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Am Fam Physician. 2004;69(9):2195

Clinical Question: Can exercise training affect survival in patients with chronic heart failure?

Setting: Various (meta-analysis)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: This meta-analysis combined individual patient data from nine studies that involved a total of 801 patients. To identify the studies, researchers searched MEDLINE, Cochrane Reviews (but not the Database of Abstracts of Reviews of Effectiveness), abstracts from cardiology meetings published in major journals, and researchers and reference lists. In an unusual (and better) approach, the reviewers were able to obtain individual data from the researchers to combine in their meta-analysis. Usually, meta-analysis relies on summary data from each study.

During the follow-up period, which ranged from five to 54 months, there were significantly more deaths in the group that did not exercise (hazard ratio = 0.65; 95 percent confidence interval, 0.46 to 0.92; number needed to treat over two years = 17). The time to death was 618 days in the exercise group compared with 421 days in the untreated group.

Bottom Line: Exercise training for at least eight weeks significantly reduces mortality in patients who have chronic heart failure. Other research has shown the benefit of exercise training on symptoms, making it an overlooked aspect of care in this type of patient. (Common POEM) (Level of Evidence: 1a)

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see

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This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at

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