Effects of Baduanjin on exercise tolerance, cardiac function, and quality of life in patients with heart failure: A systematic review and meta-analysis

Heart failure (HF) remains a significant health burden around the world, and Baduanjin is an effective intervention for patients with HF. This study aimed to objectively evaluate the effects of Baduanjin on exercise tolerance, cardiac function, and quality of life in patients with HF. From the time the database was constructed to May 8, 2025, we searched eight databases and two registry systems. Clinical randomized controlled trials (RCTs) of Baduanjin in treating HF were retrieved. The primary outcomes were the 6-minute walk test (6MWT) and left ventricular ejection fraction (LVEF). Secondary outcomes were left ventricular end-diastolic dimension (LVDD), left ventricular end-systolic dimension (LVSD), N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP), BNP levels, Minnesota Living with Heart Failure Questionnaire (MLHFQ), Anaerobic threshold (AT), Metabolic equivalent of task (MET), peak oxygen consumption (VO 2 peak), and Maximal oxygen consumption (VO 2 max). Two researchers performed rigorous data extraction and quality assessment. The quality of the included RCTs was evaluated using the Cochrane Risk of Bias assessment tool, version 2.0 (RoB 2), and statistical analyses were performed using RevMan 5.4 and Stata 17.0 software. A total of 46 RCTs involving 3597 people were included in this study. Meta-analysis showed that Baduanjin could improve the 6MWT [ MD=50.71, 95% CI (37.48, 63.94), P <0.01], LVEF [ MD=3.57, 95% CI (2.70, 4.45), P <0.01], LVDD [ MD = -2.33, 95% CI (-2.82, -1.84), P <0.01], LVSD [ MD = -1.83, 95% CI (-2.31, -1.36), P < 0.01], NT-proBNP levels [ MD = -139.49, 95% CI (-204.08, -74.89), P < 0.01], BNP levels [ MD = -77.68, 95% CI (-110.80, -44.56), P < 0.01], MLHFQ [ MD = -8.15, 95% CI (-12.31, -3.99), P < 0.01], MLHFQ-E [ MD = -3.23, 95% CI (-3.71, -2.74), P < 0.01], MLHFQ-P [ MD = -3.23, 95% CI (-4.17, -3.29), P < 0.01], MLHFQ-G [ MD = -3.56, 95% CI (-4.76, -2.35), P < 0.01], AT [ MD= 1.65, 95% CI (1.22, 2.09), P <0.01], MET [ MD=0.65, 95% CI (0.12, 1.19), P ＜0.05], VO 2 peak [ MD= 1.36, 95% CI (0.40, 2.31), P ＜0.01], and VO 2 max [ MD= 2.21, 95% CI (1.05, 3.37), P < 0.01] when compared to control groups, and the subgroup analyses showed that the efficacy of 3 months of continuous intervention with Baduanjin was the best. Our study is the first comprehensive meta-analysis to evaluate the treatment of HF with Baduanjin. The results suggest that Baduanjin improves exercise tolerance, cardiac function, and quality of life in patients with HF. • Our study is the first comprehensive meta-analysis to evaluate the treatment of Heart failure with Baduanjin. • The results suggest that Baduanjin improves exercise tolerance, cardiac function, and quality of life in patients with Heart failure. • Baduanjin exercise with a duration of 3 months is the most effective.