Effect of combined aerobic and resistance training on peak oxygen consumption, muscle strength and health-related quality of life in patients with heart failure with reduced left ventricular ejection fraction: a systematic review and meta-analysis

Objective: The aim of this study was to investigate the effects of combined aerobic and resistance training on peak oxygen consumption (peak VO₂), minute ventilation/carbon dioxide production (VE/VCO₂ slope), muscle strength and health-related quality of life (HRQoL) in heart failure patients with reduced left ventricular ejection fraction (HFrEF).

Methods: We searched Cochrane, Pubmed, and PEDro (from the earliest date available to September 2018) for RCTs that evaluated the effects of combined aerobic and resistance training in HFrEF patients. Weighted mean differences (WMD), standardized mean difference (SMD), and 95% confidence interval (CI) were calculated.

Results: 39 studies met the study criteria, including 2008 patients, 14 compared combined aerobic and resistance training versus aerobic training, and 25 compared combined aerobic and resistance training versus control. Compared to aerobic training, combined aerobic and resistance training resulted in improvement in muscle strength SMD 0.7 (95% CI: 0.3 to 1.0 N = 167) and, HRQoL WMD -2.6 (95% CI: -5.0 to -0.1 N = 138). A nonsignificant difference in peak VO₂ and VE/VCO₂ slope was found for participants in the combined aerobic and resistance training group compared with aerobic training group. Compared to control, combined aerobic and resistance training resulted in improvement in peak VO₂ WMD 2.9 (95% CI: 1.6 to 4.4 N = 638), muscle strength SMD 0.64 (95% CI: 0.4 to 0.9 N = 315) and, HRQoL WMD -9.8 (95% CI: -15.2 to -4.5 N = 524).

Conclusions: Combined aerobic and resistance training improves peak VO₂, muscle strength and HRQoL and should be considered as a component of care of HFrEF patients.