Cardiac rehabilitation in heart failure: a brief review and recommendations

The number of heart failure patients continues to increase for men and women. Our current medical therapy includes a variety of agents that can reduce morbidity and mortality. However, many patients remain limited, in part, due to deconditioning. Adding to the functional loss are the multiple hospitalizations and even recommendations from providers to maintain bed rest and avoid physical activity. The multiple studies involving conditioning and exercise for patients with heart failure have mostly shown improvements, not only in function but also in quality of life and other physiologic parameters that should be of benefit to these patients. The HF ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial, which randomized 2,231 patients to a formal prescribed exercise or control, demonstrated the safety of aerobic training in this population. The benefits on the hard end points of mortality and hospitalizations were modest but significant when adjusted for prognostic factors. The guidelines currently recommend that activity be recommended in conjunction with medical therapy. A program can be adjusted to the patient's need but should include intensity, frequency, and duration, as well as a guide to progression.