Effects of different exercise modes on cardiopulmonary function in patients with coronary artery disease: a systematic review and meta-analysis

Exercise interventions present advantageous outcomes for patients with Coronary Artery Disease (CAD). Nevertheless, there is a persistent discourse surrounding the optimal exercise modality, particularly in CTE. This research employed meta-analysis to identify the most effective exercises for improving cardiorespiratory fitness in CAD patients. This systematic review comprehensively searched databases like Web of Science, PubMed, Embase, SPORTDiscus, Cochrane Library, CNKI, and Wanfang for RCTs on exercise interventions in CAD patients published from January 1, 2010, to December 31, 2023. Two researchers screened the literature and extracted data using predefined criteria. The included studies were then assessed for quality, subgroup analysis, sensitivity analysis, and publication bias evaluation. This study included 23 literatures with a total of 1,730 CAD patients. The evaluated exercise modalities comprised aerobic exercise (AE), high-intensity interval training (HIIT), aerobic combined with resistance exercise (AE&RE), Chinese traditional exercise (CTE), and aerobic combined with Chinese traditional exercise (AE&CTE). The results demonstrated that exercise intervention had a significant impact on various physiological parameters, including oxygen consumption peak (VO2 peak) (MD = 2.86, 95%CI: 2.00 ~ 3.73, P < 0.001), oxygen pulse (O2 pulse) (MD = 1.55, 95%CI: 0.57 ~ 2.53, P < 0.01), left ventricular ejection fraction (LVEF) (MD = 3.56, 95%CI: 1.61 ~ 5.52, P < 0.01), and anaerobic threshold (AT) (MD = 2.00, 95%CI: 1.16 ~ 2.84, P < 0.01), with significant improvements observed. Subgroup analysis found that all exercise modalities (AE&CTE, HIIT, AE&RE, and AE) were associated with significant improvements in VO2 peak, with AE&CTE (MD = 3.62) and HIIT (MD = 3.60) showing numerically larger effect sizes, followed by AE&RE (MD = 2.67) and AE (MD = 2.59). LVEF improvements were observed across AE&RE (MD = 2.49) and AE subgroups (MD = 3.05), while O2 pulse showed increase in the AE&CTE (MD = 2.16) and AE&RE subgroups (MD = 1.03). For AT, AE&RE (MD = 2.03) demonstrated notable improvements. Exercise intervention significantly improves VO2 peak, O2 pulse, LVEF, and AT in patients with CAD. Numerically larger effect estimates were observed for AE&CTE and HIIT on VO2 peak, for AE&CTE and AE&RE on O2 pulse, and for AE&RE on LVEF and AT. In clinical or rehabilitation settings, exercise prescriptions should be tailored to the individual patient’s specific functional deficits and therapeutic objectives.