심부전을 진단받으면 운동을 줄여야 할 것 같은 생각이 들지만, 오히려 적절한 운동 처방이 삶의 질과 기능 회복에 결정적 역할을 한다. 특히 유산소 운동에 근력 운동을 더하면 어떤 효과가 있을까.
*Journal of Sport and Health Science*에 2026년 발표된 이 체계적 고찰 및 메타분석은 13,965개 연구를 검색해 최종 15개 연구(n=526, 여성 17%, HFrEF 466명·HFpEF 60명)를 분석했다. 유산소 훈련(AT)만 받은 그룹과 유산소+근력 병행 훈련(CT) 그룹을 비교했다.
심폐 기능이 병행 훈련에서 유의하게 더 향상됐다. 최대산소섭취량으로 대표되는 심폐 체력(CRF) 증가가 CT 그룹에서 유의하게 컸다(SMD=0.40, 95%CI: 0.10~0.71, p=0.01). 이는 소~중간 효과크기에 해당한다.
6분 보행 거리도 병행 훈련 후 48.4m 더 늘었다. 6분 보행 테스트(6MWT)는 일상 기능 능력의 실용적 지표다. CT 그룹에서 48.4m 더 증가해(MD=48.4m, 95%CI: 35.6~61.0m, p<0.001) 임상적으로 의미 있는 개선을 보였다.
상체 근력도 8.3kg 더 향상됐다. 상체 근력(MD=8.3kg, 95%CI: 3.2~13.4kg, p=0.02)에서도 병행 훈련이 우위를 보였다. HIIT와 근력 훈련의 병행도 HIIT 단독보다 심폐 기능 향상에 더 효과적이었다.
삶의 질(HRQoL)과 심장 기능 지표에서는 두 그룹 간 유의한 차이가 없었다. 이번 메타분석의 한계로는 여성 비율이 17%에 불과해 성별 대표성이 낮았으며, HFpEF 환자 수가 60명으로 매우 적어 보존 박출률 심부전에 대한 결론 도출에는 한계가 있다.
심부전을 진단받은 후 재활 프로그램에 참여할 때는 담당 의사와 상의해 주 2~3회 유산소 운동(걷기, 자전거, 수영)에 가벼운 저항 운동을 추가하는 것을 검토해볼 수 있다. 특히 HFrEF 환자에서 근력 요소를 포함한 운동이 심폐 기능을 더 크게 개선할 수 있다.
📖 *Combined strength and aerobic training vs. aerobic training alone in patients with heart failure: A systematic review and meta-analysis (메타분석, 15개 연구, 526명)* |
논문 원문
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Exercise is now a cornerstone of heart failure management — but not all exercise programs are equal. A comprehensive new meta-analysis finds that adding strength training to aerobic exercise delivers measurably greater gains in cardiorespiratory fitness, walking capacity, and muscle strength compared to aerobic training alone.
Published in the *Journal of Sport and Health Science* in 2026, this systematic review and meta-analysis screened 13,965 studies and included 15 randomized controlled trials involving 526 participants (17% female). The vast majority — 466 patients (89%) — had heart failure with reduced ejection fraction (HFrEF), while 60 (11%) had heart failure with preserved ejection fraction (HFpEF). Participating institutions spanned Canada, Slovenia, Japan, and the UK.
Combined training (CT) significantly outperformed aerobic training (AT) alone on cardiorespiratory fitness. The increase in peak exercise capacity (VO2 peak or equivalent) was greater in the CT group, with a standardized mean difference of SMD=0.40 (95%CI: 0.10–0.71, p=0.01) — a small-to-medium effect size that carries meaningful clinical significance for heart failure patients, who often have severely limited exercise tolerance.
The 6-minute walk test distance improved by an additional 48.4 meters with combined training. The 6-minute walk test (6MWT) is a validated measure of functional exercise capacity closely linked to daily activity performance and quality of life. A 48.4-meter additional improvement (MD=48.4m, 95%CI: 35.6–61.0m, p<0.001) in the CT group exceeds the minimal clinically important difference for this test in heart failure patients.
Upper body muscle strength increased by an additional 8.3 kg. This finding (MD=8.3 kg, 95%CI: 3.2–13.4 kg, p=0.02) is particularly relevant for heart failure patients who experience pronounced peripheral muscle weakness. Importantly, when exercise session duration was matched between groups, combined training still outperformed aerobic-only training — suggesting the benefit comes from the strength component itself, not just additional exercise volume.
HIIT combined with muscle strength training also outperformed HIIT alone. Subgroup analysis confirmed that even when aerobic training took the form of high-intensity interval training, adding a muscle strength component produced greater CRF gains.
However, no significant differences were found in health-related quality of life (HRQoL) or cardiac function measures such as ejection fraction. The meta-analysis also has notable limitations: the study population was predominantly male (83%), and HFpEF was represented by only 60 patients — insufficient to draw firm conclusions for that growing population. Longer follow-up data and more female participants are needed.
For heart failure patients pursuing cardiac rehabilitation, discussing the addition of supervised resistance training with your cardiologist or rehabilitation specialist is well-supported by this evidence. Even light resistance exercises — targeting both upper and lower body muscle groups — may meaningfully enhance the benefits of your aerobic training program.
📖 *Combined strength and aerobic training vs. aerobic training alone in patients with heart failure: A systematic review and meta-analysis (meta-analysis, 15 RCTs, n=526)* |
Source
*This article is based on published medical research. Individual health outcomes may vary; consult your cardiologist before modifying your exercise program.*
