Rehabilitación cardíaca con ejercicios en los receptores de un trasplante de corazón
Información
- DOI:
- https://doi.org/10.1002/14651858.CD012264.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 04 abril 2017see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Corazón
- Copyright:
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- Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
LA undertook study selection, data extraction and risk of bias assessment, led the writing of the review and approved the final manuscript.
TN undertook study selection, data extraction and risk of bias assessment, assisted in the writing of the review and approved the final manuscript.
CD assisted in writing the protocol, provided clinical expertise, edited the review and approved the final manuscript.
LB provided clinical expertise, edited the review and approved the final manuscript.
RST led the statistical analysis, edited the review and approved the final manuscript.
Sources of support
Internal sources
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University of Exeter Medical School, UK.
External sources
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NIHR, UK.
This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to the Heart Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS, or the Department of Health, UK.
Declarations of interest
LA is an author on a number of other Cochrane cardiac rehabilitation reviews.
CD is an author of several publications on exercise in heart transplant recipients.
TN declares she has no conflicts of interest.
LB declares she has no conflicts of interest.
CB declares she has no conflicts of interest.
RST is an author on a number of other Cochrane cardiac rehabilitation reviews and is currently the co‐chief investigator on the programme of research with the overarching aims of developing and evaluating a home‐based cardiac rehabilitation intervention for people with heart failure and their carers (PGfAR RP‐PG‐0611‐12004).
Acknowledgements
The authors acknowledge the support of the Cochrane Heart Group editorial team and the template protocol they made available. We would also like to thank Nicole Martin of the Cochrane Heart Group for updating the search strategy. Finally, we would like to thank Dr Felix Gradinger for his translation services and all the authors who provided additional information about their trials.
Version history
| Published | Title | Stage | Authors | Version |
| 2017 Apr 04 | Exercise‐based cardiac rehabilitation in heart transplant recipients | Review | Lindsey Anderson, Tricia T Nguyen, Christian H Dall, Laura Burgess, Charlene Bridges, Rod S Taylor | |
| 2016 Jun 23 | Exercise‐based cardiac rehabilitation in heart transplant recipients | Protocol | Lindsey Anderson, Christian H Dall, Tricia T Nguyen, Laura Burgess, Rod S Taylor | |
Differences between protocol and review
We conducted this systematic review according to the published protocol (Anderson 2016a).
However, the objectives of this review differ from those described in the protocol. In the review ‘morbidity’ was replaced by ‘adverse events’ and ‘costs’ was added, in order to better reflect the outcome measures being collected.
Also, due to the small number of included studies, we were unable to stratify meta‐analysis of outcomes according to the length of trial duration, or to undertake univariate meta‐regression to explore heterogeneity and examine potential treatment effect modifiers.
In addition to searching CPCI‐S on the Web of Science, as described in the protocol, the search was expanded to the core collection for the purposes of this review.
The protocol states that we would assess the risk of bias of blinding of participants and personnel. However, do to the nature of the intervention, this review assessed blinding of outcome assessors instead.
The protocol states that we would extract data on funding and notable conflicts of interest of trial authors. Instead, we assessed the risk of bias due to funding or conflicts of interest for each study and reported our assessment in the risk of bias tables.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Female; Humans; Male; Middle Aged;
PICO
Summary of selection process
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Funnel plot of comparison: 1 Exercise versus no‐exercise, outcome: 1.1 Exercise capacity (VO2peak)
Comparison 1 Exercise versus no‐exercise, Outcome 1 Exercise capacity (VO2peak).
Comparison 1 Exercise versus no‐exercise, Outcome 2 Sensitivity analysis (excluding Kobashigawa 1999).
Comparison 1 Exercise versus no‐exercise, Outcome 3 Sensitivity analysis (excluding Wu 2008).
Comparison 1 Exercise versus no‐exercise, Outcome 4 Sensitivity analysis (excluding Kobashigawa 1999 and Wu 2008).
