Exercise strategies in heart failure (HF) aim to improve functional capacity and quality of life, but the optimal training approach remains uncertain. A systematic review and meta-analysis published in the Journal of Sport and Health Science, evaluated the effects of combined aerobic training (AT) and muscle strength training compared with AT alone in patients with HF. 

A comprehensive search of multiple databases and registries was conducted. Eligible studies included patients across the spectrum of ejection fraction (EF), including heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Outcomes included cardiorespiratory fitness (CRF), 6-minute walk test (6MWT) distance, muscle strength, health-related quality of life (HRQoL), and cardiac function. Random-effects models were applied, with subgroup analyses by HF subtype and exercise characteristics.

Of 13,965 records screened, 15 studies (n=526; 17% female) were included, predominantly involving HFrEF (n=466; 89%) and fewer HFpEF cases (n=60; 11%). In HFrEF, combined training showed greater improvements in CRF (standardized mean difference [SMD] 0.40; 95% confidence interval [CI] 0.10-0.71; p=0.01), 6MWT distance (mean difference [MD] 48.4 m; 95% CI 35.6–61.0; p<0.001), and upper body muscle strength (MD 8.3 kg; 95% CI 3.2–13.4; p=0.02) compared with AT alone.

When exercise duration was matched, combined training showed greater CRF. High-intensity interval training (HIIT) combined with strength training also showed greater CRF compared with HIIT alone. No differences were observed in HRQoL or cardiac function. Combined training showed greater improvements in functional and strength outcomes in HFrEF, while evidence in HFpEF remains limited.