Exercise rehabilitation in cardiac resynchronization: systematic review and a meta-analysis
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Exercise rehabilitation in cardiac resynchronization: systematic review and a meta‑analysis Liza Grosman‑Rimon1,2 · Sarah Hui3 · Sara Santos5 · Brian Vadasz4 · Farid Foroutan5 · Ashley Farrell5 · Spencer Lalonde5 · Arash Ghashghai5 · Michael McDonald3,5 · Ana C. Alba5 Accepted: 27 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction: The benefit of exercise training in cardiac resynchronization therapy (CRT) recipients is not well established. We conducted a systematic review and meta-analysis to determine the effect of exercise training on clinical outcomes in CRT recipients. Methods: A comprehensive search until 2019 was conducted of MEDLINE, Epub, Embase, CINAHL and Cochrane databases as well as a bibliographic hand search to identify additional studies. We included all studies that compared aerobic exercise interventions in adults treated with CRT devices with adults treated with usual CRT care. These studies evaluated patient clinical characteristics, exercise testing measures, hemodynamic measures, echocardiography parameters, biomarkers and adverse events. Independent reviewers evaluated study eligibility, abstracted data and assessed risk of bias in duplicate. We used random-effect meta-analysis methods to estimate mean differences and odds ratios. Grades of Recommendation, Assessment, Development and Evaluation system were used to quantify absolute effects and quality of evidence. I2 was used to evaluate heterogeneity. Results: We identified seven studies, six randomized control trials and one observational study, totaling 332 CRT patients in the exercise intervention and 534 patients receiving usual care. Peak V O2 was 2.4 ml/kg/min higher in the exercise group in comparison with the control group (pooled mean difference 2.26, 95% CI 1.38–3.13, I2 = 53%, high quality). AT-VO2 improved with exercise rehabilitation, and heterogeneity was considered low (pooled mean difference 3.96, 95% CI 2.68–5.24, I2 = 0.0%, moderate quality). Conclusion: Peak VO2 and AT-VO2 are increased with aerobic exercise in CRT recipients, demonstrating a significant improvement in functional capacity. Keywords Cardiac resynchronization · Exercise rehabilitation · Systematic review · Meta-analysis
Introduction * Liza Grosman‑Rimon [email protected]
Ana C. Alba [email protected]; [email protected]
1
Cardiovascular Department and Research Center, Baruch Padeh Medical Center, Poriya, Tiberias, Israel
2
The Academic College At Wingate, Wingate Institute, Netanya, Israel
3
Faculty of Medicine, University of Toronto, Toronto, Canada
4
Ruth and Bruce Rappaport Faculty of Medicine, Technion American Medical School, Haifa, Israel
5
Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Canada
Cardiac resynchronization therapy (CRT) has been shown to improve functional capacity and mortality in heart failure (HF) patients [1–3]. HF patients treated with CRT demonstrate improvements in ex
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