The effect of exercise on left ventricular global longitudinal strain

James Murray, Hunter Bennett, Eva Bezak, Rebecca Perry, Terry Boyle, James Murray, Hunter Bennett, Eva Bezak, Rebecca Perry, Terry Boyle

Abstract

Exercise improves measures of cardiovascular (CV) health and function. But as traditional measures improve gradually, it can be difficult to identify the effectiveness of an exercise intervention in the short-term. Left ventricular global longitudinal strain (LVGLS) is a highly sensitive CV imaging measure that detects signs of myocardial dysfunction prior to more traditional measures, with reductions in LVGLS a strong prognostic indicator of future CV dysfunction and mortality. Due to its sensitivity, LVGLS may offer useful method of tracking the effectiveness of an exercise intervention on CV function in the short-term, providing practitioners useful information to improve patient care in exercise settings. However, the effect of exercise on LVGLS is unclear. This systematic review and meta-analysis aimed to determine the effect exercise has on LVGLS across a range of populations. Included studies assessed LVGLS pre-post an exercise intervention (minimum 2 weeks) in adults 18 years and over, and were published in English from 2000 onwards. Study-level random-effects meta-analyses were performed using Stata (v16.1) to calculate summary standardized mean differences (SMD) and 95% confidence intervals (CI). 39 studies met selection criteria, with 35 included in meta-analyses (1765 participants). In primary analyses, a significant improvement in LVGLS was observed in populations with CV disease (SMD = 0.59; 95% CI 0.16-1.02; p = 0.01), however, no significant effect of exercise was observed in CV risk factor and healthy populations. In populations with CV disease, LVGLS could be used as an early biomarker to determine the effectiveness of an exercise regime before changes in other clinical measures are observed.

Keywords: Cardiac function; Cardiovascular imaging; Physical activity.

Conflict of interest statement

The authors have no competing interests to declare that are relevant to the content of this article.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study identification and selection process
Fig. 2
Fig. 2
Meta-analysis of randomised control trials, non-randomised control trials and randomised cross-over trials investigating the effect of exercise on LVGLS in cardiovascular disease (a) and cardiovascular risk factor (b) populations. AMI acute myocardial infarction, HTN hypertension, IR insulin resistance, T2D type 2 diabetes, N number of participants, SD standard deviation, CI confidence intervals
Fig. 3
Fig. 3
Meta-analysis of exercise data from randomised control trials, non-randomised control trials, randomised cross-over trials and single group pre-post studies investigating the effect of exercise on LVGLS in cardiovascular disease (CVD), cardiovascular (CV) risk factor and chronic kidney disease (CKD) populations. AMI acute myocardial infarction, HIIT high intensity interval training, HFpEF heart failure preserved ejection fraction, MICT moderate intensity continuous training, CAD coronary artery disease, ACT aerobic continuous training, AIT aerobic interval training, HTN hypertension, IR insulin resistance, T2D type 2 diabetes, EX exercise, MetS metabolic syndrome, RTR renal transplant recipient, CKD chronic kidney disease, CI confidence intervals
Fig. 4
Fig. 4
Meta-analysis of exercise data from randomised control trials, non-randomised control trials, randomised cross-over trials and single group pre-post studies investigating the effect of exercise on LVGLS in healthy and athletic populations. HR-LL high repetitions, low load, LR-HL low repetitions, high load, HIIT high intensity interval training, MICT moderate intensity continuous training, CI confidence intervals

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