Abstract Aims Exercise training (ET) provides numerous benefits for heart transplant (HTx) recipients. However, direct comparisons between ET modalities remain limited. This study aims to compare the efficacy and safety of multiple ET modalities on peak oxygen consumption (peak VO2) and key secondary outcomes in HTx recipients. Methods and results We systematically searched eight electronic databases from inception to September 2024. Traditional random-effects models and Bayesian network meta-analysis were employed. Confidence in the results was evaluated using the Confidence in Network Meta-Analysis (CINeMA) tool. Thirteen randomized controlled trials involving 473 HTx recipients were analyzed. The network meta-analysis identified high-intensity interval training (HIIT) (mean difference MD: 4.34 ml.kg⁻¹.min⁻¹; 95% credible interval CrI, 1.41 to 5.6) and combined training (CT) (MD: 3.49 ml.kg⁻¹.min⁻¹; 95%CrI, 1.15 to 7.44) as the most effective interventions for improving peak VO2 compared to usual care. HIIT was also more effective than moderate-intensity continuous training (MICT) (MD: 2.09 ml.kg⁻¹.min⁻¹; 95%CrI, 0.05 to 4.03). No significant differences were observed between MICT, home-based MICT, home-based CT, and usual care. The certainty of evidence ranged from moderate to very low across comparisons. No significant differences were observed between ET modalities regarding heart rate response or ventilatory efficiency. ET was associated with improvements in specific quality of life subdomains. No exercise-related adverse events were reported. Conclusion This review demonstrates that ET significantly improves peak VO₂ in HTx recipients, with HIIT and CT outperforming usual care. HIIT also surpasses MICT in improving peak VO2. Overall, ET modalities are safe and effective for this population.
Lima et al. (2025) studied this question.