Resistance exercise enhances oxygen uptake without worsening cardiac function in patients with systolic heart failure: a systematic review and meta-analysis

Recent literature suggests that resistance training (RT) improves peak oxygen uptake (\( \dot{\mathrm{V}}{\mathrm{O}}_2 \) peak), similarly to aerobic exercise (AE) in patients with heart failure (HF), but its effect on cardiac remodeling is controversial. Thus, we examined the effects of RT and AE on \( \dot{\mathrm{V}}{\mathrm{O}}_2 \) peak and cardiac remodeling in patients with heart failure (HF) via a systematic review and meta-analysis. MEDLINE, EMBASE, Cochrane Library and CINAHL, AMEDEO and PEDro databases search were extracted study characteristics, exercise type, and ventricular outcomes. The main outcomes were \( \dot{\mathrm{V}}{\mathrm{O}}_2 \) peak (ml kg⁻¹ min⁻¹), LVEF (%) and LVEDV (mL). Fifty-nine RCTs were included. RT produced a greater increase in \( \dot{\mathrm{V}}{\mathrm{O}}_2 \) peak (3.57 ml kg⁻¹ min⁻¹, P < 0.00001, I ² = 0%) compared to AE (2.63 ml kg⁻¹ min⁻¹, P < 0.00001, I ² = 58%) while combined RT and AE produced a 2.48 ml kg⁻¹ min⁻¹ increase in \( \dot{\mathrm{V}}{\mathrm{O}}_2 \); I ² = 69%) compared to control group. Comparison among the three forms of exercise revealed similar effects on \( \dot{\mathrm{V}}{\mathrm{O}}_2 \) peak (P = 0.84 and 1.00, respectively; I ² = 0%). AE was associated with a greater gain in LVEF (3.15%; P < 0.00001, I ² = 17%) compared to RT alone or combined exercise which produced similar gains compared to control groups. Subgroup analysis revealed that AE reduced LVEDV (− 10.21 ml; P = 0.007, I ² = 0%), while RT and combined RT and AE had no effect on LVEDV compared with control participants. RT results in a greater gain in \( \dot{\mathrm{V}}{\mathrm{O}}_2 \) peak, and induces no deleterious effects on cardiac function in HF patients.