Effects of aerobic combined with resistance exercise on cardiopulmonary function in patients with coronary heart disease: a bayesian meta-analysis based on dose-response, baseline status, and other moderators

Coronary artery disease (CHD) is one of the major public health problems worldwide. International guidelines recommend ongoing management of metabolic abnormalities and improved prognosis through combined aerobic and resistance exercise (CE), and the aim of this study was to investigate the effects of CE and exercise dose on cardiorespiratory fitness, as measured by maximum oxygen uptake (VO2max), in patients with CHD. We conducted a systematic search of PubMed, Embase, the Cochrane Library, and Web of Science, with the search limited to the date of the inception of the database to January 2025 to identify randomized controlled trials (RCTs). Pairwise and regression meta-analyses of these results were conducted using Bayesian stratified models based on random effects. The 12 RCTs included a total of 697 patients. The results show that CE significantly increased the VO2max of coronary heart disease patients compared with the control group that did not exercise (MD = 3.1 ml/kg/min; 95%CrI: 2.57, 3.64; GRADE: Low). In addition, there is a nonlinear positive correlation between the weekly CE dose and the level of improvement in VO2max, with a minimum dose of 310 METs-min/week. The magnitude of VO2max improvement is more pronounced in patients with lower baseline cardiorespiratory fitness and gradually decreases with age. CE showed significant benefit in improving cardiorespiratory function in patients with CHD. In addition, even lower doses of CE (≥ 310 MET-min/week) improved cardiorespiratory fitness, and the gain was progressively apparent before reaching a critical threshold. The findings suggest that clinical practice should tailor exercise regimens to patient age and baseline VO2max.