Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis
dc.contributor.author | Taylor, RS | |
dc.contributor.author | Walker, S | |
dc.contributor.author | Smart, NA | |
dc.contributor.author | Piepoli, MF | |
dc.contributor.author | Warren, FC | |
dc.contributor.author | Ciani, O | |
dc.contributor.author | Whellan, D | |
dc.contributor.author | O'Connor, C | |
dc.contributor.author | Keteyian, SJ | |
dc.contributor.author | Coats, A | |
dc.contributor.author | Davos, CH | |
dc.contributor.author | Dalal, HM | |
dc.contributor.author | Dracup, K | |
dc.contributor.author | Evangelista, LS | |
dc.contributor.author | Jolly, K | |
dc.contributor.author | Myers, J | |
dc.contributor.author | Nilsson, BB | |
dc.contributor.author | Passino, C | |
dc.contributor.author | Witham, MD | |
dc.contributor.author | Yeh, GY | |
dc.date.accessioned | 2019-04-25T13:59:07Z | |
dc.date.issued | 2019-03-25 | |
dc.description.abstract | Background: Previous systematic reviews have indicated that exercise-based cardiac rehabilitation (ExCR) for patients with heart failure (HF) has a beneficial effect on health-related quality-of-life (HRQoL) and exercise capacity. However, there is uncertainty regarding potential differential effects of ExCR across HF patient subgroups. Objectives: The authors sought to undertake an individual participant data (IPD) meta-analysis to: 1) assess the impact of ExCR on HRQoL and exercise capacity in patients with HF; and 2) investigate differential effects of ExCR according to a range of patient characteristics: age, sex, ethnicity, New York Heart Association functional class, ischemic etiology, ejection fraction, and exercise capacity. Methods: A single dataset was produced, comprising randomized trials where ExCR (delivered for 3 weeks or more) was compared with a no exercise control group. Each trial provided IPD on HRQoL or exercise capacity (or both), with follow-up of 6 months or more. One- and 2-stage meta-analysis models were used to investigate the effect of ExCR overall and the interactions between ExCR and participant characteristics. Results: IPD was obtained from 13 trials for 3,990 patients, predominantly (97%) with reduced ejection fraction HF. Compared with the control group, there was a statistically significant difference in favor of ExCR for HRQoL and exercise capacity. At 12-month follow-up, improvements were seen in 6-min walk test (mean 21.0 m; 95% confidence interval: 1.57 to 40.4 m; p = 0.034) and Minnesota Living With HF score (mean improvement 5.9; 95% confidence interval: 1.0 to 10.9; p = 0.018). No consistent evidence was found of differential intervention effects across patient subgroups. Conclusions: These results, based on an IPD meta-analysis of randomized trials, confirm the benefit of ExCR on HRQoL and exercise capacity and support the Class I recommendation of current international clinical guidelines that ExCR should be offered to all HF patients. (Exercise Training for Chronic Heart Failure [ExTraMATCH II]: protocol for an individual participant data meta-analysis; PROSPERO: international database of systematic reviews CRD42014007170) | en_GB |
dc.description.sponsorship | National Institute for Health Research (NIHR) Health Technology Assessment Programme | en_GB |
dc.description.sponsorship | National Institute for Health Research (NIHR) | en_GB |
dc.identifier.citation | Vol. 73 (12), pp. 1430 - 1443 | en_GB |
dc.identifier.doi | 10.1016/j.jacc.2018.12.072 | |
dc.identifier.grantnumber | NIHR-HTA 15/80/30 | en_GB |
dc.identifier.grantnumber | RP-PG-1210-12004 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/36903 | |
dc.language.iso | en | en_GB |
dc.publisher | Elsevier | en_GB |
dc.rights.embargoreason | Publisher policy. | en_GB |
dc.rights | © 2019. This version is made available under the CC-BY-NC-ND 4.0 license: https://creativecommons.org/licenses/by-nc-nd/4.0/ | en_GB |
dc.subject | exercise capacity | en_GB |
dc.subject | heart failure | en_GB |
dc.subject | MLHFQ | en_GB |
dc.subject | QoL | en_GB |
dc.subject | quality-of-life | en_GB |
dc.subject | rehabilitation | en_GB |
dc.title | Impact of Exercise Rehabilitation on Exercise Capacity and Quality-of-Life in Heart Failure: Individual Participant Meta-Analysis | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2019-04-25T13:59:07Z | |
dc.identifier.issn | 0735-1097 | |
dc.description | This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record | en_GB |
dc.identifier.journal | Journal of the American College of Cardiology | en_GB |
dc.rights.uri | https://creativecommons.org/licenses/by-nc-nd/4.0/ | en_GB |
dcterms.dateAccepted | 2018-12-11 | |
rioxxterms.version | AM | en_GB |
rioxxterms.licenseref.startdate | 2018-12-11 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2019-04-25T13:55:04Z | |
refterms.versionFCD | AM | |
refterms.panel | A | en_GB |
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Except where otherwise noted, this item's licence is described as © 2019. This version is made available under the CC-BY-NC-ND 4.0 license: https://creativecommons.org/licenses/by-nc-nd/4.0/