AIM: To systematically review the methodological quality of and summarize the effects of moderate-to-high intensity resistance training (alone or in combination with endurance training) in patients with clinically stable chronic heart failure (CHF). METHODS AND RESULTS: Four non-randomized controlled trials and 6 randomized controlled trials have been identified, reviewed for relevant results, and assessed for safety monitoring and methodological quality. None of the 10 trials scored positive for all methodological criteria on the Delphi list. Failure to conceal treatment allocation, failure to blind the outcome assessor(s), failure to blind care provider and failure to use an intention-to-treat analysis strategy were the most prevalent methodological shortcomings. The effects of resistance training (alone or in combination with endurance training) are inconclusive for outcomes like exercise capacity and disease-specific quality of life. CONCLUSIONS: The current peer-reviewed literature does not provide appealing evidence that moderate-to-high intensity resistance training has statistically significant and clinically relevant positive effects on important outcome measures, such as peak aerobic capacity and disease-specific quality of life. In fact, a majority of the trials had severe methodological limitations. Even though moderate-to-high intensity resistance training does not seem be harmful for patients with CHF, the current peer-reviewed evidence seems inadequate to generally recommend incorporation of resistance training into exercise-based rehabilitation programs for patients with CHF.