{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:52:34Z","timestamp":1792000354305,"version":"4.4.0"},"reference-count":82,"publisher":"National Institute for Health and Care Research","issue":"25","license":[{"start":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T00:00:00Z","timestamp":1556668800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["15\/80\/30"],"award-info":[{"award-number":["15\/80\/30"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"\n Background<\/jats:title>\n Current national and international guidelines on the management of heart failure (HF) recommend exercise-based cardiac rehabilitation (ExCR), but do not differentiate this recommendation according to patient subgroups.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n (1) To obtain definitive estimates of the impact of ExCR interventions compared with no exercise intervention (control) on mortality, hospitalisation, exercise capacity and health-related quality of life (HRQoL) in HF patients; (2) to determine the differential (subgroup) effects of ExCR in HF patients according to their age, sex, left ventricular ejection fraction, HF aetiology, New York Heart Association class and baseline exercise capacity; and (3) to assess whether or not the change in exercise capacity mediates for the impact of the ExCR on final outcomes (mortality, hospitalisation and HRQoL), and determine if this is an acceptable surrogate end point.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n This was an individual participant data (IPD) meta-analysis.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n An international literature review.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n HF patients in randomised controlled trials (RCTs) of ExCR.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n ExCR for at least 3 weeks compared with a no-exercise control, with 6 months\u2019 follow-up.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n All-cause and HF-specific mortality, all-cause and HF-specific hospitalisation, exercise capacity and HRQoL.<\/jats:p>\n <\/jats:sec>\n \n Data sources<\/jats:title>\n IPD from eligible RCTs.<\/jats:p>\n <\/jats:sec>\n \n Review methods<\/jats:title>\n RCTs from the Exercise Training Meta-Analysis of Trials for Chronic Heart Failure (ExTraMATCH\/ExTraMATCH II) IPD meta-analysis and a 2014 Cochrane systematic review of ExCR (Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, et al<\/jats:italic>. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev<\/jats:italic> 2014;4<\/jats:bold>:CD003331).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Out of the 23 eligible RCTs (4398 patients), 19 RCTs (3990 patients) contributed data to this IPD meta-analysis. There was a wide variation in exercise programme prescriptions across included studies. Compared with control, there was no statistically significant difference in pooled time-to-event estimates in favour of ExCR, although confidence intervals (CIs) were wide: all-cause mortality had a hazard ratio (HR) of 0.83 (95% CI 0.67 to 1.04); HF-related mortality had a HR of 0.84 (95% CI 0.49 to 1.46); all-cause hospitalisation had a HR of 0.90 (95% CI 0.76 to 1.06); and HF-related hospitalisation had a HR of 0.98 (95% CI 0.72 to 1.35). There was a statistically significant difference in favour of ExCR for exercise capacity and HRQoL. Compared with the control, improvements were seen in the 6-minute walk test (6MWT) (mean 21.0 m, 95% CI 1.57 to 40.4 m) and Minnesota Living with Heart Failure Questionnaire score (mean \u20135.94, 95% CI \u20131.0 to \u201310.9; lower scores indicate improved HRQoL) at 12 months\u2019 follow-up. No strong evidence for differential intervention effects across patient characteristics was found for any outcomes. Moderate to good levels of correlation (R<\/jats:italic>\n 2<\/jats:sup>\n trial<\/jats:sub>\u2009>\u200950% and p<\/jats:italic>\u2009>\u20090.50) between peak oxygen uptake (V<\/jats:italic>O2<\/jats:sub>peak) or the 6MWT with mortality and HRQoL were seen. The estimated surrogate threshold effect was an increase of 1.6 to 4.6\u2009ml\/kg\/minute for V<\/jats:italic>O2<\/jats:sub>peak.<\/jats:p>\n <\/jats:sec>\n \n Limitations<\/jats:title>\n There was a lack of consistency in how included RCTs defined and collected the outcomes: it was not possible to obtain IPD from all includable trials for all outcomes and patient-level data on exercise adherence was not sought.