Purpose
Patients with heart failure with preserved ejection fraction (HFpEF) have significant impairments in patient-reported outcomes (PRO) including physical functioning and quality of life (QOL). We conducted a meta-analysis of randomized clinical trials of supervised exercise training (SET) to examine the efficacy of such training.
Methods
We included six single-blinded SET trials in patients with HFpEF, defined as a left ventricular EF ≥50%, published since 2010 in which participants were randomized to a facility-based exercise training program or usual care. We identified trials from a 2024 Cochrane review of exercise-based cardiac rehabilitation for adults with heart failure as well as other reviews and meta-analyses in PubMed. We used random effects meta-analysis to estimate the respective SET effects for five endpoints: the 36-Item Short Form Survey (SF-36) Physical Functioning Scale (PFS), the SF-36 Physical Component Summary, the Minnesota Living With Heart Failure Questionnaire (MLWHFQ) total score, the Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary Score, and the KCCQ QOL subscale.
Results
The treatment effect estimate favored SET for all five endpoints. However, the SET effect was only statistically significant for the SF-36 PFS ( P < .0001) and the MLWHFQ total score ( P = .01).
Conclusions
This meta-analysis demonstrated clear evidence that patient-reported physical functioning, an outcome that patients with HFpEF identify as a prominent disability, is significantly improved with SET. It also showed consistent improvements across several other multi-dimensional measures of QOL.