Non-invasive ventilation on the exercise tolerance of patients with heart failure

Silva, Géssica dos Santos; Santos, Luana Cerqueira dos; Santos, Jandesson Cena dos; Cordeiro, André Luiz Lisboa

doi:10.1590/fm.2025.38203

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Review Article • Fisioter. Mov. 38 • 2025 • https://doi.org/10.1590/fm.2025.38203 linkcopy

Non-invasive ventilation on the exercise tolerance of patients with heart failure

Ventilação não invasiva sobre a capacidade funcional de pacientes com insuficiência cardíaca

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction: Heart failure (HF) is a clinical syndrome in which the heart has a decrease in blood pumping capacity, progressing to hemodynamic, metabolic and cardiovascular changes. According to the progression of HF, individuals present a decline in functional capacity (FC). FC being one of the objectives of rehabilitation. Non-invasive ventilation (NIV) has been reported as an effective strategy for increasing FC.

Objective: To review the use of NIV on the FC of patients with HF.

Methods: This is a systematic review using the PICO strategy, with a search performed in the PubMed, Central, PeDro, SciELO and LILACS databases, with the descriptors heart failure, non-invasive ventilation and exercise tolerance added by the Boolean operators " AND" and "OR".

Results: Seventeen articles were found after reading the title and abstract, seven of which were chosen according to the inclusion criteria, based on the evaluation of 151 patients aged between 50 and 77 years, who showed that NIV can be an effective approach to increase the FC. NIV was effective in improving the distance covered in the 6-minute walk test by 26.16 meters (95% CI 9.26 to 43.06).

Conclusion: NIV was effective in improving the FC of individuals with HF.

Keywords:
Exercise tolerance; Heart failure; Non-invasive ventilation

Studies	Items											Total
Studies	1	2	3	4	5	6	7	8	9	10	11	Total
O´Donnell et al.⁵	-	1	0	0	0	0	0	1	0	1	1	4a
Wittmer al.¹⁹	-	1	0	1	1	0	0	1	0	1	1	6b
Chermont et al.⁷	-	1	0	0	0	0	1	1	0	1	1	5b
Thofehrn et al.²¹	-	0	0	0	0	0	0	1	1	1	1	4a
Moraes et al.²²	-	0	0	0	0	0	0	1	1	1	1	4b
Carvalho et al.¹⁸	-	1	1	0	1	1	1	1	1	0	1	8b
Gomes Neto et al.²⁰	-	1	1	0	0	0	1	1	1	0	1	6c

Study/Country	Sample	Participants	Interventions	Measurements	Results
O´Donnell et al.,⁵ 2001, Canada	12	Patients with stable congestive heart failure completed a screening visit that included a medical history and clinical evaluation.	IG: During the experimental visit, the patients performed three constant-load exercise tests at approximately 75% of the work rate and separated by a 1h interval. CG: Did not receive CPAP and pressure support.	Exercise constant load	Total exercise time increased significantly during exercise with pressure support (2.8 ± 0.8 min/43 ± 14%; p = 0.004, but only modestly with CPAP (1.4 ± 0.7 min/28 ± 15%; p = 0.079) compared to control.
Wittmer al.¹⁹ 2006, Brazil	22	Patients admitted to the hospital for the treatment of congestive heart failure, with a diagnosis of NYHA class II or III congestive heart failure.	IG: CPAP was applied for a period of 30 min per day and 6MWT was performed in a 25-meter corridor. CG: They did not receive CPAP.	6-minute walk test (6MWT)	The 6MWT showed progressive improvement in the distance walked in the CPAP group, reaching approximately 28% above the baseline values in the CPAP group, with no significant changes in the control group.
Chermont et al.⁷ 2009, Brazil	12	Patients over 50 years of age with congestive heart failure of ischemic or idiopathic etiology that is 6 months or older.	IG: The 6-minute walk test was performed on a flat surface of a 30-meter corridor. Patients were instructed on how to walk and rest if necessary. CG: He received continuous positive airway pressure with fixed application of 0 or 1 cm H₂O for 30 min with a bypass valve.	6MWT	In relation in 6MWT, non-invasive ventilation increased the distance walked. Non-invasive ventilation: 507 ± 33 m; placebo: 446 ± 36 m: p < 0.001.
Thofehrn et al.²¹ 2013, Brazil	28	Patients with systolic dysfunction and left ventricular ejection fraction below 40%, stable, with no history of hospitalization in the past three months.	IG: The 6MWT was performed on a flat 30-meter hallway and every 1 minute you were told "you are doing well", but there was no warm-up beforehand. CG: They did not receive expiratory positive airway pressure application.	6MWT	There was no significant difference in the distance traveled between patients who did or did not use expiratory positive airway pressure
Moraes et al.²² 2017, Brazil	13	Consecutive patients who were admitted to the intensive care unit for treatment of decompensated heart failure.	IG: The patients underwent a routine clinical evaluation within the first 24 hours. A 3-minute warm-up was performed with the cycle ergometer, and the subjects pedaled 10 watts for 1 minute. CG: Participants received minimal pressure with continuous positive airway pressure.	Constant load stress test	Endurance time during the constant load test was significant (p = 0.008) during the two-level tests (7.2 ± 2.7 min) when compared to the continuous positive airway pressure test (5.1 ± 1.5 min), having a 40% increase in total time.
Carvalho et al.¹⁸ 2017, Brazil	24	The patients were evaluated in the physical therapy laboratory at a cardiopulmonary center.	IG: Participants were referred for a clinical evaluation, with a 30-min non-invasive ventilation protocol. Performed the cardiopulmonary exercise testing with a treadmill ramp protocol with a sealed mask during exercise. CG: Bi-level intervention not applied to the control group.	Cardiopulmonary exercise testing	At the time of the test there was a 12.7% increase in the non-invasive ventilation phase versus control. Control (7.4 ± 1.5 min) vs non-invasive ventilation (8.3 ± 1.7 min, p = 0.01)
Gomes Neto et al.²⁰ 2018, Brazil	40	Patients who were admitted to the hospital and were referred to the cardiovascular rehabilitation department.	IG: All patients underwent two 6MWT tests with a 30 min interval between them. CG: They did not receive bilevel positive airway pressure ventilation.	6MWT	The intervention group showed improvement in the 6MWT distance (68.3 vs 9.8 m).

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[1] Note:

[TFN1] Items: 1 = eligibility criteria were specified (this item is not used to calculate the PEDro score); 2 = subjects were randomly assigned to groups; 3 = subject allocation was secret; 4 = initially, the groups were similar with respect to the most important prognostic indicators; 5 = all subjects participated blindly in the study; 6 = all therapists who administered the therapy did so blindly; 7 = all raters who measured at least one key outcome did so blindly; 8 = measurements of at least one key outcome were obtained in more than 85% of the subjects initially allocated to the groups; 9 = all subjects from whom outcome measurements were presented received the treatment or control condition as allocated or, when this was not the case, data analysis was performed for at least one of the outcomes by intention to treat; 10 = the results of the inter-group statistical comparisons were described for at least one key outcome; 11 = the study presents both measures of precision and measures of variability for at least one key outcome. 1 = Item present; 0 = Item not present.

[TFN2] ^a
High methodological quality.

[TFN3] ^b
Moderate methodological quality.

[TFN4] ^c
Low methodological quality.