Exercise-based cardiac rehabilitation in patients with left ventricular assist devices: an updated systematic review and meta-analysis of randomized controlled trials

Data on the efficacy and safety of exercise-based cardiac rehabilitation (EBCR) in patients with left ventricular assist devices (LVAD) remains limited. This study aims to pool evidence on EBCR’s efficacy and safety in LVAD patients and compare high-intensity (HIIT) versus moderate-intensity (MIIT) regimens. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Embase, Cochrane, Scopus, and Web of Science up to January 2024. A fixed-effects model reported dichotomous outcomes using risk ratio (RR) and continuous outcomes using standardized mean difference (SMD) with a 95% confidence interval (CI). The study was registered in PROSPERO under the identifier ‘CRD42024506485.’ Six RCTs with 160 patients were included. No significant difference was found between EBCR and usual care for peak VO2 change [<i>p</i> = 0.22] and six-minute walk distance (6-MWD) change [<i>p</i> = 0.16]. Similarly, no significant difference was observed between HIIT and MICT for peak VO2 change [<i>p</i> = 0.52] and 6-MWD change [<i>p</i> = 0.61]. Moreover, there was no significant difference between EBCR and usual care regarding the incidence of adverse events [<i>p</i> = 0.09], and between HIIT and MICT exercise [<i>p</i> = 0.71]. The evidence suggests EBCR does not improve functional capacity, measured by peak VO2 or 6-MWD, in LVAD patients. However, EBCR is safe, with similar adverse event rates compared to usual care.