Recent literature suggests that resistance training (RT) improves peak oxygen uptake (V˙ O2 peak), similarly to aerobic exercise (AE) in patients with heart failure (HF), but its effect on cardiac remodeling is controversial. Thus, we examined the effects of RT and AE on V˙ O2 peak and cardiac remodeling in patients with heart failure (HF) via a systematic review and meta-analysis. MEDLINE, EMBASE, Cochrane Library and CINAHL, AMEDEO and PEDro databases search were extracted study characteristics, exercise type, and ventricular outcomes. The main outcomes were V˙ O2 peak (ml kg−1 min−1 ), LVEF (%) and LVEDV (mL). Fifty-nine RCTs were included. RT produced a greater increase in V˙ O2 peak (3.57 ml kg−1 min−1, P < 0.00001, I2 = 0%) compared to AE (2.63 ml kg−1 min−1, P < 0.00001, I2 = 58%) while combined RT and AE produced a 2.48 ml kg−1 min−1 increase in V˙ O2; I2 = 69%) compared to control group. Comparison among the three forms of exercise revealed similar effects on V˙ O2 peak (P = 0.84 and 1.00, respectively; I2 = 0%). AE was associated with a greater gain in LVEF (3.15%; P < 0.00001, I2 = 17%) compared to RT alone or combined exercise which produced similar gains compared to control groups. Subgroup analysis revealed that AE reduced LVEDV (− 10.21 ml; P = 0.007, I2 = 0%), while RT and combined RT and AE had no effect on LVEDV compared with control participants. RT results in a greater gain in V˙ O2 peak, and induces no deleterious effects on cardiac function in HF patients.