Principles of exercise prescription for patients with chronic heart failure

Chronic heart failure (CHF) is a common and debilitating condition characterized by reduced exercise tolerance. While exercise training was once thought to be contraindicated for patients with CHF, a substantial body of data has been published over the last two decades to support the use of exercise programs for these patients. Improvements in exercise capacity, quality of life, and mortality have been demonstrated among patients with CHF who have participated in formal exercise programs. Exercise prescription is a means of assessing and interpreting clinical information and applying the principles of training to develop an appropriate regimen so that these benefits are achieved. The major principles of the exercise prescription are the mode, frequency, duration, and intensity. Importantly, safe and effective exercise prescription for patients with CHF requires more than the application of these principles; it also requires careful consideration of the individual patients' functional status, comorbid conditions, medications, contraindications, and personal goals and preferences. Recent studies have demonstrated that a wide spectrum of patients with CHF benefit from appropriately applied exercise training, including those with both systolic and diastolic dysfunction, atrial fibrillation, pacemakers, implantable cardioversion devices, and post-cardiac transplantation. Increasingly, the principles of exercise prescription are included as a component of comprehensive CHF management programs. Evidence has accumulated that CHF patients who participate in rehabilitation programs have better health outcomes in terms of reduced morbidity and mortality, as well as lower hospitalization rates and lower overall health care costs.