Effectiveness of resistance training on the improvement of functional capacity and quality of life in heart failure patients: a systematic review and meta-analysis

Nascimento, Jasiel Frutuoso do; Andrade, Armèle Dornelas de; Cardim, Adriane Borba; Brandão, Daniella Cunha

doi:10.1590/1809-2950/16416224012017

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SYSTEMATIC REVIEW • Fisioter. Pesqui. 24 (1) • Mar 2017 • https://doi.org/10.1590/1809-2950/16416224012017 copy

Effectiveness of resistance training on the improvement of functional capacity and quality of life in heart failure patients: a systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study aimed to evaluate the effectiveness of resistance training (RT) on the improvement of functional capacity (FC) and quality of life (QOL) in heart failure (HF) patients. An electronic search was performed in databases (PubMed/Medline, SCOPUS, Web of Science, CINAHL, Lilacs, and Cochrane), without restrictions of language or year of publication, using the following keywords: heart failure, resistance training, exercise tolerance, quality of life, fatigue, dyspnea, and muscle strength. Clinical trials were included, with a sample composed of individuals with HF in the functional classes I, II, or III of the New York Heart Association; with average age < 65; sedentary; clinically stable and pharmacologically optimized; with ejection fraction (EF) < 45% of the predicted. The intervention should be the exclusive RT. We described the methodological aspects by the bias risk and a meta-analysis with subgroup analysis. Seven studies were included for qualitative analysis. The agreement (Kappa index - k) between researchers was k=0.74. Most studies that assess FC and QOL showed increase in VO2 max (maximal oxygen consumption) and in the final scores of the QOL questionnaires for the intervention group. The results of FC enabled a meta-analysis, showing a final increase of 0.52 (0.17-0.87) ml×kg−1×min−1 (milliliters×kilogram−1×min−1) in the VO2 max after RT, with low heterogeneity. However, statistical limitations and diversity of interventions were evidenced after the analysis by subgroups. The limitations found in the selected studies still do not allow considering RT effective in improving FC and QOL in HF patients.

Keywords:
Heart Failure; Resistance Training; Exercise Tolerance; Quality of Life

AUTHORS	TYNI-LENNÉ et al. (1996)	TYNI-LENNÉ et al. (1997)	GORDON et al. (1997)	TYNI-LENNÉ et al. (2001)	SELIG et al. (2004)	LEVINGER et al. (2005)	MAIORANA et al. (2010)
STUDY DESIGN	RCT	COT	CT	RCT	RCT	CT	RCT
SAMPLE	21 ♂ with HF (NYHA II and III); 60Y (42-73); EF 28±11%.	16 ♀ with HF (NYHA II and III); 62±10Y and EF 28 ± 10% FE (first stage - INTERVENTION) and 63±10Y and EF 30±8% (second stage -CONTROL)**.	20 ♂ with HF (NYHA II AND III); 56±3Y; EF 27 ±3%**.	24 (13 ♂ and 11 ♀) with HF (NYHA II and III); 63±9Y; EF 30±10%**.	39 (33 ♂ and 6 ♀) with HF (NYHA II and III); 65±11Y; EF 28±7%**.	15 ♂ (NYHA?); 57.0±10.2Y; EF 34.7±7.2%**.	24 ♂ (NYHA I, II, and III); 64.4±4.4Y; EF 37±3% (CONTROL group) and 58.8±5Y; EF 26±3% (INTERVENTION group)**.
	ETIOLOGY: NM.	ETIOLOGY: CORONARY (11); CARDIOMYOPATHY (6).	ETIOLOGY: CORONARY (8); DILATED (10); HYPERTENSIVE (2).	ETIOLOGY: NM.	ETIOLOGY: ISCHEMIC (24); DILATED (16).	ETIOLOGY:NM.	ETIOLOGY: ISCHEMIC (16); DILATED (8).
	DIAGNOSIS TIME: 3M	DIAGNOSIS TIME: MINIMUM 3M.	DIAGNOSIS TIME: 58± 5M.	DIAGNOSIS TIME: NM.	DIAGNOSIS TIME: NM.	DIAGNOSIS TIME: NM.	DIAGNOSIS TIME: NM.
INTERVENTION	TYPE: bilateral (Group 1) and unilateral (Group 2) knee extension exercise with modified cycle ergometer.	TYPE: bilateral knee extension exercises with modified cycle ergometer.	TYPE: bilateral knee extension exercises with quadriceps isolation in modified cycle ergometer.	TYPE: bilateral exercises with exercise bands.	TYPE: Bilateral exercises of flexion and extension of the knees, elbows, and shoulders (30s); going up 5 steps (0.5-2 min); and cycle ergometer of the upper and lower limbs (0.5-2 min).	TYPE: 8 exercises (no information about modalities) for the main muscle groups.	TYPE: 8 sets of 9 exercises (no information on modalities)
	INTENSITY: 70% (Group 1) and 35% (Group 2) of 1RM.	INTENSITY: 65% of 1RM with progression to 70% in 4 weeks.	INTENSITY: 65% of 1RM with progression to 70% in 4 weeks.	INTENSITY: < 13 at Borg fatigue scale and between 13 and 16 at Borg dyspnea scale.	INTENSITY: HRmax - 10BPM.	INTENSITY AND TIME: 40-60% of 1RM, one set, 15 to 20 reps with a gradual increase of 80-90% of 1RM during weeks 7-8 and, at the same time, a decrease in the number of reps between weeks 8-12, for the three sets.	INTENSITY: in the first ones, 6s-60% 1RM and, in the last six, 70% 1RM.
	TIME: 60 rpm, 15 min.	TIME: 60 rpm, 15 min.	TIME: 3 min, with 1 min intervals.	TIME: 60 min of activities such as the warm-up and cooldown and periods of 45 minutes of RT.	TIME: varies.		TIME: Not defined. Interval of 3 minutes between sets.
	FREQUENCY: 3 ×/week.	FREQUENCY: 3 ×/week.	FREQUENCY: 3 ×/week.	FREQUENCY: 3 ×/week.	FREQUENCY: 3 ×/week.	FREQUENCY: 3 ×/week.	FREQUENCY: 3 ×/week.
	DURATION: 8 weeks.	DURATION: 8 s.	DURATION: 8 weeks.	DURATION: 8 weeks.	DURATION: 3M.	DURATION: 8 weeks.	DURATION: 12 weeks.
	WARM-UP: 3 min of walking and stretching.	WARM-UP: 6 min of walking and stretching.	WARM-UP: 6 min of walking on the usual speed of the volunteer.	WARM-UP: 6 min of large movements of the 4 members.	WARM-UP: 6 min of walking and stretching.	WARM-UP: NM.	WARM-UP: NM.
	COOLDOWN: 3 min of walking and stretching.	COOLDOWN: 3 min of walking and stretching.	COOLDOWN: NM.	COOLDOWN: 6 min of large movements of the 4 members.	COOLDOWN: 5 min of walking and stretching.	COOLDOWN: NM.	COOLDOWN: NM.

