In patients with HFrEF, combined strength and aerobic training increased cardiorespiratory fitness more than aerobic training alone (SMD 0.40; 95% CI 0.10 to 0.71; p=0.02).
Systematic Review (n=526)
Does combined aerobic and muscle strength training improve cardiorespiratory fitness, functional capacity, muscle strength, and quality of life compared to aerobic training alone in patients with heart failure?
Combined aerobic and strength training is more effective than aerobic training alone for improving cardiorespiratory fitness, walking distance, and muscle strength in patients with HFrEF.
Standardized Mean Difference: 0.4 (95% CI 0.1–0.71)
p-value: p=0.02
Abstract Background Heart failure (HF) is characterised by low exercise tolerance, progressive functional decline, and reduced health-related quality of life (HRQoL). Available evidence supports the independent benefits of aerobic training (AT) and muscle strength training in improving the conditions of HF. However, the effects of combined AT and muscle strength training (combined training) in HF remain unclear. Purpose The purpose of this systematic review and meta-analysis was to compare the effects of combined training and more frequently prescribed AT alone in patients with HF across the spectrum of ejection fraction (EF). Methods A systematic search was conducted on MEDLINE, EMBASE, CINAHL, SPORTDiscus, Scopus, trial registries, and grey literature that compared combined training with AT alone on cardiorespiratory fitness (CRF), 6-minute walk test (6MWT) distance, muscle strength, and HRQoL in patients with HF with reduced ejection fraction (HFrEF) and those with preserved EF (HFpEF). Pooled estimates were derived using random-effects models. Subgroup analyses were pre-specified for HF type (HFrEF or HFpEF), exercise type (high-intensity interval training HIIT or moderate-intensity continuous training), and exercise volume (equivalent or non-equivalent exercise session duration between combined and AT alone). Heterogeneity was quantified using the I² statistic. Results Of 13,965 studies screened, 15 trials were included (n=526, HFrEF: n=466, 89%, EF ranging from 23±4% to 38±14%, and HFpEF: n=60, 11%). There were 57 females with HFrEF (12 %) and 31 females with HFpEF (52%). In patients with HFrEF, combined training increased CRF (standardized mean difference SMD 0.40, 95%CI 0.10 to 0.71, p=0.02; I²=33%, p (I²)=0.08), 6MWT distance (mean difference MD 48.4 m, 95%CI 10.3 to 86.4 m, p=0.04; I²=0%, p (I²)=0.64), and upper body muscle strength (MD 8.3 kg, 95%CI 3.2 to 13.4 kg, p=0.01; I²=0%, p (I²)=0.45) more than AT alone. The superior effects of combined training on CRF in HFrEF persisted in subgroup analyses limited to trials with equivalent exercise session duration (SMD 0.44, 95%CI 0.13 to 0.75, p=0.01, I²=29%, p (I²)=0.10). HIIT combined with muscle strength training increased CRF more than HIIT alone (SMD 0.68, 95%CI 0.31 to 1.05, p=0.01, I²=0%, p (I²)=0.20). There were no differences in HRQoL between combined and AT alone. Conclusions In patients with HFrEF, combined training had greater effects on CRF, 6MWT distance, and upper body muscle strength compared to AT alone. When matched for exercise session duration, its superior effect on CRF suggests that combined training may be a more time-efficient approach to improving CRF in patients with HFrEF. HIIT may also be combined with muscle strength training to induced further increases in CRF. The small representativeness of HFpEF underscores the need for further research to clarify the effects of concurrent training in HFpEF.
Terada et al. (Mon,) conducted a systematic review in Heart failure (n=526). Combined strength training and aerobic training vs. Aerobic training alone was evaluated on Cardiorespiratory fitness (CRF) in HFrEF (SMD 0.40, 95% CI 0.10 to 0.71, p=0.02). In patients with HFrEF, combined strength and aerobic training increased cardiorespiratory fitness more than aerobic training alone (SMD 0.40; 95% CI 0.10 to 0.71; p=0.02).