Introduction
Meta-analysis | Designs of included studies, n | Participants (n) (training/control) | Results of specific echocardiographic parameter meta-analysis with exercise versus control |
---|---|---|---|
Taylor et al. [12] | 1 –observational 1 – non-RCT 1 – RCT | 102/38 | E/e′: − 0.9, 95% CI: − 3.8 to 2.0, P = 0.53*; random effect |
1 –observational 1 – non-RCT 1 – RCT | 84/45 | E/A: − 0.02, 95% CI: − 0.11 to 0.06, P = 0.56*; fixed effect | |
1 –observational 1 – RCT | 52/24 | LV EDV (ml): 4.5, 95% CI: − 1.8 to 10.9, P = 0.16*; fixed effect | |
1 –observational 2 – RCT | 96/44 | LV EF (%): 0.02, 95% CI; − 1.6 to 1.7, P = 0.98*; fixed effect | |
Pandey et al. [13] | 4 – RCT | 82/81 | E/A: 0.08, 95% CI: − 0.01 to 0.16, P = 0.08#; fixed effect |
3 – RCT | 62/70 | DecT (ms): 2.92, 95% CI: − 18.56 to 24.41, P = 0.79#; fixed effect | |
5 – RCT | 126/111 | LV EF (%): 1.26, 95% CI: − 0.13 to 2.66%, P = 0.08#; fixed effect | |
Dieberg et al. [14] | 4 – RCT | 85/60 | E/e′: − 2.3, 95% CI: − 3.44 to − 1.19, P < 0.0001*; fixed effect |
3 – RCT | 56/52 | E/A: 0.07, 95% CI: 0.02 to 0.12, P = 0.005*; fixed effect | |
3 – RCT | 56/52 | DecT (ms): − 13.2, 95% CI: − 19.8 to − 6.5, P = 0.0001*; fixed effect | |
Chan et al. [15] | 5 – RCT | 115/89 | E/e′: − 2.38, 95% CI: − 3.47 to − 1.28, P < 0.0001*, fixed effect |
4 – RCT | 86/81 | E/A: + 0.07, 95% CI: 0.02 to 0.12, P = 0.006*, fixed effect | |
3 – RCT | 56/52 | DecT (ms): − 13.2, 95% CI: − 19.8 to − 6.5, P = 0.0001*, fixed effect | |
Fukuta et al. [16] | 4 – RCT | 132/109 | E/e′: − 1.20, 95% CI: − 4.07 to 1.66, P = 0.41#, random effect |
5 – RCT | 128/124 | E/A: 0.03, 95% CI: − 0.02 to 0.08, P = 0.27#; random effect | |
3 – RCT | 102/79 | e′ (cm/s): 0.49, 95% CI: − 1.28 to 2.25, P = 0.59#; random effect | |
3 – RCT | 62/69 | DecT (ms): − 2.04, 95% CI: − 26.53 to 22.45, P = 0.87#; random effect | |
4 – RCT | 140/120 | LV EDV: − 0.03, 95% CI: − 0.28 to 0.21, P = 0.78#; fixed effect | |
3 – RCT | 116/90 | LV mass: 0.07, 95% CI: − 0.21 to 0.35, P = 0.61#; fixed effect | |
7 – RCT | 202/174 | LV EF: 0.85, 95% CI: − 0.128 to 1.83, P = 0.09#; fixed effect |
Methods
Results
Study identification and selection
Study (author, year) | Duration of the training (weeks) | Intervention | Trained patients [N; mean age, years; male gender, N (%)] | Assessed echocardiographic parameters | Significant changes of specific echocardiographic parameters | ||
---|---|---|---|---|---|---|---|
Randomized controlled trials (N = 9) | |||||||
Kitzman et al. [68] | 16 | Outpatient, supervised, endurance training; 60 min 3 times a week | N = 26; age = 70 ± 6; male 6 (23.1%) 24 patients in the final analysis | LV EF, E, A, E/A, DecT, IVRT, LVM, LVV, SV | No significant changes of measured echocardiographic parameters | ||
