Effects of physical activity on anxiety and depression symptoms in patients with heart failure: A systematic review and meta-analysis of randomized controlled trials

To investigate the effects of physical activity on depression and anxiety in heart failure patients. We searched eight major electronic databases covering all records up to December 20th, 2025. The meta-analysis of 46 RCTs ( N = 4358) investigated the effects of physical activity on these symptoms. Physical activity was defined as skeletal muscle-induced movement resulting in energy expenditure, encompassing aerobic (walking), resistance (isometric), and mind-body (Tai Chi) forms. The analysis showed physical activity significantly improved depressive and anxiety symptoms. Subgroup analysis revealed combined aerobic-resistance-mind-body training yielded the largest effect for depression, while aerobic-mind-body training was most effective for anxiety. For depression, 4–5 times/week yielded greatest benefits, with ⩽8 weeks as optimal duration. For anxiety, daily physical activity showed largest effect, also with ⩽8 weeks optimal. These findings provide evidence-based references for clinicians to integrate exercise prescriptions into routine psychological care.