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In comparison with the no-exercise control, participation in ExCR improved the exercise and HRQoL in HF patients, but appeared to have no effect on their mortality or hospitalisation. No strong evidence was found of differential intervention effects of ExCR across patient characteristics. V<\/jats:italic>O2<\/jats:sub>peak and 6MWT may be suitable surrogate end points for the treatment effect of ExCR on mortality and HRQoL in HF. Future studies should aim to achieve a consensus on the definition of outcomes and promote reporting of a core set of HF data. The research team also seeks to extend current policies to encourage study authors to allow access to RCT data for the purpose of meta-analysis.<\/jats:p>\n <\/jats:sec>\n \n Study registration<\/jats:title>\n This study is registered as PROSPERO CRD42014007170.<\/jats:p>\n <\/jats:sec>\n \n Funding<\/jats:title>\n The National Institute for Health Research Health Technology Assessment programme.<\/jats:p>\n <\/jats:sec>","DOI":"10.3310\/hta23250","type":"journal-article","created":{"date-parts":[[2019,5,29]],"date-time":"2019-05-29T14:10:44Z","timestamp":1559139044000},"page":"1-98","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":54,"title":["Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis"],"prefix":"10.3310","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3043-6011","authenticated-orcid":true,"given":"Rod S","family":"Taylor","sequence":"first","affiliation":[{"name":"Institute of Health Research, University of Exeter Medical School, Exeter, UK"},{"name":"Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4201-1093","authenticated-orcid":true,"given":"Sarah","family":"Walker","sequence":"additional","affiliation":[{"name":"Institute of Health Research, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3607-0508","authenticated-orcid":true,"given":"Oriana","family":"Ciani","sequence":"additional","affiliation":[{"name":"Institute of Health Research, University of Exeter Medical School, Exeter, UK"},{"name":"Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3833-0182","authenticated-orcid":true,"given":"Fiona","family":"Warren","sequence":"additional","affiliation":[{"name":"Institute of Health Research, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8290-6409","authenticated-orcid":true,"given":"Neil A","family":"Smart","sequence":"additional","affiliation":[{"name":"School of Science and Technology, University of New England, Armidale, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1124-234X","authenticated-orcid":true,"given":"Massimo","family":"Piepoli","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0321-7569","authenticated-orcid":true,"given":"Constantinos H","family":"Davos","sequence":"additional","affiliation":[{"name":"Biomedical Research Foundation, Academy of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2019,5]]},"reference":[{"key":"key20190527115226969_ref1-bib1","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1016\/S0140-6736(14)61889-4","article-title":"The war against heart failure: the Lancet lecture","volume":"385","author":"Braunwald","year":"2015","journal-title":"Lancet"},{"key":"key20190527115226969_ref1-bib2","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1002\/ehf2.12005","article-title":"Heart failure: preventing disease and death worldwide","volume":"1","author":"Ponikowski","year":"2014","journal-title":"ESC Heart Fail"},{"key":"key20190527115226969_ref1-bib3","volume-title":"Chronic Heart Failure in Adults: Management. Clinical Guideline [CG108]","author":"National Institute for Health and Care Excellence (NICE)","year":"2010"},{"key":"key20190527115226969_ref1-bib4","first-page":"0204","article-title":"Heart failure","volume":"2010","author":"McKelvie","year":"2010","journal-title":"BMJ Clin Evid"},{"key":"key20190527115226969_ref1-bib5","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/S0140-6736(11)61314-7","article-title":"On the horizon in heart failure","volume":"378","author":"Anonymous","year":"2011","journal-title":"Lancet"},{"key":"key20190527115226969_ref1-bib6","volume-title":"National Population Projections: 2016-Based Statistical Bulletin","author":"Office for National Statistics (ONS)","year":"2017"},{"key":"key20190527115226969_ref1-bib7","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1053\/euhj.1998.1280","article-title":"Incidence and aetiology of heart failure; a population-based study","volume":"20","author":"Cowie","year":"1999","journal-title":"Eur Heart J"},{"key":"key20190527115226969_ref1-bib8","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1016\/S0735-1097(03)00947-1","article-title":"Noncardiac comorbidity increases preventable hospitalizations and mortality among Medicare beneficiaries with chronic heart failure","volume":"42","author":"Braunstein","year":"2003","journal-title":"J