Comparison 2 High‐intensity interval training versus continued moderate‐intensity exercise, Outcome 1 Exercise capacity (VO2peak).
| Exercise versus no exercise for post‐heart transplant recipients | |||||
| Patient or population: Post‐heart transplant recipients | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | |
| Assumed risk | Corresponding risk | ||||
| Control | Exercise versus no exercise | ||||
| Exercise capacity | The mean exercise capacity in the intervention groups was | 284 | ⊕⊕⊕⊝ | ||
| Health‐related quality of life | HRQoL in comparator > HRQoL in intervention, in 16/19 domains | HRQoL in intervention > HRQoL in comparator, in 3/19 domains | 120 | ⊕⊕⊕⊝ | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||
| GRADE Working Group grades of evidence | |||||
| 1 Random sequence generation, allocation concealment or blinding of outcome assessors were poorly described in 50% or more of included studies. | |||||
| High‐intensity versus moderate intensity exercise | |||||
| Patient or population: Post‐heart transplant recipients | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of Participants | Quality of the evidence | |
| Assumed risk | Corresponding risk | ||||
| Moderate intensity exercise | High‐intensity exercise | ||||
| Exercise capacity | The mean exercise capacity in the control group was 2.6 mg/kg/min (SD 2.2) | The mean exercise capacity in the intervention group was 4.9 mg/kg/min (SD 2.7) The mean exercise capacity in the intervention groups was 2.30 higher (0.59 to 4.01 higher) | 16 | ⊕⊕⊕⊝ | |
| Health‐related quality of life | Mental component score = 89.3 (7.4) Physical component score = 76.4 (11.8) | Mental component score = 90.0 (6.6) Physical component score = 77.5 (8.9) HRQoL of patients receiving high‐intensity interval training = HRQoL of patients receiving continued moderate‐intensity exercise | 16 | ⊕⊕⊕⊝ | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||
| GRADE Working Group grades of evidence | |||||
| 1 This evidence is based on the result of only one cross‐over study with just 16 participants, resulting in a lack of precision | |||||
| Study | Number randomised | Number lost at follow‐up* | Notes | |
| Intervention | 13 | NR | NR | |
| Control | 11 | NR | NR | |
| Intervention | 10 | 1 | 1 withdrew due to illness | |
| Control | 10 | 3 | 3 participants not included in the final analysis due to non‐compliance with testing regimen | |
| Intervention | 17 | 1 | 1 participant had insufficient exercise testing (respiratory exchange ratio (RER) < 0.85) and was an outlier on several parameters, and thus excluded from the main analyses (cross‐over design) | |
| Control | 17 | 1 | ||
| Intervention | 22 | 1 | 1 participant withdrew due to illness | |
| Control | 21 | 2 | 2 participants requested not to perform the post‐intervention assessments | |
| Intervention | 15 | 1 | 1 participant withdrew due to illness (1 additional participant lost to echo follow‐up) | |
| Control | 15 | 2 | 1 participant withdrew due to illness; 1 withdrew consent (3 additional participants lost to echo follow‐up) | |
| Intervention | 14 | NR | NR | |
| Control | 13 | NR | NR | |
| Intervention | 26 | 2 | 2 participants withdrew due to illness | |
| Control | 26 | 2 | 1 participant withdrew due to illness; 1 lost to follow‐up (missing exercise capacity test) | |
| Intervention | 33 | 2 | 1 participant withdrew consent; 1 lost to follow‐up | |
| Control | 9 | 0 | 0 participants were lost to follow‐up | |
| Intervention | 16 | 8 | 2 participants declined participation due to personal reasons; 2 were excluded due to illness; 4 dropped out during the intervention due to personal reasons (N = 3) or orthopaedic impairment (N = 1) | |
| Control | 15 | 3 | 2 participants declined participation due to personal reasons; 1 excluded due to illness | |
