BACKGROUND: Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory. AIM: To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients. METHODS: This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT-Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT-Pl (inspiratory muscle training with low pressure, 10% to 15% MIP), IMT-Pm (inspiratory muscle training with medium pressure, 30% to 40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), aerobics (aerobic exercise or weight training), Qi-Ex (Tai Chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data. RESULTS: A total of 1,499 subjects from 31 RCT studies were included. IMT-Ph had the highest effect sizes for VO2peak and 6MWT, IMT-Pm highest for QoL, and Qi-Ex highest for heart rate. Aerobics had the second highest for VO2peak, Qi-Ex second highest for 6MWT, and IMT-Ph second highest for heart rate and QoL. CONCLUSION: This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.

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