Am Coll Cardiol"},{"key":"key20190527115226969_ref1-bib9","doi-asserted-by":"publisher","first-page":"1504","DOI":"10.1177\/2047487314559853","article-title":"Exercise-based cardiac rehabilitation in patients with heart failure: a meta-analysis of randomised controlled trials between 1999 and 2013","volume":"22","author":"Lewinter","year":"2015","journal-title":"Eur J Prev Cardiol"},{"key":"key20190527115226969_ref1-bib10","doi-asserted-by":"publisher","first-page":"CD003331","DOI":"10.1002\/14651858.CD003331.pub4","article-title":"Exercise-based rehabilitation for heart failure","volume":"4","author":"Taylor","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"key20190527115226969_ref1-bib11","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.1016\/j.amjcard.2013.01.303","article-title":"Meta-analysis of aerobic interval training on exercise capacity and systolic function in patients with heart failure and reduced ejection fractions","volume":"111","author":"Haykowsky","year":"2013","journal-title":"Am J Cardiol"},{"key":"key20190527115226969_ref1-bib12","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.ijcard.2012.05.070","article-title":"Effects of exercise training for heart failure with preserved ejection fraction: a systematic review and meta-analysis of comparative studies","volume":"162","author":"Taylor","year":"2012","journal-title":"Int J Cardiol"},{"key":"key20190527115226969_ref1-bib13","doi-asserted-by":"publisher","first-page":"e240","DOI":"10.1161\/CIR.0b013e31829e8776","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines","volume":"128","author":"Yancy","year":"2013","journal-title":"Circulation"},{"key":"key20190527115226969_ref1-bib14","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1053\/euhj.2000.2440","article-title":"Recommendations for exercise training in chronic heart failure patients","volume":"22","author":"Working Group on Cardiac Rehabilitation","year":"2001","journal-title":"Eur Heart J"},{"key":"key20190527115226969_ref1-bib15","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1093\/eurheartj\/ehs104","article-title":"ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC","volume":"33","author":"McMurray","year":"2012","journal-title":"Eur Heart J"},{"key":"key20190527115226969_ref1-bib16","doi-asserted-by":"publisher","first-page":"e000787","DOI":"10.1136\/bmjopen-2011-000787","article-title":"Why do so few patients with heart failure participate in cardiac rehabilitation? A cross-sectional survey from England, Wales and Northern Ireland","volume":"2","author":"Dalal","year":"2012","journal-title":"BMJ Open"},{"key":"key20190527115226969_ref1-bib17","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1002\/ejhf.271","article-title":"ExtraHF survey: the first European survey on implementation of exercise training in heart failure patients","volume":"17","author":"Piepoli","year":"2015","journal-title":"Eur J Heart Fail"},{"key":"key20190527115226969_ref1-bib18","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1136\/bmj.37938.645220.EE","article-title":"Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH)","volume":"328","author":"Piepoli","year":"2004","journal-title":"BMJ"},{"key":"key20190527115226969_ref1-bib19","doi-asserted-by":"publisher","first-page":"1439","DOI":"10.1001\/jama.2009.454","article-title":"Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial","volume":"301","author":"O\u2019Connor","year":"2009","journal-title":"JAMA"},{"key":"key20190527115226969_ref1-bib20","doi-asserted-by":"publisher","first-page":"e000163","DOI":"10.1136\/openhrt-2014-000163","article-title":"Exercise-based rehabilitation for heart failure: systematic review and meta-analysis","volume":"2","author":"Sagar","year":"2015","journal-title":"Open Heart"},{"key":"key20190527115226969_ref1-bib21","doi-asserted-by":"publisher","first-page":"e1001855","DOI":"10.1371\/journal.pmed.1001855","article-title":"Individual participant data (IPD) meta-analyses of randomised controlled trials: guidance on their use","volume":"12","author":"Tierney","year":"2015","journal-title":"PLOS Med"},{"key":"key20190527115226969_ref1-bib22","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1001\/jama.2015.3656","article-title":"Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data: the PRISMA-IPD Statement","volume":"313","author":"Stewart","year":"2015","journal-title":"JAMA"},{"key":"key20190527115226969_ref1-bib23","volume-title":"Exercise Training for Chronic Heart Failure (ExTraMATCH II): Protocol for an Individual Participant Data Meta-Analysis