Exercise Training and Rehabilitation in Heart Failure Patients

Exercise training and structured rehabilitation have become integral components in the management of patients with heart failure, offering benefits that extend beyond pharmacological and device-based therapies. Tailored exercise programmes, encompassing aerobic, resistance and combined modalities, aim to improve cardiorespiratory fitness, enhance endothelial function and attenuate skeletal muscle wasting. High-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) have both been shown to increase peak oxygen consumption (VO2peak), reduce symptoms of fatigue and dyspnoea, and improve health-related quality of life. Exercise interventions also modulate neurohormonal activation, reduce systemic inflammation and may reverse maladaptive cardiac remodelling. Delivery of cardiac rehabilitation can be centre-based, home-based or hybrid, with technology-enabled platforms facilitating remote monitoring and self-management. Optimising exercise dose, intensity and adherence is crucial, particularly in elderly patients and those with preserved or reduced ejection fraction. Globally, guidelines endorse exercise as a class I recommendation, highlighting its role in reducing hospitalisation rates, improving functional capacity and potentially influencing long-term survival.

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Exercise Training and Rehabilitation in Heart Failure Patients publication trend

The graph below shows the total number of articles in exercise training and rehabilitation in heart failure patients across all publications each year (not limited to Nature Index journals).

Technical terms

High-intensity interval training (HIIT): Repeated short bursts of vigorous exercise alternated with periods of low-intensity recovery.

Moderate-intensity continuous training (MICT): Sustained exercise performed at a steady, moderate level of exertion.

VO2peak: The maximal rate of oxygen uptake measured during incremental exercise, reflecting cardiorespiratory fitness.

Cardiac fibrosis: Excessive deposition of extracellular matrix proteins in the myocardium leading to stiffening and impaired contractility.

Epigenetic hypermethylation: Increased addition of methyl groups to DNA, commonly at CpG sites, resulting in altered gene expression.

References

1. Elevated meteorin-like protein from high-intensity interval training improves heart function via AMPK/HDAC4 pathway. Genes & Diseases (2023).
2. Hypermethylation of ACADVL is involved in the high-intensity interval training-associated reduction of cardiac fibrosis in heart failure patients. Journal of Translational Medicine (2023).
3. Effects of exercise-based cardiac rehabilitation delivery modes on exercise capacity and health-related quality of life in heart failure: a systematic review and network meta-analysis. Open Heart (2022).