Effects of Exercise on Aerobic Capacity and Quality of Life in People with Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This study aimed to investigate the effects of exercise on aerobic capacity and quality of life (QOL) in heart failure (HF) patients and to identify the optimal exercise prescription for improving aerobic capacity and QOL. A comprehensive search was conducted in Embase, PubMed, Cochrane Library, Web of Science, and Scopus covering data published up to 9 October 2024. The Population, Intervention, Comparison, Outcome (PICO) framework was used to define the inclusion. (a) Population: patients with HF; (b) Intervention: randomized controlled trials (RCTs) with subjects randomly assigned to either the intervention or control group; (c) Comparison: studies that measured peak oxygen uptake (VO2peak), maximal oxygen uptake (VO2max), or the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at baseline and compared results post-intervention; (d) Outcome: the primary outcomes were aerobic capacity and QOL. The Physiotherapy Evidence Database (PEDro) scale and the Cochrane Risk of Bias 2 (RoB-2) tool were used to assess the quality of the included studies. Weighted mean difference (WMD), standardized mean difference (SMD), and 95% confidence interval were used to pool data. A total of 47 studies met the inclusion criteria. Exercise significantly improved aerobic capacity (WMD, 2.85, p < 0.00001) and QOL (SMD, −0.79, p < 0.00001) in HF patients. Subgroup analyses indicated that combined exercise, session duration ≥ 60 min, ≥3 sessions per week, ≥180 min per week, and supervised exercise showed more significant improvements in aerobic capacity and QOL. Additionally, exercise had greater benefits in middle-aged patients. To improve aerobic capacity and QOL, the optimal exercise prescription for HF patients involves engaging in supervised combined exercise at least three times per week, with each session lasting at least 60 min, to achieve a total weekly duration of 180 min. These recommendations are particularly relevant for middle-aged patients, who may experience greater benefits from exercise interventions. The protocol has been registered on PROSPERO with the registration number CRD420250632915.