Effectiveness of different exercise modalities in Heart Failure with preserved Ejection Fraction. A systematic review with network meta-analysis.
Juan Manuel Henríquez-Jurado, Iván José Fuentes-Abolafio, Celia García-Conejo and 1 others
Four exercise types improved peak oxygen uptake over usual care in heart failure patients.
The evidence was rated very low quality, and several of these effects appeared in only one of two analysis methods.
Key findings
1Compared to usual care, combined training, inspiratory muscle training, and Tai Chi each showed an effect on peak VO2 in both analysis models, while moderate-intensity aerobic training and high-intensity interval training showed this effect only in the Frequentist model.
2Moderate-intensity aerobic training was the only exercise type that showed an effect on quality of life (MLHFQ) compared to usual care, and this held only in the Frequentist model.
31 study was rated as having some concerns and 11 as high risk of bias, and the GRADE assessment rated the evidence as very low quality for every intervention compared to usual care across all outcomes.
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What it does not show
The evidence was rated very low quality by GRADE for every outcome, and 11 of the included studies were rated as high risk of bias. Only 12 trials contributed data, so the network is small and precision is limited; several comparisons could not be tested for consistency because there were no closed loops. Heterogeneity was substantial for peak VO2, VO2 at ventilatory threshold, peak heart rate, and the 6-minute walk, which limits how confidently the pooled estimates can be applied. The large number of outcomes tested increases the chance of false-positive findings; the authors themselves recommend relying on convergence between the two statistical models. Exercise reporting in the included trials was poor (CERT completion ranged from 26% to 74%), making it hard to replicate the exact programmes. Although the inclusion criterion required a mean ejection fraction of at least 50%, the authors could not confirm the absence of individual patients below that threshold because they did not have individual-level data.
Declared interests
Funding for the open-access publication charge came from Universidad de Malaga / CBUA. The authors declare no competing interests.
The easy way to misread this
Do not select one exercise type over another for a specific HFpEF patient based on this review. The evidence was rated very low quality, nearly all included studies had high risk of bias, and most between-modality comparisons held only in one of two analysis models.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →