Comparative efficacy of various exercise types and doses for quality of life in patients with heart failure: a network and dose–response meta-analysis

Background Heart failure (HF) significantly compromises quality of life (QoL). Although exercise interventions are a well-established strategy for improving QoL in patients with HF, the efficacy of various exercise modalities and effective doses remains unclear. This study aims to ascertain the efficacy of different exercise modalities and their relative doses in optimizing QoL in patients with HF. Methods This systematic review and network meta-analysis searched PubMed, Web of Science, Embase, MEDLINE, and Cochrane databases. Randomized controlled trials (RCTs) involving exercise interventions were included. Data on dose metrics (METs-min/week), treatment regimens, exercise intensity, and study duration were extracted and analyzed. Results Thirty RCTs involving 1,780 participants were included in the review. High-intensity interval training (HIIT), combined aerobic and resistance training (CT), mind–body exercise (MBE), and resistance training (RT) all demonstrated substantial efficacy in improving QoL compared with the control group (SMD = −0.59, −0.57, −0.58, and −0.57; SUCRA: 64.8%, 63.9%, 62.1%, and 62%, respectively). The optimal doses were approximately 750, 1,000, 390, and 490 METs-min/week for HIIT, CT, MBE, and RT, respectively. While aerobic exercise (AE) also demonstrated efficacy, the observed therapeutic benefit was modest. Conclusion HIIT, CT, MBE, and RT exhibit strong and comparable efficacy in improving QoL in patients with HF, whereas AE offers a more modest benefit. MBE demonstrates efficacy at relatively low doses, while CT and HIIT yield progressive improvements with increasing doses. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251181909 , PROSPERO CRD420251181909.