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Identifying the Optimal Respiratory Muscle Training Intervention for Heart Failure Patients: A Network Meta-analysis of Randomized Controlled Trials.

Tavakoli K, Ansari A, Alaei E, Jahanfard R, Mansouri ES, Ganjalikhani M et al. · Journal of cardiology · 2026

This network meta-analysis of 88 randomized controlled trials examined which respiratory muscle training interventions work best for heart failure patients across measures like breathing strength, exercise capacity, and quality of life. Different training approaches were optimal for different outcomes: medium-intensity inspiratory muscle training improved breathing strength and walking distance, aerobic training improved lung function, and combining high-intensity inspiratory training with aerobic exercise produced the largest gains in oxygen uptake, quality of life, and reduced shortness of breath.
Takeaway: Choose your respiratory training based on your specific goal—inspiratory training for breathing strength, aerobic work for lung function, or combine high-intensity inspiratory training with cardio if you want maximum improvements in fitness and quality of life.
Abstract (source)

Background: Respiratory muscle training interventions have shown promising

Results: in improving functional capacity, quality of life, and prognosis of heart failure patients. However, the optimal respiratory muscle training intervention for rehabilitation remains unclear.

Methods: A systematic review and network meta-analysis was conducted by searching PubMed, Embase, Scopus, and Cochrane Library until September 2025 for randomized controlled trials (RCTs) evaluating the effect of respiratory muscle training interventions on maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), six-minute walk test (6MWT), peak oxygen uptake (VO 2 max), quality of life, and dyspnea. Random-effect network meta-analysis was used to estimate pooled mean differences. Interventions were ranked using the surface under the cumulative ranking curve (SUCRA).

Results A total of 88 RCTs (5,757 participants) were included. Medium-intensity inspiratory muscle training (IMT) ranked highest for improving MIP (SUCRA: 89.8%). Combined aerobic and resistance exercise was optimal for MEP (SUCRA: 79.3%). Aerobic training showed the greatest benefit for FVC (SUCRA: 94.8%) and FEV₁ (SUCRA: 93.8%). Medium-intensity IMT was most effective for enhancing 6MWT performance (SUCRA: 81.6%). A combination of high-intensity IMT with aerobic training yielded the largest gains in improving VO 2 max (SUCRA: 74.7%), quality of life (SUCRA: 81.4%), and reducing dyspnea (SUCRA: 89.3%).

Conclusion: Respiratory muscle training interventions provide different benefits across key rehabilitation outcomes in heart failure. Accordingly, rehabilitation strategies may be optimized by aligning exercise modalities with patients' rehabilitation needs, preferences, and clinical profiles, rather than adopting a uniform prescription.

Network meta-analysisEndurance & Cardiovascular
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