Comparative efficacy of different mind-body exercises on functional capacity and quality of life in patients with chronic heart failure: a systematic review and network meta-analysis.

BACKGROUND AND

OBJECTIVE

Mind-body exercise (MBE) has emerged as a vital adjunctive modality in the rehabilitation of chronic heart failure (CHF). However, the relative advantages of various MBE types in improving functional capacity and quality of life (QoL) remain elusively defined. This study aimed to compare the therapeutic efficacy of different MBEs on clinical outcomes in CHF patients using a network meta-analysis (NMA).

METHODS

A systematic search was conducted across databases including PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) investigating MBE interventions in CHF, spanning from database inception to January 12, 2026. Two researchers independently performed literature screening, data extraction, and risk of bias assessment (RoB 2.0). R software was utilized for network meta-analysis, SUCRA (Surface Under the Cumulative Ranking Curve) ranking, cluster analysis, and Egger's test for publication bias. The certainty of evidence was evaluated using the CINeMA (Confidence in Network Meta-Analysis) framework.

RESULTS

Twenty-eight RCTs were ultimately included. The NMA results indicated that Yijinjing was significantly superior to conventional care in improving quality of life (MLHFQ), cardiopulmonary endurance (Peak VO2), and cardiac systolic function (LVEF), as well as in reducing cardiac load indicators (NT-proBNP). Furthermore, Yijinjing yielded the highest SUCRA values (0.858-1.000) across these outcomes, demonstrating a high potential intervention probability. Regarding the enhancement of exercise tolerance (6MWD), Meditation showed the highest potential probability (SUCRA = 0.675); however, pairwise comparisons revealed no statistically significant differences between any MBE and conventional care (p > 0.05). Cluster analysis further confirmed a synergistic trend of Yijinjing, Liuzijue, and Meditation in enhancing both QoL and exercise endurance. No significant publication bias was detected by Egger's test for any outcome (p > 0.05). The certainty of evidence based on CINeMA was rated as Moderate.

CONCLUSION

Based on moderate-certainty evidence, Yijinjing shows the highest potential probability for promoting cardiac functional recovery and enhancing quality of life in CHF patients, while meditation particularly of the movement-integrated type shows potential advantages in strengthening functional exercise tolerance. Given the lack of statistical significance in certain indicators (e.g., 6MWD), future intervention designs should focus on the regulatory effects of mind-body integration on kinesiophobia to develop more precise and long-term validated rehabilitation strategies.

SYSTEMATIC REVIEW REGISTRATION: www.crd.york.ac.uk/prospero, CRD420261308623.