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June 12, 2026European Journal of Preventive CardiologyOpen Access

In patients with HFrEF, combined training increased CRF (SMD 0.40, 95% CI 0.10 to 0.71, p=0.02), 6MWT distance (MD 48.4 m, 95% CI 10.3 to 86.4 m, p=0.04), and upper body muscle strength (MD 8.3 kg, 95% CI 3.2 to 13.4 kg, p=0.01) more than aerobic training alone.

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Why the study?

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?

Population

526 patients with heart failure from 15 trials.

Comparison

Combined aerobic training and muscle strength… vs Aerobic training alone

Design

Meta-analysis

Authors

TTT TeradaTKT KambicTNT Noda

Discussion

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Overview

Supports adding strength training to aerobic exercise in HFrEF to boost CRF and walk distance; extends meta-analytic evidence for multimodal regimens.

Key Points

  • This research aims to compare the effects of combined aerobic and muscle strength training versus aerobic training alone in heart failure patients.
  • Conducted a systematic search across major databases and trial registries.
  • Included 15 trials (n=526) focused on patients with reduced and preserved ejection fraction.
  • Used random-effects models to analyze outcomes like cardiorespiratory fitness and muscle strength.
  • In patients with reduced ejection fraction (HFrEF), combined training significantly improved cardiorespiratory fitness (SMD 0.40, 95%CI 0.10 to 0.71, p=0.02).
  • Combined training also enhanced 6-minute walk test distance by 48.4m (MD 48.4 m, 95%CI 10.3 to 86.4 m, p=0.04).
  • No significant differences were found in health-related quality of life between combined and aerobic training alone.

Structured PICO

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?

P
Population
526 patients with heart failure (HFrEF n=466, 89%, EF ranging from 23±4% to 38±14%, 12% female; HFpEF n=60, 11%, 52% female) from 15 trials.
I
Intervention
Combined aerobic training and muscle strength training
C
Comparator
Aerobic training alone
O
Outcome
Cardiorespiratory fitness (CRF), 6-minute walk test (6MWT) distance, muscle strength, and health-related quality of life (HRQoL)surrogate

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.

Limitations

  • Small representativeness of HFpEF patients

Cite This Study

Terada et al. (2026) studied this question.

synapsesocial.com/papers/6a2bd1386550ea4541ffe97fhttps://doi.org/10.1093/eurjpc/zwag249.164
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Effects of combined high-intensity inspiratory muscle training and aerobic exercise in heart failure: a systematic review and meta-analysis2026
  2. 2Impact of different exercise training modalities on patient-reported outcomes in heart failure with reduced and preserved ejection fraction2026
  3. 3Effect of Exercise Training with Consideration of Potential Moderating Variables in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis2025 · 2 citations
  4. 4Comparative effects of different strength training modalities in cardiac rehabilitation: preliminary results2026
  5. 5The role of physical exercise in management of patients with chronic heart failure2025