PROSPERO","author":"Taylor"},{"key":"key20190527115226969_ref1-bib24","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1016\/j.amjmed.2003.11.033","article-title":"Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity","volume":"116","author":"Smart","year":"2004","journal-title":"Am J Med"},{"key":"key20190527115226969_ref1-bib25","doi-asserted-by":"publisher","first-page":"c221","DOI":"10.1136\/bmj.c221","article-title":"Meta-analysis of individual participant data: rationale, conduct, and reporting","volume":"340","author":"Riley","year":"2010","journal-title":"BMJ"},{"key":"key20190527115226969_ref1-bib26","doi-asserted-by":"publisher","first-page":"d7762","DOI":"10.1136\/bmj.d7762","article-title":"Assessment of publication bias, selection bias, and unavailable data in meta-analyses using individual participant data: a database survey","volume":"344","author":"Ahmed","year":"2012","journal-title":"BMJ"},{"key":"key20190527115226969_ref1-bib27","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1016\/j.ijcard.2014.04.203","article-title":"Exercise training for chronic heart failure (ExTraMATCH II): protocol for an individual participant data meta-analysis","volume":"174","author":"Taylor","year":"2014","journal-title":"Int J Cardiol"},{"key":"key20190527115226969_ref1-bib28","volume-title":"Budgeting for Involvement: Practical Advice on Budgeting for Actively Involving the Public in Research Studies","author":"Cartwright","year":"2013"},{"key":"key20190527115226969_ref1-bib29","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"key":"key20190527115226969_ref1-bib30","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"key20190527115226969_ref1-bib31","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/XEB.0000000000000020","article-title":"Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX","volume":"13","author":"Smart","year":"2015","journal-title":"Int J Evid Based Healthc"},{"key":"key20190527115226969_ref1-bib32","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"key20190527115226969_ref1-bib33","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0","author":"The Cochrane Collaboration"},{"key":"key20190527115226969_ref1-bib34","volume-title":"An Introduction to Survival Analysis Using Stata","author":"Cleves","year":"2016","edition":"3rd edn."},{"key":"key20190527115226969_ref1-bib35","doi-asserted-by":"publisher","first-page":"1870","DOI":"10.1002\/sim.3165","article-title":"Meta-analysis of continuous outcomes combining individual patient data and aggregate data","volume":"27","author":"Riley","year":"2008","journal-title":"Stat Med"},{"key":"key20190527115226969_ref1-bib36","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s12955-016-0425-7","article-title":"The Minnesota Living with Heart Failure Questionnaire: comparison of different factor structures","volume":"14","author":"Bilbao","year":"2016","journal-title":"Health Qual Life Outcomes"},{"key":"key20190527115226969_ref1-bib37","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1016\/S0735-1097(00)00531-3","article-title":"Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure","volume":"35","author":"Green","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"key20190527115226969_ref1-bib38","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/BF02602348","article-title":"Development and testing of a new measure of health status for clinical trials in heart failure","volume":"4","author":"Guyatt","year":"1989","journal-title":"J Gen Intern Med"},{"key":"key20190527115226969_ref1-bib39","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/1471-2466-10-31","article-title":"The six minute walk test accurately estimates mean peak oxygen uptake","volume":"10","author":"Ross","year":"2010","journal-title":"BMC Pulm Med"},{"key":"key20190527115226969_ref1-bib40","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1016\/S0140-6736(05)60821-5","article-title":"Shuttle-walk test to assess chronic heart failure","volume":"352","author":"Keell","year":"1998","journal-title":"Lancet"},{"key":"key20190527115226969_ref1-bib41","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.physio.2004.08.009","article-title":"Reproducibility and validity of the incremental shuttle walking test in patients following coronary artery bypass surgery","volume":"91","author":"Fowler","year":"2005","journal-title":"Physiotherapy"},{"key":"key20190527115226969_ref1-bib42","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1007\/s11897-017-0330-3","article-title":"Six-minute walk test for assessing physical functional capacity in chronic heart failure","volume":"14","author":"Du","year":"2017","journal-title":"Curr Heart Fail