The Effects of Exercise-Based Interventions on Fluid Overload Symptoms in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Mei Rosemary Fu, Yuan Li, Catherine Conway, Alessandra Masone, Jinbo Fang, Christopher Lee, Mei Rosemary Fu, Yuan Li, Catherine Conway, Alessandra Masone, Jinbo Fang, Christopher Lee

Abstract

Patients with heart failure are subjected to a substantial burden related to fluid overload symptoms. Exercise can help the lymphatic system function more effectively to prevent fluid build-up in tissues and interstitium, thus potentially mitigating the symptoms due to fluid overload. The objective of this systematic review was to examine the effects of exercise-based interventions on fluid overload symptoms among patients with heart failure. MEDLINE, Embase, Cochrane Library, and CINAHL databases were systematically searched for relevant studies published from inception to August 2021. We included randomized controlled trials that compared exercise-based interventions of different modalities and usual medical care for adult patients with heart failure and reported the effects of interventions on any symptoms related to fluid overload. A random-effects meta-analysis was used to estimate the effectiveness, and a subgroup analysis and univariate meta-regression analysis were used to explore heterogeneity. Seventeen studies covering 1086 participants were included. We found robust evidence indicating the positive effect of exercises in dyspnea relief (SMD = -0.48; 95%CI [-0.76, -0.19]; p = 0.001); the intervention length also influenced the treatment effect (β = 0.033; 95%CI [0.003, 0.063]; p = 0.04). Initial evidence from existing limited research showed that exercise-based intervention had positive effect to alleviate edema, yet more studies are needed to verify the effect. In contrast, the exercise-based interventions did not improve fatigue compared with usual care (SMD = -0.27; 95%CI [-0.61, 0.06]; p = 0.11). Findings regarding the effects of exercises on bodily pain, gastro-intestinal symptoms, and peripheral circulatory symptoms were inconclusive due to limited available studies. In conclusion, exercise-based interventions can be considered as an effective nonpharmacological therapy for patients with heart failure to promote lymph flow and manage fluid overload symptoms. Exercise-based interventions seem to have very limited effect on fatigue. More research should investigate the mechanism of fatigue related to heart failure. Future studies with high methodological quality and comprehensive assessment of symptoms and objective measure of fluid overload are warranted.

Keywords: dyspnea; exercise; fatigue; fluid overload; heart failure; nursing; symptom; systematic review.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the study selection process according to PRISMA guidelines.
Figure 2
Figure 2
Forest plot showing the effect of exercise-based interventions on dyspnea and risk of bias assessment for each study. (Studies were stratified by the corresponding muscle group contracted during the exercise).
Figure 3
Figure 3
Forest plot showing the effect of exercise-based interventions on fatigue and risk of bias assessment for each study. (Studies are stratified by the corresponding muscle group contracted during the exercise).
Figure 4
Figure 4
(A) Sensitivity analysis for dyspnea by omitting one study in turn (did not change the results of primary meta-analysis); (B) Sensitivity analysis for fatigue by omitting one study in turn (changed the results of primary meta-analysis after removing Wall 2010).

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