Edelmann et al. [30] | 12 | Outpatient, supervised, endurance training (supplemented with resistance training from the 5th week); 40 min 3 times a week | N = 44; age = 64 ± 8; male 20 (45.5%) | LV EF, e' (septal), E/e' (septal), S/D ratio, LAVI, LVMI, LVVI | ↓E/e’ from 12.8 ± 3.2 to 10.5 ± 2.5, change − 2.3 (− 3.0 to − 1.6), p < 0.001; between groups − 3.2 (− 4.3 to − 2.1) p < 0.001 ↑e’ from 5.4 ± 1.2 to 6.3 ± 1.3, change 0.9 (0.6 to 1.1), p < 0.001; between groups 1.2 (0.8 to 1.7) p < 0.001 ↓LAVI from 27.9 ± 7.6 to 24.3 ± 6.5, change − 3.7 (− 4.9 to − 2.4), p < 0.001; between groups − 4.0 (− 5.9 to − 2.2) p < 0.001 | ||
Alves et al. [31] | 26 | Outpatient, supervised, endurance training; 35 min 3 times a week | N = 20; age = 62.9 ± 10.2; male 22 (71%) mean age and gender distribution of all of the sample size (trained + control) | LV EF, E/A, DecT, LV dimensions (EDD, ESD) | ↑EF from 56.4 to 57.7, change 1.3% p = 0.01 ↑E/A from 0.93 to 1.05, p < 0.001 ↓DecT from 236.7 to 222.7, p < 0.001 | ||
Smart et al. [27] | 16 | Outpatient, supervised, endurance training; 30 min 3 times a week | N = 12; age = 67 ± 5.8; male 7 (58.3%) | LV EF, E, A, E/A, E/e' (undetermined), DecT, s’, e’ (undetermined), SV, CO, LV-GLS, LV-GSR | ↑CO from 5.7 ± 2.7 to 7.1 ± 3.1, change 1.4, p = 0.04; | ||
Haykowsky et al. [28] | 17 | Outpatient, supervised, endurance training; 60 min 3 times a week | N = 22; age = 70 ± 6; male 4 (18.2%) | LVV, SV, CO | No significant changes of measured echocardiographic parameters | ||
Karavidas et al. [69] | 6 | Outpatient physiotherapy (functional electrical stimulation of the lower limb muscles); 30 min 5 times a week | N = 15; age = 69.4 ± 8.6; male 6 (40.0%) | E, A, E/A, E/e' (undetermined), DecT, LAV, a pulmonary − a mitral duration | No significant changes of measured echocardiographic parameters | ||
Kitzman et al. [70] | 16 | Outpatient, supervised, endurance training; 60 min 3 times a week | N = 32; age = 70 ± 7; male 9 (28.1%) 24 patients in the final analysis | LV EF, E, A, E/A, DecT, IVRT, LVV, SV | No significant changes of measured echocardiographic parameters | ||
Palau et al. [71] | 12 | At home, unattended, inspiratory muscle training; 20 min 2 times a day | N = 14; age = 68 [60–76]; male 7 (50.0%) | LV EF, e' (septal), E/e' (septal), LAVI, LVMI | No significant changes of measured echocardiographic parameters | ||
Palau et al. [32] | 12 | Home, unattended, inspiratory muscle training; 20 min 2 times a day Outpatient, physiotherapy (functional electrical stimulation of the lower limb muscles); 45 min 2 times a week | IMT (baseline): N = 15; age = 75 ± 10; male 7 (46.7%) FES (baseline): N = 15; age = 72 ± 9; male 6 (40.0%) IMT + FES (baseline): N = 16; age = 73 ± 10; male 8 (50%) 13 patients in each group in the final analysis | E/e' (undetermined), LAVI | IMT: After 12 weeks: ↓E/e’ from 18.4 [14.4–28.0] to 17.2 [12.4–23.1], p = 0.015 After 24 weeks3: ↓LAVI from 39 ± 11 to 31 ± 11, p = 0.008 | FES: After 12 weeks: ↓E/e’ from 20.5 [12–26.4] to 15.7 [11.8–21.8], p = 0.001 After 24 weeks3: No significant changes of measured echocardiographic parameters | IMT + FES: After 12 weeks: No significant changes of measured echocardiographic parameters After 24 weeks3: No significant changes of measured echocardiographic parameters |
