Scientific Reports · Nov 8, 2026
A systematic review and meta analysis of early exercise based cardiac rehabilitation in patients hospitalized with acute heart failure
By Zhang X, Luo Z, Yang M et al.
Early exercise-based cardiac rehabilitation (ExCR) has been increasingly investigated in patients hospitalized with acute heart failure (AHF), but its effects on functional recovery and whether these effects vary across selected study-level characteristics remain uncertain. This systematic review and meta-analysis aimed to evaluate the effects of ExCR initiated during hospitalization on functional capacity in patients with AHF and to explore potential differences according to rehabilitation delivery model, World Bank country income classification, and study-level mean age. PubMed, Embase, the Cochrane Library, Web of Science, and CNKI were searched from inception to May 2026. Randomized controlled trials were eligible if they enrolled adults hospitalized with AHF, initiated a structured ExCR program during hospitalization, compared ExCR with usual care or no structured exercise intervention, and reported 6-minute walk distance (6MWD). The primary outcome was 6MWD, secondary outcomes included health-related quality of life (HRQoL), clinical events and safety. Random-effects models were used, and subgroup analyses were considered exploratory. Twelve independent randomized controlled trials were included. Early ExCR significantly improved 6MWD compared with control group (mean difference [MD] 54.44 m, 95% CI 35.62 to 73.26; I² = 60%). Exploratory subgroup analyses showed no statistically significant differences according to rehabilitation delivery model, World Bank country income classification, or study-level mean age. ExCR also showed potential benefits for disease-specific HRQoL, whereas evidence for HF-related readmission and all-cause mortality remained inconclusive. Sensitivity analyses supported the robustness of the primary 6MWD finding, although the certainty of evidence was rated as low because of risk of bias and inconsistency. Early ExCR initiated during hospitalization may improve functional capacity in patients with AHF. Exploratory subgroup analyses did not identify significant effect modification by rehabilitation delivery model, World Bank country income classification, or study-level mean age. However, the exact magnitude of benefit should be interpreted cautiously, and larger, methodologically rigorous trials are needed to clarify optimal delivery strategies and long-term clinical effects.