Efficacy and safety of exercise rehabilitation in the vulnerable phase in patients with acute decompensated heart failure: A systematic review and meta-analysis

Abstract

Objectives

This study aimed to assess the impact of exercise rehabilitation during the vulnerable period on cardiac recovery (CR) outcomes in patients with acute decompensated heart failure (ADHF).

Methods

Multiple databases including PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang database, SinoMed, ClinicalTrials.gov, and American Heart Association (AHA) and European Society of Cardiology (ESC) were searched for RCTs on exercise rehabilitation in ADHF patients’ vulnerable period from inception to April 2, 2025. The risk of bias was assessed with Cochrane Risk of Bias 2.0, and data were analyzed in RevMan 5.3.

Results

A total of seven RCTs involving 946 patients were included. The results demonstrated that exercise rehabilitation training during the vulnerable period in patients with ADHF significantly increased the 6-min walk test distance (6-MWTD) (SMD = 0.37; 95 %CI: 0.09, 0.65; P = 0.01), short physical performance battery (SPPB) score (MD = 1.26; 95 %CI: 0.82, 1.70; P < 0.001) and peak oxygen consumption (VO₂peak) (SMD = 1.43; 95 %CI: 0.53, 2.34; P = 0.002), improved quality of life (QoL) (SMD = 0.85; 95 %CI: 0.07, 1.64, P = 0.03), reduced depression score (MD = −0.73; 95 %CI: 1.27, −0.18; P = 0.009), frailty (MD = −0.22; 95 %CI: −0.48, 0.05; P = 0.11), and decreased 6-month all-cause readmission (OR = 0.67; 95 %CI: 0.49, 0.91; P = 0.01). However, no statistically significant differences were observed between the two groups in left ventricular ejection fraction (LVEF) (MD = 0.96; 95 %CI: −1.84, 3.77; P = 0.50), 6-month heart failure (HF)-related readmission (OR = 1.01; 95 %CI: 0.66, 1.53; P = 0.98), and all-cause mortality (OR = 0.63; 95 %CI: 0.18, 2.24; P = 0.47). There were no adverse events reported.

Conclusions

Exercise rehabilitation during the vulnerable phase improves exercise tolerance, QoL, and depressive symptoms while reducing 6-month all-cause readmissions in ADHF patients, with no reported adverse events. Although trends toward improved LVEF, HF-related readmissions, and all-cause mortality were observed. Large-scale, high-quality studies are warranted to explore individualized responses and long-term outcomes.