Effects of Exercise Training on Cognitive Function in Individuals With Heart Failure: A Meta-Analysis.

OBJECTIVE: Cognitive function is critical for disease self-management; however, it is poorer in individuals with heart failure (HF) than in age-matched people who are healthy. Aging and disease progression collectively threaten the cognitive function of individuals with HF. Exercise has been shown to improve the mobility and mortality risk factors of this population, but the effects of exercise on the cognitive function of individuals with HF are unclear. This meta-analysis aimed to examine these potential effects. METHODS: A systematic literature search was conducted in PubMed, MEDLINE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, and ClinicalKey on literature published until January 2022. Studies examining the effects of exercise training on cognitive function in individuals with HF were included. Characteristics of participants and details of interventions were extracted. Effects of exercise training on global cognitive function, attention, and executive function were analyzed using the Comprehensive Meta-Analysis software. RESULTS: Six studies were included. Individuals with chronic HF were examined in most studies. The average ejection fraction of participants was 23 to 46%. Aerobic exercise was used in most studies. All included studies had exercise frequency of 2 to 3 times per week and a duration of 30 to 60 minutes per session for 12 to 18 weeks. Compared with the control group, exercise training benefited the global cognitive function of individuals with HF and cognitive impairments (standardized mean difference = 0.44; 95% CI = 0.01-0.87). The attention of individuals with HF improved after exercise training compared with that before the intervention. CONCLUSION: Exercise may improve cognitive function in individuals with HF and cognitive impairments. However, due to large heterogeneity in the study design, more studies are needed to support clinical application. IMPACT: These findings should raise clinicians' awareness about the role of exercise on the cognitive function of individuals with HF, in addition to benefits in physical domains.

The feasibility and safety of stepwise protocol in cardiopulmonary exercise testing-exercise stress echocardiography for subjects with heart failure.

BACKGROUND: Exercise stress testing using a ramp protocol has been favored for cardiopulmonary exercise testing (CPX) in patients with heart failure (HF). However, the stepwise protocol for CPX was preferred for its possible combination with exercise stress echocardiography (ESE). We, therefore, investigated the feasibility and safety of using a stepwise protocol for CPX-ESE in patients with HF. METHODS: Ambulatory outpatients with chronic HF were enrolled for a symptom-limited stepwise bicycle exercise test in the semi-supine position on a cycle ergometer. The test was started at a workload of 30 W and increased by 15 W every 3 minutes until maximal exertion. The echocardiographic and respiratory variables and any complications during the exercise were recorded. RESULTS: Among a total of 36 participants (age 61.2 ± 12.4 years; 69.4% men), all subjects achieved anerobic threshold during CPX-ESE and reached 72.3% of the age-predicted peak heart rate. The peak oxygen consumption was 14.7 mL/kg/min, and the peak RER was 1.25. There were no severe adverse complications, and only two minor rhythmic events were reported: nonsustained supraventricular tachycardia and isolated ventricular premature beats. The echocardiographic images acquired at each stage were of good quality in 92.6% of all acquisitions, and the intra-observer and interobserver repeatability was >80%. CONCLUSION: The stepwise protocol, with an initial workload of 30 W, followed by 15 W increments every 3 minutes, was feasible and provided an adequate stress load for patients with HF. This exercise stress modality was safe and well-tolerated.