The effects of combined endurance and resistance exercise training in heart failure: a meta-analysis

To evaluate the efficacy of Combined endurance and resistance exercise training in patients with heart failure (HF) and provide an evidence-based foundation for clinical management.

A comprehensive search was conducted across domestic and international databases from inception to November 2025 for studies on Combined endurance and resistance exercise training in HF. Study quality was evaluated using the Cochrane Risk of Bias tool. Literature management was performed using NoteExpress 3.2. Data collection and extraction were conducted with Excel 2003. Statistical analysis was performed using RevMan 5.4.1 software. Heterogeneity was determined via the Q-test (P-value). Accordingly, the pooled effect size was calculated as the mean difference (MD) or odds ratio (OR) using a fixed- or random-effects model. Forest plots were generated, and publication bias was assessed via funnel plots.

Nine studies met the inclusion criteria. Meta-analysis results demonstrated that, compared to the control group, the intervention group showed significantly greater improvement in peak oxygen consumption (MD = 4.36, 95% CI: 1.68-7.04, P = 0.001) and quality of life (MD = -9.32, 95% CI: -16.92 to -1.71, P = 0.02). Performance on the six-minute walk test was also significantly better in the intervention group (MD = 53.76, 95% CI: 38.81-68.70, P < 0.0001). However, no statistically significant differences were observed between the two groups regarding sleep parameters or depression levels. Sensitivity analysis indicated that the findings were stable and reliable. Funnel plot results suggest a relatively low possibility of publication bias.

Combined endurance and resistance exercise training is beneficial for improving clinical outcomes in HF patients.