Objective:

To compare the effects of various exercise modalities (aerobic exercise, resistance training, combined exercise, mind-body exercise, high-intensity interval training) and doses on left ventricular ejection fraction (LVEF) in patients with heart failure.

Key Findings:

• 42 RCTs with 3,519 participants were included.
• All exercise modalities significantly improved LVEF compared to control (p < 0.05).
• Resistance training showed the largest treatment effect (MD: 9.9; 95% CrI: 6.5, 13.0).
• HIIT, CE, and AE followed in effectiveness with MDs of 8.4, 6.0, and 5.2 respectively.
• RT had the highest probability of being optimal (93.1%).
• Minimum effective dose was 280 MET-minutes/week; optimal range was 500–800 MET-minutes/week.

Interpretation:

Resistance training is the most effective exercise modality for improving LVEF in HF patients, particularly at low-to-moderate doses, suggesting a need for clinical integration of resistance training in rehabilitation programs.

Limitations:

• Evidence certainty ranged from very low to moderate across comparisons.
• Language bias due to inclusion of only English and Chinese studies, potentially limiting the applicability of findings.

Conclusion:

These findings support a precision-based rehabilitation strategy centered on resistance training to optimize cardiac function, emphasizing the role of exercise in heart failure management.