| Intervention | 14 | 2 | 2 participants dropped out after evaluation. In addition, 4 participants in the exercise group changed over to the control group after randomisation. Analyses conducted using the latter group allocation and not original randomised groups | |
| Control | 23 | 4 | 4 participants dropped out: 2 due to renal problem/anaemia; 2 for personal reasons | |
| Combined results | Intervention | 180 | 18 | 10.0% |
| Control | 160 | 17 | 10.6% | |
| * All causes of drop out from follow‐up included (including mortality) | ||||
| Measure of HRQoL | Mean (SD) outcome values at follow‐up | P value | Difference between groups | |
| High‐intensity interval training | Continued moderate‐intensity training | |||
| SF‐36 at 3 months follow‐up | ||||
| Physical functioning | 83.1 (15.9) | 83.1 (15.5) | NS | HIIT = CON |
| Physical performance | 84.4 (25.6) | 83.1 (15.5) | NS | HIIT = CON |
| Bodily pain | 85.2 (17.0) | 83.1 (18.2) | NS | HIIT = CON |
| General health | 65.6 (16.4) | 65.5 (12.7) | NS | HIIT = CON |
| Vitality | 77.2 (15.5) | 78.4 (12.6) | NS | HIIT = CON |
| Social functioning | 95.3 (11.1) | 96.1 (7.5) | NS | HIIT = CON |
| Emotional performance | 89.6 (20.1) | 91.7 (22.8) | NS | HIIT = CON |
| Mental health | 89.3 (7.4) | 89.3 (5.8) | NS | HIIT = CON |
| Mental component | 89.3 (7.4) | 90.0 (6.6) | NS | HIIT = CON |
| Physical component | 76.4 (11.8) | 77.5 (8.9) | NS | HIIT = CON |
| Measure of HRQoL | Mean (SD) outcome values at follow‐up | P value | Difference between groups | |
| Exercise | Usual care | |||
| SF‐36 at 6 months follow‐up | ||||
| Physical functioning | NR | NR | *NS | Exercise = Comparator |
| Physical performance | NR | NR | *NS | Exercise = Comparator |
| Bodily pain | NR | NR | *NS | Exercise = Comparator |
| General health | 54 | 49 | P < 0.05 | Exercise > Comparator |
| Vitality | NR | NR | *NS | Exercise = Comparator |
| Social functioning | NR | NR | *NS | Exercise = Comparator |
| Emotional performance | NR | NR | *NS | Exercise = Comparator |
| Mental health | NR | NR | *NS | Exercise = Comparator |
| Mental component | NR | NR | *NS | Exercise = Comparator |
| Physical component | NR | NR | *NS | Exercise = Comparator |
| **Profile of quality of life in the chronically ill (PLC) | ||||
| Physical function | NR | NR | P < 0.05 | Exercise > Comparator |
| Psychological function | NR | NR | NS | Exercise = Comparator |
| Positive mood | NR | NR | NS | Exercise = Comparator |
| Negative mood | NR | NR | NS | Exercise = Comparator |
| Social function | NR | NR | NS | Exercise = Comparator |
| Social well being | NR | NR | NS | Exercise = Comparator |
| Physical well being | NR | NR | P < 0.01 | Exercise > Comparator |
| World Health Organization Quality of Life (WHOQoL) ‐ BREF | ||||
| Physical domain | 13.84 (1.78) | 13.64 (2.11) | NS | Exercise = Usual care |
| Psychological domain | 13.33 (1.85) | 14.00 (2.45) | NS | Exercise = Usual care |
| Social relationship domain | 13.90 (2.49) | 14.55 (1.88) | NS | Exercise = Usual care |
| Environment domain | 14.00 (2.30) | 14.30 (2.10) | NS | Exercise = Usual care |
| CON = continued moderate‐intensity exercise | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Exercise capacity (VO2peak) Show forest plot | 9 | 284 | Mean Difference (IV, Fixed, 95% CI) | 2.49 [1.63, 3.36] |
| 2 Sensitivity analysis (excluding Kobashigawa 1999) Show forest plot | 8 | 257 | Mean Difference (IV, Fixed, 95% CI) | 2.59 [1.69, 3.49] |
| 3 Sensitivity analysis (excluding Wu 2008) Show forest plot | 8 | 247 | Mean Difference (IV, Fixed, 95% CI) | 2.99 [1.93, 4.05] |
| 4 Sensitivity analysis (excluding Kobashigawa 1999 and Wu 2008) Show forest plot | 7 | 220 | Mean Difference (IV, Fixed, 95% CI) | 3.20 [2.08, 4.33] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Exercise capacity (VO2peak) Show forest plot | 1 | 32 | Mean Difference (IV, Fixed, 95% CI) | 2.30 [0.59, 4.01] |
