Should high-intensity-aerobic interval training become the clinical standard in heart failure?

Aerobic exercise training in the heart failure (HF) population is supported by an extensive body of literature. The clinically accepted model for exercise prescription is currently moderate-intensity-aerobic continuous training (MI-ACT). Documented benefits from the literature include improvements in various aspects of physiologic function, aerobic exercise capacity and quality of life while the impact on morbidity and mortality is promising but requires further investigation. Recently, however, a body of evidence has begun to emerge demonstrating high-intensity-aerobic interval training (HI-AIT) can be performed safely with impressive improvements in physiology, functional capacity and quality of life. These initial findings have led some to question the long-standing clinical approach to aerobic exercise training in patients with HF (i.e., MI-ACT), implying it should perhaps be replaced with a HI-AIT model. This is a potentially controversial paradigm shift given the potential increase in adverse event risk associated with exercising at higher intensities, particularly in the HF population where the likelihood of an untoward episode is already at a heightened state relative to the apparently healthy population. The present review therefore addresses key issues related to HI-AIT in the HF population and makes recommendations for future research and current clinical practice.