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Effectiveness of various exercise interventions on peak VO2 and quality of life in patients with heart failure with preserved ejection fraction (HFpEF): a network meta-analysis
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DOI：10.1186/s12872-026-05787-9.png)
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Abstract
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Background Heart failure with preserved ejection fraction (HFpEF) is a prevalent and challenging subtype of heart failure, with limited effective treatment options, especially for improving functional capacity and quality of life. Exercise interventions have shown potential benefits for patients with HFpEF; however, the relative efficacy of different exercise modalities remains unclear. Objective This study aimed to evaluate and compare the effects of various exercise interventions on peak oxygen uptake (peak VO2) and quality of life in patients with HFpEF using a network meta-analysis approach. Methods A systematic search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library to identify randomized controlled trials (RCTs) evaluating exercise interventions in HFpEF patients. Eligible studies included those comparing exercise modalities such as high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), inspiratory muscle training (IMT), usual care (UC), and no-exercise control. Data on peak VO2 (mL/kg/min) and Minnesota Living with Heart Failure Questionnaire (MLWHF) scores were extracted. A network meta-analysis was performed to assess relative efficacy, and surface under the cumulative ranking (SUCRA) values were calculated for each intervention. Results A total of 14 RCTs comprising 810 participants were included. For peak VO2, compared to no exercise (medical treatment without structured exercise), IMT showed the largest numerical improvement (mean difference [MD] 3.29 mL/kg/min; 95% confidence interval [CI]: 0.76 to 5.82), followed by HIIT (MD 2.77 mL/kg/min; 95% CI: 0.85 to 4.69) and MICT (MD 1.90 mL/kg/min; 95% CI: 0.63 to 3.17). Usual care showed no significant difference from no exercise (MD 0.36; 95% CI: -1.77 to 2.49). Head-to-head comparisons among HIIT, MICT, and IMT did not reach statistical significance. Regarding quality of life, IMT demonstrated a significant reduction in MLWHF scores compared to UC (MD -10.20; 95% CI: -19.13 to -1.28). MICT and HIIT showed numerical improvements that did not reach statistical significance (MICT vs UC: MD -6.00, 95% CI: -16.28 to 4.28; HIIT vs UC: MD -6.00, 95% CI: -22.46 to 10.46). SUCRA rankings indicated that IMT had the highest probability of being the best intervention for peak VO2 (SUCRA = 88.5%) and quality of life (SUCRA = 80.7%), while HIIT ranked second for peak VO2 (SUCRA = 88.2%). Conclusion Among the exercise modalities analyzed, IMT and HIIT demonstrated the most substantial improvements in peak VO2 for patients with HFpEF, whereas IMT showed the greatest benefit for enhancing quality of life. However, head-to-head differences among exercise modalities were not statistically significant, and peak VO2 is a composite outcome reflecting multiple physiological systems. These findings suggest that exercise intervention selection should be individualized based on patient-specific limitations and therapeutic goals in HFpEF management.
Keywords:
HFpEF
Exercise intervention
Network meta-analysis
Peak VO2
Quality of life
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