Effectiveness of different exercise modalities in Heart Failure with preserved Ejection Fraction. A systematic review with network meta-analysis

AIMS: The study aimed to compare the effectiveness of various exercise modalities in improving exercise performance, echocardiographic parameters and quality of life in patients with heart failure with preserved ejection fraction. METHODS: A systematic review over 7 databases was conducted up to May 2024. Randomised controlled trials analysing the efficacy of any exercise modality in isolation were included. For each variable, a Frequentist and Bayesian Network Meta-Analysis were conducted. Mean differences between groups with 95% confidence and credible intervals were calculated for each outcome. Quality of the evidence was assessed with GRADE, being very low for every outcome. RESULTS: 12 RCTs were included, providing data from 602 patients. The Frequentist model showed effectiveness for: CT on peak VO2, VO2 at ventilatory threshold (VT) and E/é ratio; high-intensity interval training (HIIT) on peak VO2, VE/VCO2 slope, cardiopulmonary exercise testing (CPET) time and E/é; inspiratory muscle training (IMT) on peak VO2, VE/VCO2 slope, RER and 6-minute walking test (6MWT); moderate-intensity aerobic training (MIAT) on peak VO2, CPET time, peak power output (PPO), 6MWT and E/é ratio; and Tai Chi on peak VO2. The Bayesian model only supports these findings for CT on peak VO2; IMT on peak VO2; MIAT on CPET time, PPO, and 6MWT; and Tai Chi on peak VO2. CONCLUSIONS: Considering both models, the evidence, albeit of very low quality, supports the effectiveness of various exercise modalities except HIIT in exercise capacity parameters (peak VO2, CPET time, PPO and 6MWT). There is an effect over VO2 at VT, VE/VCO2 slope, RER, LVEF, E/é and MLHFQ, but only supported by the Frequentist model. PROSPERO REGISTRATION NUMBER: CRD42024560028.