This systematic review evaluates the role of exercise-based rehabilitation in heart failure with preserved ejection fraction (HFpEF) by synthesizing findings from high-quality meta-analyses. A comprehensive literature search was conducted following PRISMA guidelines, identifying six meta-analyses that examined the effects of structured exercise programs, including aerobic training, resistance training, inspiratory muscle training, and supervised rehabilitation. The findings consistently demonstrate significant improvements in functional capacity, with notable increases in peak oxygen uptake (VO₂ max) and 6-minute walk test (6MWT) distance. Quality of life measures, including the Minnesota Living With Heart Failure Questionnaire (MLWHFQ) and the SF-36 physical function domain, also showed meaningful enhancements. However, the impact of exercise on diastolic function and left ventricular remodeling remains inconclusive, with limited improvements in echocardiographic parameters such as the E/A ratio and E/e' ratio. The study selection process ensured the inclusion of only meta-analyses synthesizing randomized controlled trials (RCTs), providing a high level of evidence while minimizing biases associated with individual trials. Despite variability in exercise modalities, intervention duration, and patient characteristics, the overall findings support the integration of structured exercise programs into HFpEF management strategies. Further research is needed to explore long-term myocardial adaptations, optimal training regimens, and potential synergies between exercise therapy and pharmacological interventions to enhance clinical outcomes.