Effects of exercises based on ACSM recommendations on patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials

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• Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 26 July 2026): Exercise in HFpEF improves capacity and QoL
• Picked for Physiology (medical) (top studies of the week, 26 July 2026).

Abstract

OBJECTIVE: This study aimed to evaluate the effects of exercise training following the American College of Sports Medicine (ACSM) guidelines on exercise capacity, quality of life, and left ventricular function in patients with heart failure with preserved ejection fraction (HFpEF). METHODS: PubMed, Embase, Web of Science, and the Cochrane Library were searched for randomized controlled trials (RCTs) comparing exercise interventions with usual care in patients with HFpEF. Primary outcomes included exercise capacity (6-MWT, Peak VO2, quality of life (total score of MLHFQ), LVEF, and diastolic function indicator (E/e' ratio). The included studies were subgrouped for analysis into a high-adherence group (≥70%) and a low/uncertain-adherence group based on their compliance with the ACSM exercise recommendations. RESULTS: A total of 19 RCT involving 1490 participants were included in this meta-analysis. Pooled results demonstrated that exercise training compliant with ACSM guidelines significantly improved exercise capacity, including the 6-MWT (SMD = 0.82, 95% CI: 0.34 to 1.30, P = 0.0008) and Peak VO2 (SMD = 0.63, 95% CI: 0.36 to 0.91, P < 0.00001). The intervention also markedly enhanced patients' quality of life reflected by the MLHFQ total score (SMD = -0.52, 95% CI: -0.84 to -0.20, P = 0.05). Marginally significant improvements were observed in left ventricular ejection fraction (SMD = 0.19, 95% CI: 0.00 to 0.38, P = 0.05) and E/e' ratio (SMD = -0.14, 95% CI: -0.29 to 0.00, P = 0.05).Subgroup analyses stratified by adherence to ACSM recommendations (≥70% vs. <70%) showed that the high-adherence group achieved statistically greater improvements in 6-MWT (P = 0.03) and peak VO2 (P = 0.003). Although the high-adherence group obtained larger effect sizes for MLHFQ scores and LVEF, the between-group differences did not reach statistical significance. No significant intergroup differences were found in other diastolic function indicators. CONCLUSION: This study indicates that implementing the ACSM-recommended exercise regimen with high adherence can effectively improve exercise capacity, quality of life, and certain left ventricular function parameters in patients with HFpEF. Stratified analysis by ACSM adherence enriches evidence for individualized HFpEF exercise rehabilitation and guides clinical exercise strategy optimization.

Abstract as published, via PubMed.