoulos S, Anastasiou-Nana M, Sakellariou D, et al. Effects of exercise rehabilitation program on heart rate recovery in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil, 2006, 13(1): 67-73.
22. Fu TC, Wang CH, Lin PS, et al. Aerobic interval training improves oxygen uptake efficiency by enhancing cerebral and muscular hemodynamics in patients with heart failure. Int J Cardiol, 2013, 167(1): 41-50.
23. Smart NA, Steele M. A comparison of 16 weeks of continuous vs intermittent exercise training in chronic heart failure patients. Congest Heart Fail, 2012, 18(4): 205-211.
24. Roditis P, Dimopoulos S, Sakellariou D, et al. The effects of exercise training on the kinetics of oxygen uptake in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil, 2007, 14(2): 304-311.
25. Wisløff U, Støylen A, Loennechen JP, et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation, 2007, 115(24): 3086-3094.
26. 许娜. 高强度间歇有氧运动治疗慢性心衰患者研究的进展. 心血管康复医学杂志, 2017, 26(5): 578-580.
27. Crozier J, Roig M, Eng JJ, et al. High-intensity interval training after stroke: an opportunity to promote functional recovery, cardiovascular health, and neuroplasticity. Neurorehabil Neural Repair, 2018, 32(6-7): 543-556.
28. Maillard F, Pereira B, Boisseau N. Effect of high-intensity interval training on total, abdominal and visceral fat mass: a meta-analysis. Sports Med, 2018, 48(2): 269-288.
29. Mugele H, Freitag N, Wilhelmi J, et al. High-intensity interval training in the therapy and aftercare of cancer patients: a systematic review with meta-analysis. J Cancer Surviv, 2019, 13(2): 205-223.
30. Ross LM, Porter RR, Durstine JL. High-intensity interval training (HIIT) for patients with chronic diseases. J Sport Health Sci, 2016, 5(2): 139-144.
31. 黄凯, 彭朋, 王大宁, 等. 一次不同方式运动对青少年克罗恩病患者炎症反应和生长因子的影响. 武警后勤学院学报 (医学版), 2018, 27(5): 392-397.
32. 巫治文, 谢广渊. 不同运动方式在缓解期溃疡性结肠炎患者康复治疗中的作用分析. 中医临床研究, 2017, 9(15): 81-82.
33. Perrier-Melo RJ, Figueira FAMDS, Guimarães GV, et al. High-intensity interval training in heart transplant recipients: a systematic review with meta-analysis. Arq Bras Cardiol, 2018, 110(2): 188-194.
34. 孙景权, 苏浩, 严翊, 等. 高强度间歇运动改善心肺耐力的线粒体合成机制. 中国运动医学杂志, 2015, 34(10): 1022-1027.
35. Oliveira BRR, Santos TM, Kilpatrick M, et al. Affective and enjoyment responses in high intensity interval training and continuous training: a systematic review and meta-analysis. PLoS One, 2018, 13(6): e0197124.
36. 刘锦铭, 刘海舰. 心肺运动试验的基本概念及其临床意义. 中华结核和呼吸杂志, 2012, 35(12): 954-956.
37. 阎炜, 余静. 六分钟步行试验:评估慢性心衰患者心功能的一种简单客观方法. 心血管病学进展, 2002, (2): 86-88.
38. 魏洪悦, 靳英辉, 谷晓玲, 等. 太极拳对心力衰竭患者作用效果的系统评价. 中国循证医学杂志, 2017, 17(6): 677-684.
39. 施龙永. 抑郁对心力衰竭患者因心因及全因死亡风险影响的 Meta 分析. 护理学报, 2016, 23(14): 60-64.
40. 喻芳, 齐晓燕. 住院慢性心力衰竭患者焦虑和抑郁症状分析. 中国心血管病研究, 2018, 16(8): 724-726, 748.
41. 朱训明, 吴强强. 放松疗法应用于老年慢性充血性心衰患者焦虑、抑郁情绪改善效果分析. 中国健康心理学杂志, 2018, 26(9): 1419-1422.
42. 沈彩云, 狄嘉伟, 王铁成. 运动康复对慢性心力衰竭患者抑郁焦虑状态及生活质量的影响. 中华行为医学与脑科学杂志, 2018, 27(7): 628-632.
43. Meyer FA, Hugentobler E, Stauber S, et al. Depressive symptoms at discharge from rehabilitation predict future cardiovascular-related hospitalizations. Cardiology, 2015, 131(2): 80-85.

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High-intensity intermittent aerobic exercise on exercise capacity and quality of life in patients with heart failure: a meta-analysis

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