Combined Exercise Shows Added Benefit for a Common Heart Failure Type
A new meta-analysis finds that for patients with heart failure with reduced ejection fraction (HFrEF), a regimen combining aerobic and strength training yields greater improvements in aerobic fitness, walking distance, and upper body strength than aerobic training alone.
A systematic review and meta-analysis published in the Journal of Sport and Health Science has found that, for patients with a specific type of heart failure, a combined regimen of aerobic and muscle strength training yields greater improvements in certain physical measures than aerobic training alone. The analysis, which synthesized data from 15 previous studies, found these benefits were specific to patients with heart failure with reduced ejection fraction (HFrEF).
Study Details and Methodology
The research, led by Tasuku Terada, was published online on March 23, 2026. The team conducted a systematic review and meta-analysis of studies directly comparing combined aerobic and muscle strength training to aerobic training alone in patients with heart failure.
The analysis included data from 15 studies involving a total of 526 patients. Of these participants, 466 (89%) had heart failure with reduced ejection fraction (HFrEF), while 60 (11%) had heart failure with preserved ejection fraction (HFpEF). The study population was predominantly male (83%) and 17% female.
Key Findings for HFrEF Patients
For patients diagnosed with HFrEF, the pooled analysis indicated that combined training led to statistically greater improvements compared to aerobic training alone in the following areas:
- Aerobic fitness
- Walk test distance
- Upper body muscle strength
These superior effects on aerobic fitness and walking distance were maintained even in scenarios where the total exercise session duration was matched between the two training groups.
A specific analysis noted that high-intensity interval training (HIIT) combined with muscle strength training increased aerobic fitness more than HIIT alone in patients with HFrEF.
The analysis found no statistically significant differences between combined training and aerobic training alone for:
- Lower body muscle strength
- Health-related quality of life (HRQoL)
Adherence, Safety, and Study Limitations
- Overall adherence to the combined training regimen was reported as high or comparable to adherence for aerobic training alone.
- Dropout rates and the risk of adverse events were found to be comparable between the combined training group and the aerobic training alone group.
- The researchers noted that the available evidence was insufficient to draw clear conclusions about the effects of combined training in patients with HFpEF, indicating a need for further study in this population.
Background and Context
Heart failure is a condition reported to affect more than 64 million people worldwide, with a general adult population prevalence of 1%–3%. Prevalence is projected to increase. The condition is commonly categorized into two main types:
- HFrEF: Where the heart muscle is too weak to pump blood effectively.
- HFpEF: Where the heart muscle becomes stiff and cannot relax sufficiently to fill with blood.
Previous research has established that aerobic training, resistance training, and HIIT independently improve various outcomes—such as aerobic fitness, walking distance, muscle strength, and quality of life—in heart failure patients. The comparative effectiveness of a combined training approach versus aerobic training alone had not been clearly established prior to this analysis.
Research Conclusions
Based on the findings, the researchers concluded that for patients with HFrEF, allocating exercise time within a fixed period to both aerobic and strength training may be a more effective strategy for improving aerobic fitness than dedicating the entire period to aerobic training alone. They noted that combining HIIT with strength training could represent a time-efficient approach.
The study suggests that, given the comparable adherence and safety profiles, replacing a portion of an aerobic training regimen with muscle strength training may be an effective strategy to improve specific outcomes in patients with HFrEF.