Rep"},{"key":"key20190527115226969_ref1-bib43","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1161\/CIRCULATIONAHA.112.105890","article-title":"Validation of 6-minute walk distance as a surrogate end point in pulmonary arterial hypertension trials","volume":"126","author":"Gabler","year":"2012","journal-title":"Circulation"},{"key":"key20190527115226969_ref1-bib44","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1177\/0962280209105014","article-title":"Mediation and moderation of treatment effects in randomised controlled trials of complex interventions","volume":"19","author":"Emsley","year":"2010","journal-title":"Stat Methods Med Res"},{"key":"key20190527115226969_ref1-bib45","volume-title":"Explanation in Causal Inference: Methods for Mediation and Interaction","author":"VanderWeele","year":"2015"},{"key":"key20190527115226969_ref1-bib46","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1002\/pst.207","article-title":"Surrogate threshold effect: an alternative measure for meta-analytic surrogate endpoint validation","volume":"5","author":"Burzykowski","year":"2006","journal-title":"Pharm Stat"},{"key":"key20190527115226969_ref1-bib47","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1038\/nrclinonc.2010.43","article-title":"Biomarkers and surrogate end points \u2013 the challenge of statistical validation","volume":"7","author":"Buyse","year":"2010","journal-title":"Nat Rev Clin Oncol"},{"key":"key20190527115226969_ref1-bib48","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1017\/S0266462314000300","article-title":"Validation of surrogate endpoints in advanced solid tumors: systematic review of statistical methods, results, and implications for policy makers","volume":"30","author":"Ciani","year":"2014","journal-title":"Int J Technol Assess Health Care"},{"key":"key20190527115226969_ref1-bib49","doi-asserted-by":"publisher","first-page":"d549","DOI":"10.1136\/bmj.d549","article-title":"Interpretation of random effects meta-analyses","volume":"342","author":"Riley","year":"2011","journal-title":"BMJ"},{"key":"key20190527115226969_ref1-bib50","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1161\/01.CIR.99.9.1173","article-title":"Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome","volume":"99","author":"Belardinelli","year":"1999","journal-title":"Circulation"},{"key":"key20190527115226969_ref1-bib51","doi-asserted-by":"publisher","first-page":"3095","DOI":"10.1001\/jama.283.23.3095","article-title":"Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: a randomized trial","volume":"283","author":"Hambrecht","year":"2000","journal-title":"JAMA"},{"key":"key20190527115226969_ref1-bib52","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1067\/mhj.2002.123310","article-title":"Effects of exercise training in patients with heart failure: the Exercise Rehabilitation Trial (EXERT)","volume":"144","author":"McKelvie","year":"2002","journal-title":"Am Heart J"},{"key":"key20190527115226969_ref1-bib53","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1053\/euhj.1999.1485","article-title":"Safety and effects of physical training in chronic heart failure. Results of the Chronic Heart Failure and Graded Exercise study (CHANGE)","volume":"20","author":"Wielenga","year":"1999","journal-title":"Eur Heart J"},{"key":"key20190527115226969_ref1-bib54","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/S0167-5273(00)00383-1","article-title":"Effects on quality of life, symptoms and daily activity 6 months after termination of an exercise training programme in heart failure patients","volume":"77","author":"Willenheimer","year":"2001","journal-title":"Int J Cardiol"},{"key":"key20190527115226969_ref1-bib55","first-page":"647","article-title":"Multidisciplinary non-pharmachological intervention prevents hospitalization, improves morbidity rates and functional status in patients with congestive heart failure","volume":"18","author":"Zanelli","year":"1997","journal-title":"Eur Heart J"},{"key":"key20190527115226969_ref1-bib56","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1016\/j.jacc.2012.06.036","article-title":"10-year exercise training in chronic heart failure: a randomized controlled trial","volume":"60","author":"Belardinelli","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"key20190527115226969_ref1-bib57","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1016\/j.ahj.2007.12.033","article-title":"Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial","volume":"155","author":"Zwisler","year":"2008","journal-title":"Am Heart J"},{"key":"key20190527115226969_ref1-bib58","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/j.ahj.2007.07.019","article-title":"Effects