Combining Cardio and Strength Training Beats Cardio Alone in Heart Rehab

The evidence comes from a systematic review and meta-analysis, which pools results from many studies. It was published in 2026 in Sports Medicine - Open by Gois and colleagues. The team gathered 61 randomized controlled trials, the strongest kind of trial design, covering 5,388 randomized participants. All had coronary heart disease, meaning narrowed arteries that supply the heart.

The trials tested combined aerobic and resistance training, which the authors call CART. Resistance training means working muscles against weight or resistance. Of the 61 trials, 30 compared CART with aerobic training alone, 2 compared it with resistance training alone, and 28 compared it with usual care that included no exercise. Participants ranged in age from 45.3 to 78.5 years, and 23.4% were women. Training typically ran about 3 days a week, and programs averaged about 16 weeks.

Against usual care without exercise, the authors report that CART improved fitness, strength and quality of life. Peak oxygen consumption, a standard measure of how well the body uses oxygen during hard effort, rose by 2.20 ml/kg/min. Handgrip strength and peak muscle torque also improved. The review also found fewer deaths in the CART groups.

The comparison with aerobic training alone is the most relevant for people already in rehab. According to the authors, CART appeared superior to aerobic training for peak oxygen consumption, the 6-minute walking distance, muscle strength measured by one-repetition maximum and peak torque, and quality of life. CART was also more effective than resistance training alone for peak oxygen consumption. The authors conclude that CART should be considered a method in the rehabilitation of people with coronary heart disease.

There are limits. The mortality finding is a pooled count of events across trials. It does not show that strength training prevents death in any one person. Most trials were short, so the review says little about long-term effects. Only 41 of the 61 trials reported that the exercise was supervised, so the results may not apply to unsupervised exercise.

What follows is our suggestion, not a finding of the review. People with heart disease who are in or entering rehab might ask their care team whether the program includes strength training alongside aerobic work, and whether it is supervised. The review does not tell patients how to change their own exercise, so any change after a heart event should be decided with a clinician.

Researchers and rehab programs will next need to show which mix of aerobic and strength work, and how much of each, delivers these gains most safely, especially over longer follow-up.

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