Effects of exercise based cardiac rehabilitation delivery modes on chronic heart failure: a systematic review and network meta-analysis

Chronic heart failure (CHF) represents one of the most severe and advanced stages of cardiovascular disease. Despite the critical importance of cardiac rehabilitation (CR) in CHF management, while studies have explored the effectiveness of various CR delivery modes and offered valuable context-specific insights, their relative efficacy remains inconsistent across different patient groups, healthcare environments, and intervention approaches. A clearer understanding requires comprehensive comparisons and in-depth analyses to address these variations. Systematic searches were conducted in databases including Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science, up to August 2024. Two researchers independently screened the literature according to strict inclusion criteria, extracted relevant data, and assessed the quality of included studies using Cochrane Collaboration tools and the Jadad scale. Subsequent pairwise and network meta-analyses were performed using statistical software, including Stata 17.0, to present the results graphically. The network meta-analysis included 9,552 articles, with 33 meeting the inclusion criteria and examining eleven different interventions. All interventions outperformed routine care. Combined CR with aerobic exercise and resistance training (HCR [AE + RE]) significantly improved Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores and 6-min walk test (6MWT) performance, and reduced rehospitalization rates [SUCRA = 96%]. Center-based cardiac rehabilitation (CBCR) with high-intensity interval training (HIIT) was the most effective in enhancing left ventricular ejection fraction (LVEF), while CBCR(AE) demonstrated the greatest improvement in peak oxygen uptake (Peak VO 2 ) [RR = 3.64, 95% CI: 1.66–7.95]. Our analysis identifies HCR (AE + RE) as the most effective intervention for improving quality of life (MLHFQ), exercise capacity (6MWT), and reducing hospital readmissions. CBCR (HIIT) was optimal for enhancing cardiac function through improved LVEF, while CBCR (AE) effectively boosted peak VO 2 . PROSPERO: CRD42024517039, Review Completed not published.