The Effectiveness of Lifestyle Interventions in Heart Failure with Preserved Ejection Fraction: A Systematic review and Network Meta-Analysis

Aims

To perform a network meta-analysis to determine the effectiveness of lifestyle interventions on exercise tolerance and quality of life (QoL) in people with HFpEF.

Methods

Ten databases were searched for randomised controlled trials that evaluated a diet and/or exercise intervention in people with HFpEF up until May 2022. The co-primary outcomes were peak oxygen uptake (V̇O_2peak) and QoL as assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). We synthesised data using network meta-analysis.

Results

Thirteen trials were identified including a total of 869 participants and incorporated six different interventions. Improvements in V̇O_2peak compared to controls were seen for all exercise interventions (2.88 [95%CI: 1.36; 4.39]ml/kg/min) for high intensity interval training (HIIT); 2.37 [95%CI: 1.02; 3.71] ml/kg/min for low intensity exercise (LIT) combined with a hypocaloric diet; 2.05 [95%CI: 0.81; 3.29]ml/kg/min for moderate intensity continuous training (MICT); 1.94 [95%CI: 0.59; 3.29] ml/kg/min for LIT; 1.85 [95%CI: 0.27; 3.44]ml/kg/min for MICT combined with resistance training) but not a hypocaloric diet alone (1.26 [95%CI: -0.08; 2.61]ml/kg/min). Only HIIT (-14.45 [95%CI: -24.81; -4.10] points) and LIT (95%CI: -11.05 [-20.55; -1.54] ml/kg/min) significantly improved MLHFQ score. Network meta-analysis indicated HIIT was the most effective intervention for improving both V̇O_2peak (mean improvement 2.88 [95%CI: 1.36; 4.39]ml/kg/min, follow up (FU) range 4 weeks- 3 years) and QoL (-14.45 [95%CI: -24.81; -4.10] points, FU range 12-26 weeks) compared to usual care.

Conclusions

This network meta-analysis indicates that HIIT is the most effective lifestyle intervention studied to improve exercise capacity and QoL with mean improvements exceeding the minimum clinically meaningful thresholds. HIIT is likely to be an underused management strategy in HFpEF, but further studies are needed to confirm long-term improvements in symptoms and clinical outcomes.