| Objective:1.Systematically search the related guidelines of cardiac rehabilitation exercise in patients with heart failure,evaluate and summarize the recommended exercise methods in different guidelines.2.The method of reticular meta analysis was used to explore the effects of different exercise modes in the literature on patients with heart failure,and to rank the effects of peak oxygen uptake,ejection fraction,6-minute walking distance and quality of life according to the probability of different exercise modes,so as to find the best evidence for clinic.Method:1.Medical keywords and keywords were used to search the guidelines in Pub Med,Embase,Webof Science,China knowledge Network,China Biomedical Database,Wanfang and other databases.At the same time,search the guide database,including the National Guide Information Center(NGC),the American Institute of Health and Care Excellence(NICE),the Scottish Intercollegiate Guide mesh(SIGN)and the Guide International mesh(GIN).A supplementary search of the official websites of the World Health Organization(WHO)and the Heart failure Association may be omitted.The search time limit is2022.6.The included guidelines are evaluated by four evaluators and the recommendations are presented in an evidence map.2.A comprehensive search of domestic and foreign databases,clinical registration platforms and other databases,according to the inclusion and exclusion criteria to include the RCTs in line with the scheme,using Cochrane bias risk assessment tool to evaluate the included RCTs,Bayesian network Meta analysis method was used to analyze the cardiac rehabilitation effects of different exercise modes in patients with heart failure,and the cumulative ranking probability(SUCRA)was used to rank the rehabilitation effects.Results:1.Clinical practice guidelines and quality evidence map of heart failure exercise rehabilitation: a total of 11 CPG were included,of which 8 CPG were dedicated to heart failure practice,and 1 CPG focused on the exercise rehabilitation practice of heart failure by physiotherapists.One CPG focuses on the practice of cardiac rehabilitation exercise in patients with chronic heart failure.The guidelines recommend that all capable patients with heart failure take exercise,which can improve their exercise ability and quality of life,and that exercise is safe and effective.However,in terms of the choice of exercise mode,26 recommendations were summarized and extracted into 8 suggestions.2.Network meta analysis of the effects of different exercise modes on cardiac rehabilitation in patients with heart failure: a total of 44 randomized controlled trials were included(involving 1914 patients with heart failure).There are 28 different exercise patterns(A:high intensity continuous resistance exercise B: high intensity continuous aerobic exercise C: high intensity continuous resistance exercise + high intensity continuous aerobic exercise E: medium intensity continuous aerobic exercise F: medium intensity intermittent aerobic exercise G: new Waltz J: high intensity intermittent exercise K:high intensity intermittent impedance exercise L: medium continuous aerobic exercise + medium intensity.Continuous Impedance exercise M: Taijiquan N: medium intensity continuous Impedance exercise O:high intensity inspiratory muscle exercise P: high intensity inspiratory muscle exercise + medium continuous aerobic exercise Q: medium continuous aerobic exercise + medium intensity continuous Impedance exercise R: yoga T: very low inspiratory muscle exercise U:high intensity inspiratory muscle exercise + high intensity intermittent exercise V: medium continuous aerobic exercise + medium intensity continuous resistance exercise.Anti-exercise + high-intensity inspiratory muscle exercise W: medium-intensity inspiratory muscle exercise X: low-intensity inspiratory muscle exercise Y: high-intensity continuous aerobic exercise + high-intensity inspiratory muscle exercise Z: high-intensity continuous aerobic exercise +pseudo-inspiratory muscle exercise a: medium-intensity intermittent aerobic exercise + high-intensity continuous resistance exercise b:medium-intensity intermittent aerobic exercise + medium-intensity continuous resistance exercise c: Tai Chi.Boxing + high intensity continuous aerobic exercise d: high intensity intermittent exercise +high intensity intermittent impedance exercise e: low to medium intensity continuous aerobic exercise f: hydrotherapy)and D: no exercise control.The results of network meta analysis showed that the order of 24 exercise modes in improving cardiopulmonary function in patients with heart failure was J>H>X>K>V>a>b>A>C>F>S>G>B>P>E>Q>Z>Y>L>M>I>O>D>T.The effect of 18 kinds of exercise on improving left ventricular ejection fraction in patients with heart failure was F>J>P>E>C>Q>B>V>G>A>O>N>Y>D>M>I>T>Z.The effect of 17 kinds of exercise on improving 6-minute walking distance in patients with heart failure was N>U>V>W>O>M>Q>F>J>E>P>I>T>R>S>H>D.The effect of 12 kinds of exercise on improving the quality of life of Zuminidas in patients with heart failure is V>P>M>U>B>I>J>O>Q>H>E>DConclusion:1.The guidelines recommend cardiac rehabilitation for patients with heart failure,but the guidelines do not recommend the best mode of exercise.2.Multiple exercise methods can improve peak oxygen uptake,ejection fraction,6-minute walking distance and quality of life in patients with chronic heart failure.3.The best exercise in improving cardiac function in patients with heart failure is high-intensity intermittent exercise.4.The best exercise for improving the quality of life of patients with heart failure is medium continuous aerobic exercise + medium intensity continuous impedance exercise + high intensity inspiratory muscle exercise.5.It is suggested that a community-based cardiac rehabilitation center should be established in the future,and a large-scale study of cardiac rehabilitation exercise suitable for Chinese patients with heart failure should be carried out,and the best evidence should be applied to clinic. |
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