{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:16:45Z","timestamp":1783574205389,"version":"3.55.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"am","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Aims<\/jats:title>\n Inspiratory muscle training (\u0399\u03bc\u03a4) with high loads, an adjuvant exercise modality in cardiac rehabilitation programs, seems beneficial for patients with heart failure (HF). This systematic review and meta-analysis aims to investigate the effects of combined high \u0399\u03bc\u03a4 (H-IMT) and aerobic exercise (AE) training in patients with HF.<\/jats:p>\n <\/jats:sec>\n \n Methods and results<\/jats:title>\n A systematic search of randomized controlled trials (RCTs) was conducted across Medline (via EBSCOhost), PEDro, PubMed, Scopus, Web of Science up to 15 July 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The revised Cochrane Risk of Bias tool for randomized trials (RoB2) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were used to assess the methodological quality and overall evidence quality, respectively. A narrative synthesis of findings was completed, and meta-analysis was conducted on clinical outcomes when data were available from at least two studies. Seven RCTs were included, with female participants comprising 33% of the total sample. Interventions lasted from 6 to 16 weeks in hospital or home settings. Adding H-IMT elicits extra benefits in maximum inspiratory pressure (MIP) (MD = 15.24\u2005cm H2O, 95% CI 7.30 to 23.17, P = 0.0002), quality of life (QoL) (MD = \u22126.96 units, 95% CI \u221211.33 to \u22122.59, P = 0.002) compared with AE training. No extra benefit was reported in pulmonary indices, left ventricular ejection fraction, aerobic and functional capacity. Still, most studies (4 out of 7) had a considerable risk of bias.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Combined H-IMT and AE training may improve MIP and QoL in patients with HF. However, these findings are preliminary and based on very low-quality evidence. Larger, high-quality trials are needed to confirm benefits before broad clinical implementation.<\/jats:p>\n <\/jats:sec>\n \n Registration<\/jats:title>\n PROSPERO registration number is CRD42024568200.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag328","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T04:39:49Z","timestamp":1783571989000},"source":"Crossref","is-referenced-by-count":0,"title":["Effects of combined high-intensity inspiratory muscle training and aerobic exercise in heart failure: a systematic review and meta-analysis"],"prefix":"10.1093","author":[{"given":"Maria","family":"Isakoglou","sequence":"first","affiliation":[{"name":"Physiotherapy Department, Clinical Exercise Physiology & Rehabilitation Research Laboratory, School of Health Sciences, University of Thessaly , 3rd Old National Road Lamia-Athens, Lamia 35132 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaia","family":"Sapouna","sequence":"additional","affiliation":[{"name":"Physiotherapy Department, Clinical Exercise Physiology & Rehabilitation Research Laboratory, School of Health Sciences, University of Thessaly , 3rd Old National Road Lamia-Athens, Lamia 35132 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Andriopoulou","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Laboratory of Cardiac Rehabilitation, Asklepieio General Hospital , Vasileos Paulou 1, Voula 16673 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evdokia","family":"Billis","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Laboratory of Clinical Physiotherapy & Research, School of Health Rehabilitation Sciences, University of Patras , Building B, Central Campus, Rio, Patras 26504 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5640-0332","authenticated-orcid":false,"given":"Gerasimos","family":"Filippatos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens , Rimini 1, Chaidari, Athens 12462 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2214-5545","authenticated-orcid":false,"given":"Eleni A","family":"Kortianou","sequence":"additional","affiliation":[{"name":"Physiotherapy Department, Clinical Exercise Physiology & Rehabilitation Research Laboratory, School of Health Sciences, University of Thessaly , 3rd Old National Road Lamia-Athens, Lamia 35132 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"2026070900394209600_zwag328-B1","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global burden of heart failure: a comprehensive and updated review of epidemiology","volume":"118","author":"Savarese","year":"2023","journal-title":"Cardiovasc Res"},{"key":"2026070900394209600_zwag328-B2","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.ejheart.2008.08.005","article-title":"ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. 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