TY - JOUR
T1 - Exercise Interventions in Patients with Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy
T2 - A SYSTEMATIC REVIEW and META-ANALYSIS
AU - Steinhaus, Daniel A.
AU - Lubitz, Steven A.
AU - Noseworthy, Peter A.
AU - Kramer, Daniel B.
N1 - Funding Information:
Dr Steinhaus has consulted for Abbott Laboratories and Boston Scientific and has a family member who is an executive for Medtronic. Dr Lubitz receives sponsored research support from Bayer HealthCare, Biotronik, and Boehringer Ingelheim, and has consulted for St Jude Medical and Quest Diagnostics. Dr Noseworthy has no disclosures to report regarding this publication. Dr Kramer has consulted to the Baim Institute for Clinical Research for clinical trials of medical devices.
Funding Information:
Dr Lubitz is supported by NIH grants K23HL114724 and a Doris Duke Charitable Foundation Clinical Scientist Development Award #2014105. Dr Noseworthy is supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Dr Kramer is supported by a Paul Beeson Career Development Award (NIH-NIA K23AG049563) and the Greenwall Faculty Scholars Program in Bioethics.
Publisher Copyright:
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Purpose: Physical activity improves outcomes across a broad spectrum of cardiovascular disease. The safety and effectiveness of exercise-based interventions in patients with implantable cardioverter-defibrillators (ICDs) including cardiac resynchronization therapy defibrillators (CRT-Ds) remain poorly understood. Methods: We identified clinical studies using the following search terms: "implantable cardioverter-defibrillators"; "ICD"; "cardiac resynchronization therapy"; "CRT"; and any one of the following: "activity"; "exercise"; "training"; or "rehabilitation"; from January 1, 2000 to October 1, 2015. Eligible studies were evaluated for design and clinical endpoints. Results: A total of 16 studies were included: 8 randomized controlled trials, 5 single-arm trials, 2 observational cohort trials, and 1 randomized crossover trial. A total of 2547 patients were included (intervention groups = 1215 patients, control groups = 1332 patients). Exercise interventions varied widely in character, duration (median 84 d, range: 23-168 d), and follow-up time (median 109 d, range: 23 d to 48 mo). Exercise performance measures were the most common primary endpoints (87.5%), with most studies (81%) demonstrating significant improvement. Implantable cardioverter-defibrillator shocks were uncommon during active exercise intervention, with 6 shocks in 635 patients (0.9%). Implantable cardioverter-defibrillator shocks in follow-up were less common in patients receiving any exercise intervention (15.6% vs 23%, OR = 0.68; 95% CI, 0.48-0.80, P <.001). o2 peak improved significantly in patients receiving exercise intervention (1.98 vs 0.36 mL/kg/min, P <.001). Conclusion: In conclusion, exercise interventions in patients with ICDs and CRT-Ds appear safe and effective. Lack of consensus on design and endpoints remains a barrier to broader application to this important patient population.
AB - Purpose: Physical activity improves outcomes across a broad spectrum of cardiovascular disease. The safety and effectiveness of exercise-based interventions in patients with implantable cardioverter-defibrillators (ICDs) including cardiac resynchronization therapy defibrillators (CRT-Ds) remain poorly understood. Methods: We identified clinical studies using the following search terms: "implantable cardioverter-defibrillators"; "ICD"; "cardiac resynchronization therapy"; "CRT"; and any one of the following: "activity"; "exercise"; "training"; or "rehabilitation"; from January 1, 2000 to October 1, 2015. Eligible studies were evaluated for design and clinical endpoints. Results: A total of 16 studies were included: 8 randomized controlled trials, 5 single-arm trials, 2 observational cohort trials, and 1 randomized crossover trial. A total of 2547 patients were included (intervention groups = 1215 patients, control groups = 1332 patients). Exercise interventions varied widely in character, duration (median 84 d, range: 23-168 d), and follow-up time (median 109 d, range: 23 d to 48 mo). Exercise performance measures were the most common primary endpoints (87.5%), with most studies (81%) demonstrating significant improvement. Implantable cardioverter-defibrillator shocks were uncommon during active exercise intervention, with 6 shocks in 635 patients (0.9%). Implantable cardioverter-defibrillator shocks in follow-up were less common in patients receiving any exercise intervention (15.6% vs 23%, OR = 0.68; 95% CI, 0.48-0.80, P <.001). o2 peak improved significantly in patients receiving exercise intervention (1.98 vs 0.36 mL/kg/min, P <.001). Conclusion: In conclusion, exercise interventions in patients with ICDs and CRT-Ds appear safe and effective. Lack of consensus on design and endpoints remains a barrier to broader application to this important patient population.
KW - exercise
KW - implantable cardioverter defibrillator
KW - meta-analysis
KW - review
UR - http://www.scopus.com/inward/record.url?scp=85071713077&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071713077&partnerID=8YFLogxK
U2 - 10.1097/HCR.0000000000000389
DO - 10.1097/HCR.0000000000000389
M3 - Review article
C2 - 31397767
AN - SCOPUS:85071713077
SN - 1932-7501
VL - 39
SP - 308
EP - 317
JO - Journal of Cardiopulmonary Rehabilitation and Prevention
JF - Journal of Cardiopulmonary Rehabilitation and Prevention
IS - 5
ER -