Network meta-analysis reveals resistance training offers largest LVEF gains for adult heart failure patients compared to other exercise types
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Key Takeaway
Resistance training showed the largest LVEF improvement with a mean difference of 9.9 points and highest SUCRA probability of 93.1%.
This network meta-analysis evaluated five exercise interventions against control in adult patients with heart failure. The study included aerobic exercise, resistance training, combined exercise, mind-body exercise, and high-intensity interval training. Researchers analyzed data from 3,519 participants to determine which approach most effectively improved left ventricular ejection fraction.
results showed that resistance training produced the largest treatment effect with a mean difference of 9.9 percentage points. High-intensity interval training followed as the second most effective intervention with a mean difference of 8.4 points. Combined exercise and aerobic exercise ranked third and fourth respectively, demonstrating smaller but still positive effects on cardiac function.
SUCRA ranking probabilities confirmed resistance training as the optimal choice with a 93.1% probability of being the best intervention. Dose-response analysis indicated a non-linear quadratic relationship between exercise volume and LVEF improvement. The optimal dosage range for general exercise was found between 500 and 800 MET-minutes per week.
Evidence certainty ranged from very low to moderate across comparisons per CINeMA framework. These findings support a precision-based rehabilitation strategy centered on resistance training to optimize cardiac function in this population.
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View Original Abstract ↓
ObjectiveTo compare the effects of various exercise modalities and doses on left ventricular ejection fraction (LVEF) in patients with heart failure.MethodsWe systematically searched eight electronic databases through December 2025. Randomized controlled trials involving adult HF patients were eligible. Interventions comprised aerobic exercise (AE), resistance training (RT), combined exercise (CE), mind-body exercise (ME), high-intensity interval training (HIIT), and control. Random-effects network meta-analysis was employed to estimate mean differences with 95% credible intervals, and surface under the cumulative ranking curve probabilities were calculated. Nonlinear dose-response relationships were modeled using MET-minutes per week.Results42 RCTs comprising 3,519 participants were included. Network meta-analysis demonstrated that all exercise modalities significantly improved LVEF compared with control. Resistance training showed the largest treatment effect (MD: 9.9; 95% CrI: 6.5, 13.0), followed by HIIT (MD: 8.4; 95% CrI: 4.2, 12.0), CE (MD: 6.0; 95% CrI: 2.9, 9.0), and AE (MD: 5.2; 95% CrI: 3.3, 7.1). SUCRA rankings indicated RT had the highest probability of being optimal (93.1%), followed by HIIT (76.1%), ME (55.3%), CE (46.0%), and AE (29.5%). Dose-response analysis revealed a non-linear quadratic relationship between MET-minutes per week and LVEF improvement. The minimum effective dose was 280 MET-minutes/week, with the optimal dosage range of 500–800 MET-minutes/week. Modality-specific patterns emerged: RT produced benefits at low doses (220 MET-minutes/week; optimal 330–440), whereas HIIT required higher thresholds (440 MET-minutes/week; optimal 560–780). Evidence certainty ranged from very low to moderate across comparisons per CINeMA framework.ConclusionsResistance training is the most effective exercise modality for improving LVEF in HF patients, particularly at low-to-moderate doses. These findings support a precision-based rehabilitation strategy centered on RT to optimize cardiac function.Systematic Review RegistrationPROSPERO, CRD420261329239.
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