高强度间歇有氧运动对心力衰竭患者运动耐力及生活质量影响的Meta分析

High-intensity intermittent aerobic exercise on exercise capacity and quality of life in patients with heart failure: a meta-analysis

目的系统评价高强度间歇有氧运动(HIIE)对心衰患者心功能、运动耐力、生活质量及抑郁状态的影响。方法计算机检索PubMed、Web of Science、The Cochrane Library、EBSCOhost、EMbase、CBM、CNKI、WanFang Data和VIP数据库,搜集HIIE应用于心衰患者的随机对照试验(RCT),检索时限均从建库至2019年4月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件和Stata 15.1软件进行Meta分析。结果共纳入16个RCT,包括549例患者。Meta分析结果显示:HIIE在提高心衰患者的峰值摄氧量(PeakVO2)[MD=2.04,95%CI(0.74,3.33),P=0.002]、峰值功率(PeakWR)[MD=12.85,95%CI(1.17,24.52),P=0.03]、左室射血分数(LVEF)[MD=4.24,95%CI(1.40,7.07),P=0.003]、生活质量[MD=7.32,95%CI(1.41,13.22),P=0.02]、6分钟步行距离(6MWD)[MD=42.46,95%CI(20.40,64.52),P=0.000 2]等方面均优于对照组。但两组在抑郁量表得分(HADS、ZDRS)[SMD=0.39,95%CI(-0.52,1.31),P=0.40]、CO2通气当量斜率(VE/VCO2 Slope)[MD=0.12,95%CI(-1.02,1.26),P=0.84]的差异无统计学意义。结论当前证据表明,HIIE相比常规运动或中等强度运动更能提高心衰患者运动耐力和生活质量、改善心功能,但两组在改善抑郁方面无明显差别。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objectives To systematically review the efficacy of high-intensity intermittent exercise(HIIE) on cardiac function, exercise capacity, quality of life and depression in patients with heart failure. Methods PubMed, Web of Science, The Cochrane Library, EBSCOhost, EMbase, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials(RCTs) on HIIE on cardiac function, exercise capacity,quality of life and depression in patients with heart failure from inception to April, 2019. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, RevMan 5.3 software and Stata 15.1 software were used for meta-analysis. Results A total of 16 RCTs involving 549 patients were included. The results of meta-analysis showed that, compared with the control group, HIIE could increase peak oxygen consumption(MD=2.04,95%CI 0.74 to 3.33, P=0.002), peak work rate(MD=12.85, 95%CI 1.17 to 24.52, P=0.03), left ventricular ejection fraction(MD=4.24, 95% CI 1.40 to 7.07, P=0.003), quality of life(MD=7.32, 95%CI 1.41 to 13.22, P=0.02), and the six minute walk distance(MD=42.46, 95%CI 20.40 to 64.52, P=0.000 2). However, there was no significant difference between two groups in the depression score(SMD=0.39, 95%CI-0.52 to 1.31, P=0.40) and VE/VCO2 Slope(MD=0.12, 95%CI-1.02 to 1.26, P=0.84). Conclusions Current evidence shows that compared with routine exercise or moderate intensity exercise, HIIE can improve exercise capacity, quality of life and cardiac function in patients with heart failure, but there is no significant difference in improving depression. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.