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：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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, Dur?es AR, Concei??o 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.	中國康復醫學會心血管病專業委員會中國老年學學會心腦血管病專業委員會. 慢性穩定性心力衰竭運動康復中國專家共識. 中華心血管病雜志, 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.	劉海寧, 吳昊, 姚燦, 等. Meta 分析中連續性數據的深度提取方法. 中國循證醫學雜志, 2017, 17(1): 117-121.
10.	王紅雨, 岳建興. 強化間歇訓練對慢性心衰患者心肺耐力及自主神經功能的影響. 中國應用生理學雜志, 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 ?, 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.	Wisl?ff U, St?ylen 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.	許娜. 高強度間歇有氧運動治療慢性心衰患者研究的進展. 心血管康復醫學雜志, 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.	黃凱, 彭朋, 王大寧, 等. 一次不同方式運動對青少年克羅恩病患者炎癥反應和生長因子的影響. 武警后勤學院學報 (醫學版), 2018, 27(5): 392-397.
32.	巫治文, 謝廣淵. 不同運動方式在緩解期潰瘍性結腸炎患者康復治療中的作用分析. 中醫臨床研究, 2017, 9(15): 81-82.
33.	Perrier-Melo RJ, Figueira FAMDS, Guimar?es 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.	孫景權, 蘇浩, 嚴翊, 等. 高強度間歇運動改善心肺耐力的線粒體合成機制. 中國運動醫學雜志, 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.	劉錦銘, 劉海艦. 心肺運動試驗的基本概念及其臨床意義. 中華結核和呼吸雜志, 2012, 35(12): 954-956.
37.	閻煒, 余靜. 六分鐘步行試驗:評估慢性心衰患者心功能的一種簡單客觀方法. 心血管病學進展, 2002, (2): 86-88.
38.	魏洪悅, 靳英輝, 谷曉玲, 等. 太極拳對心力衰竭患者作用效果的系統評價. 中國循證醫學雜志, 2017, 17(6): 677-684.
39.	施龍永. 抑郁對心力衰竭患者因心因及全因死亡風險影響的 Meta 分析. 護理學報, 2016, 23(14): 60-64.
40.	喻芳, 齊曉燕. 住院慢性心力衰竭患者焦慮和抑郁癥狀分析. 中國心血管病研究, 2018, 16(8): 724-726, 748.
41.	朱訓明, 吳強強. 放松療法應用于老年慢性充血性心衰患者焦慮、抑郁情緒改善效果分析. 中國健康心理學雜志, 2018, 26(9): 1419-1422.
42.	沈彩云, 狄嘉偉, 王鐵成. 運動康復對慢性心力衰竭患者抑郁焦慮狀態及生活質量的影響. 中華行為醫學與腦科學雜志, 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, Dur?es AR, Concei??o 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. 中國康復醫學會心血管病專業委員會中國老年學學會心腦血管病專業委員會. 慢性穩定性心力衰竭運動康復中國專家共識. 中華心血管病雜志, 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. 劉海寧, 吳昊, 姚燦, 等. Meta 分析中連續性數據的深度提取方法. 中國循證醫學雜志, 2017, 17(1): 117-121.
10. 王紅雨, 岳建興. 強化間歇訓練對慢性心衰患者心肺耐力及自主神經功能的影響. 中國應用生理學雜志, 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 ?, 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. Wisl?ff U, St?ylen 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. 許娜. 高強度間歇有氧運動治療慢性心衰患者研究的進展. 心血管康復醫學雜志, 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. 黃凱, 彭朋, 王大寧, 等. 一次不同方式運動對青少年克羅恩病患者炎癥反應和生長因子的影響. 武警后勤學院學報 (醫學版), 2018, 27(5): 392-397.
32. 巫治文, 謝廣淵. 不同運動方式在緩解期潰瘍性結腸炎患者康復治療中的作用分析. 中醫臨床研究, 2017, 9(15): 81-82.
33. Perrier-Melo RJ, Figueira FAMDS, Guimar?es 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. 孫景權, 蘇浩, 嚴翊, 等. 高強度間歇運動改善心肺耐力的線粒體合成機制. 中國運動醫學雜志, 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. 劉錦銘, 劉海艦. 心肺運動試驗的基本概念及其臨床意義. 中華結核和呼吸雜志, 2012, 35(12): 954-956.
37. 閻煒, 余靜. 六分鐘步行試驗:評估慢性心衰患者心功能的一種簡單客觀方法. 心血管病學進展, 2002, (2): 86-88.
38. 魏洪悅, 靳英輝, 谷曉玲, 等. 太極拳對心力衰竭患者作用效果的系統評價. 中國循證醫學雜志, 2017, 17(6): 677-684.
39. 施龍永. 抑郁對心力衰竭患者因心因及全因死亡風險影響的 Meta 分析. 護理學報, 2016, 23(14): 60-64.
40. 喻芳, 齊曉燕. 住院慢性心力衰竭患者焦慮和抑郁癥狀分析. 中國心血管病研究, 2018, 16(8): 724-726, 748.
41. 朱訓明, 吳強強. 放松療法應用于老年慢性充血性心衰患者焦慮、抑郁情緒改善效果分析. 中國健康心理學雜志, 2018, 26(9): 1419-1422.
42. 沈彩云, 狄嘉偉, 王鐵成. 運動康復對慢性心力衰竭患者抑郁焦慮狀態及生活質量的影響. 中華行為醫學與腦科學雜志, 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.

Previous Article
Efficacy of yoga intervention for low back pain: a meta-analysis
Next Article
SMS intervention on improving antiretroviral treatment adherence in HIV patients: a meta-analysis

Chinese Journal of Evidence-Based Medicine

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

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content