Meta-analysis of exercise training on left ventricular ejection fraction in heart failure with reduced ejection fraction: A 10-year update




Tucker, Wesley J.
Beaudry, Rhys I.
Liang, Yuanyuan
Clark, Alexander M.
Tomczak, Corey R.
Nelson, Michael D.
Oyvind, Ellingsen
Haykowsky, Mark J.

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BACKGROUND: The role of exercise training modality to attenuate left ventricular (LV) remodeling in heart failure patients with reduced ejection fraction (HFrEF) remains uncertain. The authors performed a systematic review and meta-analysis of published reports on exercise training (moderate-intensity continuous aerobic, high-intensity interval aerobic, and resistance exercise) and LV remodeling in clinically stable HFrEF patients.

METHODS: We searched MEDLINE, Cochrane Central Registry of Controlled Trials, CINAHL, and PubMed (2007 to 2017) for randomized controlled trials of exercise training on resting LV ejection fraction (EF) and end-diastolic and end-systolic volumes in HFrEF patients.

RESULTS: 18 trials reported LV ejection fraction (LVEF) data, while 8 and 7 trials reported LV end-diastolic and LV end-systolic volumes, respectively. Overall, moderate-intensity continuous training (MICT) significantly increased LVEF (weighted mean difference, WMD = 3.79%; 95% confidence interval, CI, 2.08 to 5.50%) with no change in LV volumes versus control. In trials ≥6 months duration, MICT significantly improved LVEF (WMD = 6.26%; 95% CI 4.39 to 8.13%) while shorter duration (<6 months) trials modestly increased LVEF (WMD = 2.33%; 95% CI 0.84 to 3.82%). High-intensity interval training (HIIT) significantly increased LVEF compared to control (WMD = 3.70%; 95% CI 1.63 to 5.77%) but was not different than MICT (WMD = 3.17%; 95% CI −0.87 to 7.22%). Resistance training performed alone or combined with aerobic training (MICT or HIIT) did not significantly change LVEF.

CONCLUSIONS: In clinically stable HFrEF patients, MICT is an effective therapy to attenuate LV remodeling with the greatest benefits occurring with long-term (≥6 months) training. HIIT performed for 2 to 3 months is superior to control, but not MICT, for improvement of LVEF.


Article originally published in Progress in Cardiovascular Diseases, 62(2), 163–171. English. Published online 2019.


Exercise therapy, Moderate-intensity continuous training, High-intensity interval training, Resistance training, Left ventricular ejection fraction


This is the post-print version of an article that is available at Recommended citation: Tucker, W. J., Beaudry, R. I., Liang, Y., Clark, A. M., Tomczak, C. R., Nelson, M. D., Ellingsen, O., & Haykowsky, M. J. (2019). Meta-analysis of exercise training on left ventricular ejection fraction in heart failure with reduced ejection fraction: A 10-year update. Progress in Cardiovascular Diseases, 62(2), 163–171. This item has been deposited in accordance with publisher copyright and licensing terms and with the author’s permission.