Effect of exercise on endothelial function in heart transplant recipients: systematic review and meta-analysis.

Endothelial dysfunction is associated with increased cardiovascular risk and death in heart transplant recipients (HTx). Although the measurement of peripheral endothelial function is considered a significant predictor of cardiovascular events in several populations, few studies have investigated this outcome after therapeutic strategies, including different exercise types, duration, and intensity. This systematic review and meta-analysis aimed to investigate the effects of continuous moderate exercise (CON) or high-intensity interval training (HIIT) to improve endothelial function (EF) in HTx. The search was conducted in Cochrane Central Registry of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Web of Science and Scopus/Elsevier, CINAHL/Ebsco, Physiotherapy Evidence Database (PEDro), LILACS/BIREME, and SciELO databases. Quality of the evidence was assessed using the Grading of Recommendations Assessment Development and Evaluation (GRADE). The search strategy retrieved 5192 titles. A total of four articles met the inclusion criteria and were included for the qualitative analysis. Meta-analysis showed that exercises improved EF ([mean difference-MD] 3.48 95% CI - 0.29 to 7.25, p = 0.007) when compared with the control. However, there was a poor quality of evidence to demonstrate that CON or HIIT is better than usual care to improve EF. Exercise training provides benefits to patients, but the poor quality of evidence does not allow us to state that exercise is related to endothelial function improvement in HTx.

Impact of a supervised strength training or walking training over a subsequent unsupervised therapy period on walking capacity in patients with claudication.

Previous studies have demonstrated that supervised strength training (ST) or walking training (WT) improve walking capacity in patients with claudication. However, it remains unknown whether these improvements would be sustained over a subsequent unsupervised period. This article reports the findings of a study to analyze whether the improvements in walking capacity, achieved with a supervised ST or WT, would be sustained over a subsequent unsupervised therapy period in patients with claudication. Patients were initially randomized to supervised exercise consisting of ST (n = 15) or WT (n = 15) for 12 weeks. After this period, 12 patients in each group consented to be followed for an additional 12 weeks of unsupervised therapy. Initial claudication distance (ICD) and total walking distance (TWD) were measured at baseline, after the supervised period (Week 12) and after the unsupervised period (Week 24). In comparison with baseline values, both groups similarly increased ICD and TWD at Week 12. From Week 12 to Week 24, both groups similarly decreased ICD (ST: -55 ± 110 m and WT: -82 ± 142 m, P =.04) and TWD (ST: -68 ± 186 m and WT: -128 ± 112 m, P < .01). However, in both groups, ICD (ST: +126 ± 149 m and WT: +50 ± 167 m, P = .01) and TWD (ST: +104 ± 162 m and WT: +45 ± 139 m, P =.01) at Week 24 remained greater than baseline values. The conclusion is that supervised ST or WT followed by an unsupervised therapy period similarly decreased walking capacity in patients with claudication. However, after the unsupervised period, walking capacity remained at a higher level than before the onset of the supervised exercise-training period.