Randomized parallel group trials (N = 5) | |||||||
Yeh et al. [72] | 12 | Outpatient and home, endurance training compared with Taichi training; supervised 60 min 2 times a week + exercising at home 35 min 3 times a week | AT: N = 8; age = 63 ± 11; male 4 (50.0%) Tai Chi: N = 8; age = 68 ± 11; male 4 (50.0%) | LV EF, E/A, E/e' (undetermined), LA dimension, LAV | Tai Chi#: ↓LA dimensions decreased more in the Tai Chi (from 3.8 ± 0.4 to 3.7 ± 0.3) comparing with AT (from 3.7 ± 0.3 to 3.8 ± 0.3), p = 0.04 | AT#: ↓E⁄e’ improved more in the AT (from 17 ± 4 to 14 ± 4), comparing with the Tai Chi (from 14 ± 4 to 13 ± 5), p = 0.01 | |
Angadi et al. [33] | 4 | Outpatient, supervised, endurance training; 45 min 3 times a week | HIT: N = 9; age = 69.0 ± 6.1; male 8 (88.9%) MI-ACT: N = 6; age = 71.5 ± 11.7; male 4 (66.7%) | LV EF, E, A, e' (septal), E/A, E/e' (septal), DecT, IVRT, diastolic dysfunction grade1, diastolic dysfunction grade distribution2, LAVI | HIIT: ↓Diastolic dysfunction grade* from 2.1 ± 0.3 to 1.3 ± 0.7, p < 0.01 ↓E from 0.9 ± 0.3 to 0.8 ± 0.3, p = 0.02 ↑DecT from 194 ± 55 to 225 ± 40, p = 0.02 | MI-ACT: No significant changes of measured echocardiographic parameters | |
Angadi et al. [29]** | 4 | Outpatient, supervised, endurance training; 45 min 3 times a week | HIIT: N = 9; age = 69 ± 6.1; male 8 (88.9%) MI-ACT: N = 6; age = 71.5 ± 11.7; male 4 (66.7%) | LV EF, LVM, LVMI, SV, SVI, RV-GLS, RV-GSR, LV-GLS, LV-GSR | HIIT: ↑RV-GLS from − 18.4 ± 3.2 to − 21.4 ± 1.7, p = 0.02 | MI-ACT: No significant changes of measured echocardiographic parameters | |
Silveira et al. [36] | 12 | Outpatient, supervised, endurance training; 38 min (HIIT), 47 min (MCT) 3 times a week | HIIT: N = 10; age = 60 ± 10; male 3 (30.0%) MI-ACT: N = 9; age = 60 ± 9; male 4 (44.4%) | LV EF, E, A, e' (average), E/A, E/e' (average), DecT, LV dimensions (EDD, ESD), LAVI, LVM, LVVI, LA diameter, SVI | HIIT: ↓E/e’ from 13.3 ± 3 to 11.1 ± 2, p < 0.001 | MI-ACT: ↓E/e’ from 14.2 ± 4 to 11.6 ± 3, p < 0.001 | |
Mueller et al. [73] | 52 | Outpatient, supervised (3 months), then continued at home, unattended (for the next 9 months), endurance training; 38 min (HIIT), 47 min (MCT) 3 times a week | HIIT: N = 58; age = 70 ± 7; male 17 (29.3%) MI-ACT: N = 58; age = 70 ± 8; male 23 (39.7%) 47 patients in the HIIT final and 52 in the MI-ACT final analysis | E/e' (septal), e' (septal), LAVI | No significant change on measured echocardiographic parameters between HIIT, MI-ACT, and control group# | ||
Observational trials (N = 4) | |||||||
Smart et al. [74] | 16 | Outpatient, supervised, endurance training (supplemented with resistance training from the 8th week); 60 min 3 times a week | N = 18; age = 65 ± 5; male 9 (50.0%) | LV EF, E, A, s’, e’ (average), E/A, E/e' (average), DecT, LVV, LV-GLS, LV-GSR, SV | No significant changes of measured echocardiographic parameters | ||
Fujimoto et al. [37] | 52 | Outpatient, supervised, endurance training; 40 min 3 times a week | N = 7; age = 74.9 ± 6; male 3 (42.9%) | LV EF, E, A, e' (average), a’, E/A, IVRT, LVV, LVVI | ↑E/A from 0.75 ± 0.11 to 0.89 ± 0.14, p = 0.03 | ||
