86, 95% CI 1.11 to 12.46). Funnel plots were constructed for the five meta-analyses performed. Although they demonstrated Epigenetics inhibitor no evidence of publication bias, each plot contained four data points or fewer. This makes the power of the tests too low to distinguish change from real asymmetry (Higgins and Green, 2008). Therefore, the funnel plots are not presented. This systematic review provides some firm evidence about the effects of resistance

training on cardiac function, exercise capacity, and quality of life in people with chronic heart failure. The search for evidence was systematic and thorough. The included studies had PEDro scores of 4 to 7 (out of 10). Meta-analysis of the results was performed where possible. When compared to usual or low-intensity activity, a significant beneficial effect of resistance training on 6-minute walk distance was demonstrated based on the results of two studies. However, further research is required to determine whether this is considered clinically worthwhile by people with chronic heart

failure. The results did not indicate a beneficial effect of resistance training on cardiac function. People with chronic heart failure have reduced cardiac output because of impaired ventricular systolic or diastolic function, or both. Chronic heart failure patients primarily have elevated heart rates rather than stroke volume. This allows them to meet metabolic demands accompanied by possible high work load on the heart resulting from

Akt inhibition increased exercise intensity (Cheetham et al 2002). A study of one bout of isotonic exercise with different Phosphoprotein phosphatase intensities found minimal changes in central haemodynamics, which were well tolerated by the chronic heart failure patients (King et al 2000). Significant improvements in muscular strength as well as reduction in peripheral resistance, resulting in improved afterload to the heart, were demonstrated after long-term resistance training (Maiorana et al 2000b, Selig et al 2004, Tyni-Lenné et al 2001). Two studies found that exercise training did not alter left ventricular function regardless of exercise mode (Mandic et al 2009, Pu et al 2001), while other studies reported favourable but non-significant effects on left ventricular function (Beckers et al 2008, Feiereisen et al 2007). Notably, the participants in the former two studies had a slightly higher left ventricular ejection fraction (at 30% and 36%) at baseline than in the latter two studies (at 23% and 26%). Further study is required to examine if there was a ceiling effect or if cardiac function could adapt after exercise training. This review partially supports the belief that resistance training could elevate maximally tolerable exercise workload without changing peak oxygen consumption (Magnusson et al 1996), given the effect on 6-minute walk distance.