BMJ  2004;328:189 (24 January), doi:10.1136/bmj.37938.645220.EE (published 16 January 2004)

Paper

Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH)

¹ Department of Clinical Cardiology, Imperial College of Science, Technology, and Medicine, Royal Brompton Hospital, London SW3 6NP

Objective To determine the effect of exercise training on survival in patients with heart failure due to left ventricular systolic dysfunction.

Design Collaborative meta-analysis.

Inclusion criteria Randomised parallel group controlled trials of exercise training for at least eight weeks with individual patient data on survival for at least three months.

Studies reviewed Nine datasets, totalling 801 patients: 395 received exercise training and 406 were controls.

Main outcome measure Death from all causes.

Results During a mean (SD) follow up of 705 (729) days there were 88 (22%) deaths in the exercise arm and 105 (26%) in the control arm. Exercise training significantly reduced mortality (hazard ratio 0.65, 95% confidence interval, 0.46 to 0.92; log rank ² = 5.9; P = 0.015). The secondary end point of death or admission to hospital was also reduced (0.72, 0.56 to 0.93; log rank ² = 6.4; P = 0.011). No statistically significant subgroup specific treatment effect was observed.

Conclusion Meta-analysis of randomised trials to date gives no evidence that properly supervised medical training programmes for patients with heart failure might be dangerous, and indeed there is clear evidence of an overall reduction in mortality. Further research should focus on optimising exercise programmes and identifying appropriate patient groups to target.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Exercise training in patients with chronic heart failure: More information is needed on outcomes in individual studies

Chris Metcalfe
BMJ 2004 328: 711. [Extract] [Full Text]

Exercise training is beneficial in heart failure
BMJ 2004 328: 0. [Full Text]

This article has been cited by other articles:

