Effect of exercise on physical fitness and quality of life in patients with pulmonary embolism: a systematic review and meta-analysis

Background: Pulmonary embolism (PE) survivors frequently experience persistent dyspnea and diminished quality of life (QoL). Evidence suggests that rehabilitation exercise has a positive impact on QoL, physical fitness, and dyspnea in patients with heart disease and chronic obstructive pulmonary disease. However, the effects of exercise on patients with PE remain ambiguous. The purpose of our study was to systematically evaluate the impact of exercise on physical fitness and QoL in patients with PE. Methods: PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science (WOS) databases were searched from their inception to May 21, 2024. Two reviewers independently extracted the data and evaluated the methodological quality and risk of bias in the included studies. Results: Two studies involving 348 participants were included. This meta-analysis showed that exercise did not significantly improve the outcomes of incremental shuttle walk test (ISWT) [mean difference (MD) =60.46; 95% confidence interval (CI): -5.51, 126.42; P=0.07] or the EuroQol-5 Dimensions questionnaire (EQ-5D) (MD =0.02; 95% CI: -0.01, 0.05; P=0.14), and it did not significantly reduce pulmonary embolism quality of life (PEmbQoL) (MD =0.00; 95% CI: -0.04, 0.04; P=0.93). Conclusions: The potential benefits of exercise programs range from no improvement in ISWT and PEmb-QoL to significant improvements in both. Implementing exercises may be valuable for patients with PE. Future meticulously designed randomized controlled trials are needed to validate these findings.