Early Supervised Exercise Interventions After Acute HF Improve Quality of Life Outcomes

senior women walking between parallel bar in physiotherapy and therapist next to her helping
A study was conducted to determine the effect of early exercise rehabilitation on outcomes in patients with acute heart failure.

A systematic review and meta-analysis found that early exercise after acute heart failure (HF) improved physical capacity and quality of life outcomes. These findings were published in the International Journal of Nursing Studies.

Investigators at the Shanghai Jiao Tong University in China searched publication databases from the earliest date available through November 2021 for studies of early exercise interventions among patients with acute HF. Early exercise therapy was defined as a supervised intervention using exercise training.

A total of 13 articles comprising sample sizes of 20-349 patients (N=1466) aged mean 53 to 81 years were included in this analysis. The interventions included combinations of balance, breathing and light resistance, endurance, ergometric bicycle, flexibility, interval, mobility, motorized treatment, progressive aerobic, rehabilitation, or strengthening exercises. The control conditions were usual care or exercise advice.

Compared with controls, early exercise interventions had significant effects on 6-minute walk distance (mean difference [MD], 33.10; 95% CI, 31.43-34.77; P <.001; I2, 34%), short physical performance battery scores (MD, 1.40; 95% CI, 1.36-1.44; P <.001; I2, 0%), N-terminal pro-B-type natriuretic peptide levels (MD, -58.84; 95% CI, -89.25 to -28.43; P <.001; I2, 0%), Minnesota Living with HF Questionnaire scores (MD, -6.55; 95% CI, -9.99 to -3.11; P =.0002; I2, 79%), Kansas City Cardiomyopathy Questionnaire scores (MD, 7.00; 95% CI, 6.58-7.42; P <.001; I2, 0%), Barthel index scores (MD, 4.43; 95% CI, 2.20-6.65; P <.001; I2, 0%), and all-cause remission rates (MD, 0.69; 95% CI, 0.51-0.94; P =.02; I2, 0%).

The early exercise interventions did not have an effect on left ventricular ejection fraction (MD, 1.93; 95% CI, -2.19 to 6.05; P =.36; I2, 0%), HF-related remission rates (MD, 0.76; 95% CI, 0.50-1.17; P =.21; I2, 0%), or all-cause mortality (MD, 0.63; 95% CI, 0.18-2.24; P =.47; I2, 59%).

In a sensitivity analysis, the interventions improved 6-minute walk distance among inpatients only (MD, 38.16; 95% CI, 20.57-55.74; P <.01) and inpatients and outpatients (MD, 33.06; 95% CI, 31.38-34.73; P <.01).

The early exercise interventions were associated with no adverse events in 9 of the 13 articles. In the remaining 4 trials, aggravation of HF, asymptomatic sporadic supraventricular and ventricular premature contractions, atrial fibrillation, chest pain, decreased systolic blood pressure, and falls were reported.

This analysis may have been limited by the overall lack of blinding which may have introduced performance bias.

“…early exercise was, to a great extent, safe and effective for improving 6-minute walk distance, short physical performance battery, N-terminal pro-B-type natriuretic peptide, quality of life, activities of daily living and all-cause readmission,” the study authors noted. “More multi-center and large-sample randomized controlled trials are needed for further verification.”


Yingtong M, Wei Z, Hanjun H, Tingting Z, Xiaohua G. The effects of early exercise on cardiac rehabilitation-related outcome in acute heart failure patients: a systematic review and meta-analysis. Int J Nurs Stud. Published online April 11, 2022. doi:10.1016/j.ijnurstu.2022.104237