• Beckers, P. J., Denollet, J., Possemiers, N. M., Wuyts, F. L., Vrints, C. J., Conraads, V. M. (2008). Combined endurance-resistance training vs. endurance training in patients with chronic heart failure: a prospective randomized study. Eur Heart J 29: 1858-1866 [Abstract] [Full text]  
• Belardinelli, R., Lacalaprice, F., Ventrella, C., Volpe, L., Faccenda, E. (2008). Waltz Dancing in Patients With Chronic Heart Failure: New Form of Exercise Training. Circ Heart Fail 1: 107-114 [Abstract] [Full text]  
• Nunes, R. B., Tonetto, M., Machado, N., Chazan, M., Heck, T. G., Veiga, A. B. G., Dall'Ago, P. (2008). Physical exercise improves plasmatic levels of IL-10, left ventricular end-diastolic pressure, and muscle lipid peroxidation in chronic heart failure rats. J. Appl. Physiol. 104: 1641-1647 [Abstract] [Full text]  
• Beer, M., Wagner, D., Myers, J., Sandstede, J., Kostler, H., Hahn, D., Neubauer, S., Dubach, P. (2008). Effects of Exercise Training on Myocardial Energy Metabolism and Ventricular Function Assessed by Quantitative Phosphorus-31 Magnetic Resonance Spectroscopy and Magnetic Resonance Imaging in Dilated Cardiomyopathy. J Am Coll Cardiol 51: 1883-1891 [Abstract] [Full text]  
• Eisen, H. J. (2008). Exercise Training and Myocardial Energetics in Patients With Heart Failure: When More Is Less. J Am Coll Cardiol 51: 1892-1895 [Full text]  
• Azad, N., Molnar, F., Byszewski, A. (2008). Lessons learned from a multidisciplinary heart failure clinic for older women: a randomised controlled trial. Age Ageing 37: 282-287 [Abstract] [Full text]  
• Mousa, T. M., Liu, D., Cornish, K. G., Zucker, I. H. (2008). Exercise training enhances baroreflex sensitivity by an angiotensin II-dependent mechanism in chronic heart failure. J. Appl. Physiol. 104: 616-624 [Abstract] [Full text]  
• Mueller, L., Myers, J., Kottman, W., Oswald, U., Boesch, C., Arbrol, N., Dubach, P. (2007). Exercise capacity, physical activity patterns and outcomes six years after cardiac rehabilitation in patients with heart failure. Clin Rehabil 21: 923-931 [Abstract]  
• Sarma, S., Schulze, P. C. (2007). Exercise as a Physiologic Intervention to Counteract Hypertension: Can a Good Idea Go Bad?. Hypertension 50: 294-296 [Full text]  
• Selig, S. E, Hare, D. L (2007). Evidence-based approach to exercise prescription in chronic heart failure. Br. J. Sports. Med. 41: 407-408 [Full text]  
• Rubin, S. A. (2007). Exercise Training in Heart Failure: Contradictory or Conventional?. J Am Coll Cardiol 49: 2337-2340 [Full text]  
• Haykowsky, M. J., Liang, Y., Pechter, D., Jones, L. W., McAlister, F. A., Clark, A. M. (2007). A Meta-Analysis of the Effect of Exercise Training on Left Ventricular Remodeling in Heart Failure Patients: The Benefit Depends on the Type of Training Performed. J Am Coll Cardiol 49: 2329-2336 [Abstract] [Full text]  
• Gao, L., Wang, W., Liu, D., Zucker, I. H. (2007). Exercise Training Normalizes Sympathetic Outflow by Central Antioxidant Mechanisms in Rabbits With Pacing-Induced Chronic Heart Failure. Circulation 115: 3095-3102 [Abstract] [Full text]  
• Oh, J., Chung, J.-H., Kang, S.-M., Smith, S. W., Niederseer, D., Thaler, C., Niebauer, J., Korantzopoulos, P., Goudevenos, J. A., Knaapen, P., Knuuti, J., van Rossum, A. C., Taegtmeyer, H., Haddy, F. J., Neubauer, S. (2007). The Failing Heart. NEJM 356: 2544-2546 [Full text]  
• Piepoli, M. F., Coats, A. J. S. (2007). COUNTERPOINT: INCREASED METABORECEPTOR STIMULATION EXPLAINS THE EXAGGERATED EXERCISE PRESSOR REFLEX SEEN IN HEART FAILURE. J. Appl. Physiol. 102: 494-496 [Full text]  
• Ventura-Clapier, R., Mettauer, B., Bigard, X. (2007). Beneficial effects of endurance training on cardiac and skeletal muscle energy metabolism in heart failure. Cardiovasc Res 73: 10-18 [Abstract] [Full text]  
• Pavy, B., Iliou, M. C., Meurin, P., Tabet, J.-Y., Corone, S., for the Functional Evaluation and Cardiac Rehabili, (2006). Safety of Exercise Training for Cardiac Patients: Results of the French Registry of Complications During Cardiac Rehabilitation. Arch Intern Med 166: 2329-2334 [Abstract] [Full text]  
• Jelic, S., Le Jemtel, T. H. (2006). Diagnostic Usefulness of B-Type Natriuretic Peptide and Functional Consequences of Muscle Alterations in COPD and Chronic Heart Failure.. Chest 130: 1220-1230 [Abstract] [Full text]  
• Piepoli, M. F., Kaczmarek, A., Francis, D. P., Davies, L. C., Rauchhaus, M., Jankowska, E. A., Anker, S. D., Capucci, A., Banasiak, W., Ponikowski, P. (2006). Reduced Peripheral Skeletal Muscle Mass and Abnormal Reflex Physiology in Chronic Heart Failure. Circulation 114: 126-134 [Abstract] [Full text]  
• Dimopoulos, K., Okonko, D. O., Diller, G.-P., Broberg, C. S., Salukhe, T. V., Babu-Narayan, S. V., Li, W., Uebing, A., Bayne, S., Wensel, R., Piepoli, M. F., Poole-Wilson, P. A., Francis, D. P., Gatzoulis, M. A. (2006). Abnormal Ventilatory Response to Exercise in Adults With Congenital Heart Disease Relates to Cyanosis and Predicts Survival. Circulation 113: 2796-2802 [Abstract] [Full text]  