AUTHORS	TYNI-LENNÉ et al. (1996)	TYNI-LENNÉ et al. (1997)	GORDON et al. (1997)	TYNI-LENNÉ et al. (2001)	SELIG et al. (2004)	LEVINGER et al. (2005)	MAIORANA et al. (2010)
OUTCOMES PRIMARY	NA	FC (CPET): increase of 1.2 (0.6-1.7) ml×kg⁻¹×min¹ (p=0.0005)* in the VO₂ max.	FC (CPET): no difference.	FC (CPET): increase of 1.5 (1.9-4.9) ml×kg⁻¹×min⁻¹ (p<0.05)* in the VO₂ max.	FC (CPET): increase of 2 (0.53-4.53) ml×kg⁻¹×min⁻¹ (p<0.01)* in the VO₂ max.	FC (CPET): increase of 3 (0.35-5.35) ml×kg⁻¹×min⁻¹ (p=0.01)* in the VO₂ max.	CF (CPET): compared with the initial values, there was an increase in the intervention group in the VO₂ max (p<0.01)†.
OUTCOMES PRIMARY	QOL (SIP): improvement in 4 points on the scale (−5.32-13.32) (p<0.01)*.	QOL (SIP): improvement in 1.2 points on the scale (−3.0-0.6) (p<0.01)*.	QOL (SIP): compared with the initial values, the intervention group showed improvement in all domains of SIP (p<0.05-0.01)**†.	QOL (MLWHFQ): improvement on the final score (p<0.01)º.		QOL (MLWHFQ): improvement in 23.1 (2.85-43.35) points on the scale (p=0.03)*.
SECONDARY OUTCOMES	NA	NA	MS (peak knee extension torque): Compared with initial values, the intervention group showed an increase in muscle strength of 19 Nm ± 13% (p<0.01)**†.		MS (flexor and extensor torque measures of knees and elbows): increased muscle strength of knee extension in 12 Nm (4.73-28.73) (p<0.05)*.	MS (RM): increase in muscular strength (p<0.001).	MS (RM): Compared with initial values, the intervention group showed an increase in RM (p<0.05)†.
SECONDARY OUTCOMES	NA	NA	DISP (Borg scale): Compared with initial values, the intervention group showed an increase in the perception of dyspnea (p<0.01)**†.	DISP (Borg scale): no difference.

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[1] Corresponding address: Daniella Cunha Brandão - Centro de Ciências Exatas e da Natureza - Av. Jornalista Aníbal Fernandes, s/n, Cidade Universitária - Recife (PE) - Zip Code: 50740-560 - Phone: +55 (81) 2126-8496 - E-mail: daniellacunha@hotmail.com