IJCS | Volume 32, Nº4, July/August 2019

420 Gonzáles et al. Exercise and erectile dysfunction in heart Int J Cardiovasc Sci. 2019;32(4):418-427 Review Article such as renal diseases, cardiac transplantation, chronic obstructive pulmonary disease (COPD), stenosis, ventricular assist devices, and patients using any type of supplementation or experimental medication that could affect sexual function. Selection of studies The selection of studies was conducted by two independent investigators. Studies were initially screened by titles, then by abstracts, and those considered potentially eligible were selected for full reading. The divergences were resolved by consensus. Data extraction Data extraction was performed using a dataset constructed by the researchers; data were added to the dataset by one researcher and then checked by the other researcher. When necessary, the corresponding authors of the studies were contacted to clarify methodological issues or results when necessary or to provide relevant data missing from the abstract or full text. Assessment of study quality For assessment of methodological quality, we used the TESTEX (Tool for the assessment of study quality and reporting in exercise) tool. This instrument was developed specifically for use in exercise training studies. 39 Results Search results The flow chart of the search process and results of the search is shown in Figure 1. A total of 318 studies was identified in PubMed, LILACS, Cochrane-Library, Science Direct, and in the Annals of the main scientific conferences in the area. Then, studies were excluded due to duplicity and analysis of the title, abstract and full reading. Finally, three studies met the eligibility criteria. A total of 99 individuals with HF was included in this review, with mean age ranging from 53 years (± 7.48) to 58 years (± 12). Of these, 70 individuals were submitted to a supervised aerobic exercise program three times per week, and 29 were controls. In all studies, only males were included, and all patients were inNYHA functional class II (n = 37) or III (n = 62) and had left ventricular ejection fraction (LVEF) ≤ 45%. Of the selected studies, only one randomized clinical trial, conducted in Italy, was published in the format of scientific paper, 25 while the other two studies 26,40 were published in Annals of international scientific conferences. The other two studies, in the form of abstracts, were developed in Brazil by the same research group; the first study was a randomized, controlled clinical trial40 and the second one was a uncontrolled, non-randomized prospective clinical trial. 26 Intervention Protocols Regarding the intervention protocols of the selected studies in this review, in the study by Belardinelli et al., 25 the intervention was supervised exercise training with a cycle ergometer, 3x/week for 8 weeks; each session had a total duration of one hour, divided into 15 minutes of initial stretching, 40 minutes on a cycle ergometer at 60% of peak oxygen consumption (VO 2 peak) and five minutes of recovery. This study was the only one that used a control group that was not submitted to any type of physical exercise and asked to refrain from exercise during the study period. Sties et al., 26 in a prospective study, applied a supervised exercise on a treadmill 3x/week for 12 weeks, with sessions of 40 minutes of aerobic training in which individuals should remain between the anaerobic threshold and the point of respiratory compensation determined by the cardiopulmonary test. In the randomized clinical trial, Sties et al., 40 evaluated two groups submitted to different intensities of supervised exercise trainingona treadmill. The activitywas performed 3x/week for 12weeks, with sessions of 50minutes divided in 5 minutes of stretching, 40 minutes of aerobic exercise in the target training zone and 5 minutes of stretching exercises. In this study, the first group (n = 11) performed continuous aerobic exercise of moderate intensity and instructed to remain close to the first threshold (aerobic threshold), determined by cardiopulmonary test. The second group (n = 9) was submitted to interval aerobic exercise on a treadmill, in a high-intensity protocol, and instructed to remain as long as possible near the second respiratory compensation threshold. Sexual Function For assessment of sexual function, all studies used specific questionnaires. The “Sexual Activity Profile