of a home-based exercise program on clinical outcomes in heart failure","volume":"154","author":"Dracup","year":"2007","journal-title":"Am Heart J"},{"key":"key20190527115226969_ref1-bib59","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.jpsychores.2010.01.013","article-title":"Combined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure","volume":"69","author":"Gary","year":"2010","journal-title":"J Psychosom Res"},{"key":"key20190527115226969_ref1-bib60","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1161\/01.CIR.0000081780.38477.FA","article-title":"Antiremodeling effect of long-term exercise training in patients with stable chronic heart failure: results of the Exercise in Left Ventricular Dysfunction and Chronic Heart Failure (ELVD-CHF) Trial","volume":"108","author":"Giannuzzi","year":"2003","journal-title":"Circulation"},{"key":"key20190527115226969_ref1-bib61","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1093\/eurjhf\/hfn029","article-title":"A randomized trial of the addition of home-based exercise to specialist heart failure nurse care: the Birmingham Rehabilitation Uptake Maximisation study for patients with Congestive Heart Failure (BRUM-CHF) study","volume":"11","author":"Jolly","year":"2009","journal-title":"Eur J Heart Fail"},{"key":"key20190527115226969_ref1-bib62","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1177\/0269215507079097","article-title":"Exercise capacity, physical activity patterns and outcomes six years after cardiac rehabilitation in patients with heart failure","volume":"21","author":"Mueller","year":"2007","journal-title":"Clin Rehabil"},{"key":"key20190527115226969_ref1-bib63","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1016\/j.amjcard.2008.06.046","article-title":"Long-term effects of a group-based high-intensity aerobic interval-training program in patients with chronic heart failure","volume":"102","author":"Nilsson","year":"2008","journal-title":"Am J Cardiol"},{"key":"key20190527115226969_ref1-bib64","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1016\/j.amjcard.2005.01.031","article-title":"Effect of a seated exercise program to improve physical function and health status in frail patients > or =\u200970 years of age with heart failure","volume":"95","author":"Witham","year":"2005","journal-title":"Am J Cardiol"},{"key":"key20190527115226969_ref1-bib65","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1161\/CIRCHEARTFAILURE.111.963132","article-title":"Efficacy and cost of an exercise program for functionally impaired older patients with heart failure: a randomized controlled trial","volume":"5","author":"Witham","year":"2012","journal-title":"Circ Heart Fail"},{"key":"key20190527115226969_ref1-bib66","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1001\/archinternmed.2011.150","article-title":"Tai chi exercise in patients with chronic heart failure: a randomized clinical trial","volume":"171","author":"Yeh","year":"2011","journal-title":"Arch Intern Med"},{"key":"key20190527115226969_ref1-bib67","doi-asserted-by":"publisher","first-page":"1835","DOI":"10.1016\/j.jacc.2005.12.050","article-title":"Aerobic training decreases B-type natriuretic peptide expression and adrenergic activation in patients with heart failure","volume":"47","author":"Passino","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"key20190527115226969_ref1-bib68","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/S0002-8703(00)90234-5","article-title":"Exercise training and myocardial remodeling in patients with reduced ventricular function: one-year follow-up with magnetic resonance imaging","volume":"139","author":"Myers","year":"2000","journal-title":"Am Heart J"},{"key":"key20190527115226969_ref1-bib69","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1097\/HJR.0b013e328334ea56","article-title":"Can a heart failure-specific cardiac rehabilitation program decrease hospitalizations and improve outcomes in high-risk patients?","volume":"17","author":"Davidson","year":"2010","journal-title":"Eur J Cardiovasc Prev Rehabil"},{"key":"key20190527115226969_ref1-bib70","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.ejheart.2004.10.004","article-title":"Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure","volume":"7","author":"Austin","year":"2005","journal-title":"Eur J Heart Fail"},{"key":"key20190527115226969_ref1-bib71","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1097\/HJR.0b013e3280114f12","article-title":"Physical training in patients with chronic heart failure of ischemic origin: effect on exercise capacity and left ventricular