Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2019; 7(18): 2760-2775
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2760
Respiratory training interventions improve health status of heart failure patients: A systematic review and network meta-analysis of randomized controlled trials
Mei-Hua Wang, Mei-Ling Yeh
Mei-Hua Wang, Mei-Ling Yeh, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
Author contributions: All authors equally contributed to this paper.
Conflict-of-interest statement: The authors have no financial or any other kind of personal conflicts with this paper.
PRISMA 2009 Checklist statement: The manuscript has been checked according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mei-Ling Yeh, PhD, DMS, Professor, School of Nursing, National Taipei University of Nursing and Health Sciences, 365 Minte Road, Taipei 11219, Taiwan. meiling@ntunhs.edu.tw
Telephone: +886-2-28227101
Received: January 30, 2019
Peer-review started: January 31, 2019
First decision: May 31, 2019
Revised: July 4, 2019
Accepted: July 27, 2019
Article in press: July 27, 2019
Published online: September 26, 2019
Abstract
BACKGROUND

Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory.

AIM

To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients.

METHODS

This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2 peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data.

RESULTS

A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO2 peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO2 peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL.

CONCLUSION

This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.

Keywords: Heart failure, Network meta-analysis, Respiratory training, Cardiac function, Exercise capacity, Quality of life

Core tip: Breathing training interventions, including inspiratory muscle training, tai chi, yoga, and breathing exercises, are effective strategies for improving cardiac function, exercise capacity, and quality of life in heart failure patients. Machine-assisted respiratory training in hospital settings should be prioritized over respiratory training provided in non-hospital settings. Inspiratory muscle training with high pressure effectively improves cardiac function, and inspiratory muscle training with moderate pressure effectively improves quality of life in heart failure patients. In home settings, non-machine-assisted respiratory training such as tai chi, yoga, and breathing exercise effectively reduces (improves) heart rate in heart failure patients.