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17th June 2022
The different exercise-based cardiac rehabilitation programs available for those with heart failure all appear to provide broadly similar benefits to patients. This was the main conclusion of a network meta-analysis by Australian researchers.
A 2020 analysis found that the current worldwide prevalence of heart failure is 64.34 million cases and which account for 9.91 million years lost due to disability. Heart failure patients have a reduced exercise capacity and one important aspect of a cardiac rehabilitation program is physical activity and exercise. In fact, exercise-based cardiac rehabilitation programs have demonstrated numerous benefits for people with heart failure including improvements in exercise capacity, quality of life and better clinical outcomes. There are several different types of exercise-based cardiac rehabilitation programs including home-based (HB), centre-based (CB), hybrid-based (HB), where more two delivery modes were included in the program and finally, technology-enabled (TE) where > 50% of the program was delivered via text messaging or video calls.
While there is clear evidence that exercise-based cardiac rehabilitation programs are effective, what is not so clear is the the relative merits of the different programs, since in most analyses, pairwise comparisons have be used. For the present study, the Australian team turned to the use of a network meta-analysis, which enables the simultaneous comparison of the different interventions to overcome the limitations imposed by using a pairwise approach. They searched for randomised trials (with usual care as a comparator) in which there was a comparison of exercise-based cardiac rehabilitation programs in adult, heart failure patients with either a preserved or reduced ejection fraction and where the program lasted for a minimum of 4 weeks. In addition, studies were included if these reported on several different outcomes such as exercise capacity (peak oxygen uptake, Vo2 peak), the 6 minute walk distance, the Kansas City Cardiomyopathy questionnaire (KCCQ) and the physical component summary score of the short form survey 36 (SF-36). Additionally, the researchers considered the impact of programs on clinical outcomes such as heart failure-related hospitalisation and mortality.
Exercise-based cardiac rehabilitation an heart failure outcomes
A total 139 randomised controlled trials including 18,670 participants with a median age of 61.1 years (71.4% male) were analysed. The median duration of the exercise program was 12 weeks and median length of follow-up in studies was 16 weeks.
Only CB, HB and TE programs were associated with an increase in Vo2 peak compared to usual care and there were no statistically significant differences between these three modes of delivery.
The six minute walk distance was improved only by hybrid, CB and HB programs and again, there were no significant differences between the programs. Only HB programs improved the KCCQ and none of the delivery modes improved the SF-36 physical component summary score compared to usual care.
Heart failure-related hospitalisation (odds ratio, OR = 0.41, 95% CI 0.17 – 0.76) and mortality (OR = 0.42, 95% CI 0.16 – 0.90) were only reduced after CB programs.
The authors concluded that exercise-based cardiac rehabilitation programs appeared to improve functional capacity and clinical outcomes in those with heart failure. They added that since the different programs were comparably beneficial, the selection of a program should be tailored to the needs of the individual patient.
Tegegne TK et al. Effects of exercise-based cardiac rehabilitation delivery modes on exercise capacity and health-related quality of life in heart failure: a systematic review and network meta-analysis Open Heart 2022