remodeling","volume":"14","author":"Klecha","year":"2007","journal-title":"Eur J Cardiovasc Prev Rehabil"},{"key":"key20190527115226969_ref1-bib72","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.1016\/S0735-1097(97)82540-5","article-title":"Effect of high intensity exercise training on central hemodynamic responses to exercise in men with reduced left ventricular function","volume":"29","author":"Dubach","year":"1997","journal-title":"J Am Coll Cardiol"},{"key":"key20190527115226969_ref1-bib73","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1016\/S0022-3999(97)00309-7","article-title":"Effect of exercise training on quality of life in patients with chronic heart failure","volume":"45","author":"Wielenga","year":"1998","journal-title":"J Psychosom Res"},{"key":"key20190527115226969_ref1-bib74","volume-title":"Minnesota Living with Heart Failure Questionnaire 2004","author":"American Thoracic Society (ATS)","year":"2004"},{"key":"key20190527115226969_ref1-bib75","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1002\/sim.1187","article-title":"How should meta-regression analyses be undertaken and interpreted?","volume":"21","author":"Thompson","year":"2002","journal-title":"Stat Med"},{"key":"key20190527115226969_ref1-bib76","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1161\/CIRCHEARTFAILURE.114.001995","article-title":"Prognostic significance of depression in blacks with heart failure: insights from Heart Failure: a Controlled Trial Investigating Outcomes of Exercise Training","volume":"8","author":"Mentz","year":"2015","journal-title":"Circ Heart Fail"},{"key":"key20190527115226969_ref1-bib77","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1016\/j.jchf.2018.03.017","article-title":"Validation of exercise capacity as a surrogate endpoint in exercise-based rehabilitation for heart failure: a meta-analysis of randomized controlled trials","volume":"6","author":"Ciani","year":"2018","journal-title":"JACC Heart Fail"},{"key":"key20190527115226969_ref1-bib78","doi-asserted-by":"publisher","first-page":"2057","DOI":"10.1002\/sim.4780141902","article-title":"Practical methodology of meta-analyses (overviews) using updated individual patient data. Cochrane Working Group","volume":"14","author":"Stewart","year":"1995","journal-title":"Stat Med"},{"key":"key20190527115226969_ref1-bib79","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1111\/j.1749-6632.1993.tb26345.x","article-title":"The Cochrane Collaboration: preparing, maintaining, and disseminating systematic reviews of the effects of health care","volume":"703","author":"Chalmers","year":"1993","journal-title":"Ann N Y Acad Sci"},{"key":"key20190527115226969_ref1-bib80","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.7326\/0003-4819-124-12-199606150-00004","article-title":"Exercise training in patients with heart failure. A randomized, controlled trial","volume":"124","author":"Keteyian","year":"1996","journal-title":"Ann Intern Med"},{"key":"key20190527115226969_ref1-bib81","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1186\/s13063-016-1238-z","article-title":"Contacting authors to retrieve individual patient data: study protocol for a randomized controlled trial","volume":"17","author":"Veroniki","year":"2016","journal-title":"Trials"},{"key":"key20190527115226969_ref1-bib82","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1016\/S0002-8703(02)00148-5","article-title":"Effects of exercise training on left ventricular volumes and function in patients with nonischemic cardiomyopathy: application of magnetic resonance myocardial tagging","volume":"104","author":"Myers","year":"2002","journal-title":"Am Heart J"}],"container-title":["Health Technology Assessment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta23250\/hta23250.xml","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2003466","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta23250\/hta23250.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2029247","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T15:40:41Z","timestamp":1692114041000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/hta\/hta23250"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5]]},"references-count":82,"journal-issue":{"issue":"25","published-online":{"date-parts":[[2019,5]]}},"alternative-id":["10.3310\/hta23250"],"URL":"https:\/\/doi.org\/10.3310\/hta23250","relation":{},"ISSN":["1366-5278","2046-4924"],"issn-type":[{"value":"1366-5278","type":"print"},{"value":"2046-4924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5]]},"assertion":[{"value":"This content has been made freely available to all.","name":"free","label":"Free to read"}]}}