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Abstract
To determine the effect of exercise training on survival in patients with heart failure
due to left ventricular systolic dysfunction.
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.
Death from all causes.
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 chi(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 chi(2) = 6.4; P = 0.011). No statistically significant
subgroup specific treatment effect was observed.
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.