Nolte et al. [34]* | 24 | Outpatient, supervised, endurance training (supplemented with resistance training from the 5th week); 30–35 min; 3 times a week | N = 24; age = 62 ± 7; male 15 (62.5%) | LV EF, e' (septal), E/e' (septal), S/D ratio, LAVI, LVMI, LVVI | ↓E/e’ from 12.2 ± 3.5 to 10.1 ± 3.0, change − 2.1 (− 3.3 to − 0.9), p = 0.002 ↑e’ from 5.9 ± 1.3 to 6.8 ± 1.4, change 0.9 (0.4 to 1.4), p = 0.001 ↓LAVI from 30.0 ± 7.9 to 25.1 ± 8.7, change − 4.9 (− 6.7 to − 3.2), p < 0.001 | ||
Fu et al. [35] | 12 | Outpatient, supervised, endurance training; 30 min 3 times a week | N = 30; age = 60.5 ± 2.7; male 20 (66.7%) | LV EF, E/A, E/e’(septal), LV dimensions (EDD, ESD) | ↓E/e ‘ (septal) from 21.0 ± 2.2 to 16.1 ± 1.8, p < 0.05 |
Characteristics of included studies and patients
Study type | Reporting (11) | External validity (3) | Internal validity | Power (1) | Total (28) | Quality* | ||
---|---|---|---|---|---|---|---|---|
Bias (7) | Confounding (6) | |||||||
Kitzman et al. [70] | RCT | 10 | 3 | 6 | 5 | 1 | 25 | Excellent |
Donelli da Silveira et al. [36] | Randomized parallel group | 10 | 3 | 6 | 5 | 1 | 25 | Excellent |
Mueller et al. [73] | Randomized parallel group | 10 | 3 | 6 | 5 | 1 | 25 | Excellent |
Kitzman et al. [68] | RCT | 10 | 2 | 6 | 4 | 1 | 23 | Good |
Edelmann et al. [30] | RCT | 10 | 1 | 6 | 5 | 1 | 23 | Good |
Alves et al. [31] | RCT | 10 | 1 | 6 | 5 | 1 | 23 | Good |
Smart et al. [27] | RCT | 9 | 3 | 5 | 5 | 1 | 23 | Good |
Palau et al. [71] | RCT | 9 | 2 | 6 | 5 | 1 | 23 | Good |
Karavidas et al. [69] | RCT | 8 | 3 | 5 | 5 | 1 | 22 | Good |
Palau et al. [32] | RCT | 9 | 1 | 5 | 5 | 1 | 21 | Good |
Yeh et al. [72] | Randomized parallel group | 9 | 1 | 6 | 5 | 0 | 21 | Good |
Angadi et al. [29] | Randomized parallel group | 9 | 1 | 5 | 5 | 1 | 21 | Good |
Haykowsky et al. [28] | RCT | 10 | 1 | 5 | 4 | 0 | 20 | Moderate |
Angadi et al. [33] | Randomized parallel group | 8 | 1 | 4 | 5 | 1 | 19 | Moderate |
Smart et al. [74] | Observational | 10 | 0 | 5 | 1 | 0 | 16 | Moderate |
Nolte et al. [34] | Observational | 9 | 1 | 5 | 4 | 0 | 19 | Moderate |
Fu et al. [35] | Observational | 9 | 1 | 6 | 3 | 1 | 20 | Moderate |
Fujimoto et al. [37] | Observational | 9 | 1 | 3 | 2 | 0 | 15 | Poor |
Echocardiographic assessment
Echocardiographic parameter | Number of the studies with assessment of parameter | Number of trained patients with assessment of parameter |
---|---|---|
LV EF | 14 | 292 |
E/e’ | 12 | 330 |
E/e’ (septal) | 6 | 211 |
E/e’ (average) | 2 | 37 |
E/e’ (undetermined) | 4 | 82 |
e’ | 9 | 261 |
e’ (septal) | 5 | 205 |
e’ (average) | 3 | 44 |
e’(undetermined) | 1 | 12 |
LAVI | 7 | 250 |
E/A | 11 | 210 |
E | 8 | 144 |
A | 8 | 144 |
E wave DecT | 8 | 144 |
LVMI | 4 | 92 |
SV | 6 | 113 |
LVVI | 4 | 87 |
LV IVRT | 4 | 80 |
SVI | 3 | 46 |
LV GLS | 3 | 45 |
LV GRS | 3 | 45 |
CO | 2 | 34 |
LV tissue S vel | 2 | 30 |
RV GLS | 1 | 15 |
RV GSR | 1 | 15 |