• Jankowska, E. A., Ponikowski, P., Piepoli, M. F., Banasiak, W., Anker, S. D., Poole-Wilson, P. A. (2006). Autonomic imbalance and immune activation in chronic heart failure - Pathophysiological links. Cardiovasc Res 70: 434-445 [Abstract] [Full text]  
• Passino, C., Severino, S., Poletti, R., Piepoli, M. F., Mammini, C., Clerico, A., Gabutti, A., Nassi, G., Emdin, M. (2006). Aerobic Training Decreases B-Type Natriuretic Peptide Expression and Adrenergic Activation in Patients With Heart Failure. J Am Coll Cardiol 47: 1835-1839 [Abstract] [Full text]  
• Clark, A. L (2006). Exercise and heart failure: assessment and treatment.. Heart 92: 699-703 [Full text]  
• De Bono, J. P., Adlam, D., Paterson, D. J., Channon, K. M. (2006). Novel quantitative phenotypes of exercise training in mouse models. Am. J. Physiol. Regul. Integr. Comp. Physiol. 290: R926-R934 [Abstract] [Full text]  
• Dall'Ago, P., Chiappa, G. R.S., Guths, H., Stein, R., Ribeiro, J. P. (2006). Inspiratory Muscle Training in Patients With Heart Failure and Inspiratory Muscle Weakness: A Randomized Trial. J Am Coll Cardiol 47: 757-763 [Abstract] [Full text]  
• Thompson, P. D. (2005). Exercise Prescription and Proscription for Patients With Coronary Artery Disease. Circulation 112: 2354-2363 [Full text]  
• Bruunsgaard, H. (2005). Physical activity and modulation of systemic low-level inflammation. J. Leukoc. Biol. 78: 819-835 [Abstract] [Full text]  
• Doehner, W., Rauchhaus, M., Ponikowski, P., Godsland, I. F., von Haehling, S., Okonko, D. O., Leyva, F., Proudler, A. J., Coats, A. J.S., Anker, S. D. (2005). Impaired Insulin Sensitivity as an Independent Risk Factor for Mortality in Patients With Stable Chronic Heart Failure. J Am Coll Cardiol 46: 1019-1026 [Abstract] [Full text]  
• Kojda, G., Hambrecht, R. (2005). Molecular mechanisms of vascular adaptations to exercise. Physical activity as an effective antioxidant therapy?. Cardiovasc Res 67: 187-197 [Abstract] [Full text]  
• Petersen, A. M. W., Pedersen, B. K. (2005). The anti-inflammatory effect of exercise. J. Appl. Physiol. 98: 1154-1162 [Abstract] [Full text]  
• Wang, J.-S., Li, Y.-S., Chen, J.-C., Chen, Y.-W. (2005). Effects of Exercise Training and Deconditioning on Platelet Aggregation Induced by Alternating Shear Stress in Men. Arterioscler. Thromb. Vasc. Bio. 25: 454-460 [Abstract] [Full text]  
• Tachibana, H., Cheng, H.-J., Ukai, T., Igawa, A., Zhang, Z.-S., Little, W. C., Cheng, C.-P. (2005). Levosimendan improves LV systolic and diastolic performance at rest and during exercise after heart failure. Am. J. Physiol. Heart Circ. Physiol. 288: H914-H922 [Abstract] [Full text]  
• Bibbins-Domingo, K., Lin, F., Vittinghoff, E., Barrett-Connor, E., Grady, D., Shlipak, M. G. (2004). Renal insufficiency as an independent predictor of mortality among women with heart failure. J Am Coll Cardiol 44: 1593-1600 [Abstract] [Full text]  
• Scott, A. C., Wensel, R., Davos, C. H., Georgiadou, P., Ceri Davies, L., Coats, A. J.S., Francis, D. P., Piepoli, M. F. (2004). Putative contribution of prostaglandin and bradykinin to muscle reflex hyperactivity in patients on Ace-inhibitor therapy for chronic heart failure. Eur Heart J 25: 1806-1813 [Abstract] [Full text]  
• Massie, B. (2004). Review: exercise training delays death and hospital admission in chronic heart failure. Evid. Based Med. 9: 137-137 [Full text]  
• (2004). Other articles noted: 06 Feb 2004 to 16 Apr 2004. Evid. Based Nurs. 7: e3-e3 [Full text]  
• Pantilat, S. Z., Steimle, A. E. (2004). Palliative Care for Patients With Heart Failure. JAMA 291: 2476-2482 [Abstract] [Full text]  
• (2004). Exercise Training Improves Survival in Chronic Heart Failure. Journal Watch Cardiology 2004: 4-4 [Full text]  
• Malik, I. (2004). JournalScan. Heart 90: 471-472 [Full text]  
• Metcalfe, C. (2004). Exercise training in patients with chronic heart failure: More information is needed on outcomes in individual studies. BMJ 328: 711-711 [Full text]  
• (2004). Good Heart Failure Outcomes with Exercise Training. JWatch General 2004: 3-3 [Full text]  

Rapid Responses:

Read all Rapid Responses

We need efficacious “clinical” method in heart failure exercise training research

Sergio Stagnaro
bmj.com, 23 Jan 2004 [Full text]

Can we have more information on the outcomes in individual studies?

Chris Metcalfe
bmj.com, 25 Jan 2004 [Full text]

Anti-inflammatory nature of physical exercise

Undurti N Das
bmj.com, 25 Jan 2004 [Full text]

Exercise training for chronic heart failure: Time to apply Darwin's theory

Simon G Williams, et al.
bmj.com, 26 Jan 2004 [Full text]

Re: Exercise training for chronic heart failure: Time to apply Darwin's theory

Peter Morrell
bmj.com, 30 Jan 2004 [Full text]

Common sense: proof by meta-analysis

Paresh A Mehta
bmj.com, 2 Feb 2004 [Full text]

Trials in older heart failure patients are needed

Miles D. Witham, et al.
bmj.com, 5 Feb 2004 [Full text]

Pooling data is not meta-analysis

Douglas G Altman
bmj.com, 22 Feb 2004 [Full text]

Does exercise training lower mortality in patients with chronic heart failure?

Peter C Gøtzsche
bmj.com, 6 Jan 2005 [Full text]