Exercise Training in Patients with Heart Failure: From Pathophysiology to Exercise Prescription.

Area of Science:

• Cardiology
• Geriatrics
• Rehabilitation Medicine

Background:

• Heart failure (HF) affects millions globally, with rising prevalence due to an aging population, imposing significant healthcare costs.
• Exercise training (ET) is an established, evidence-based adjunctive therapy for HF patients, with increasing focus on elderly and frail individuals.
• The COVID-19 pandemic impacted cardiac rehabilitation services, highlighting the need for adaptable ET strategies.

Purpose of the Study:

• To review the epidemiology of HF and the mechanisms behind ET's benefits.
• To examine the efficacy of ET in frail elderly HF patients.
• To discuss challenges and propose solutions for optimizing ET in HF management.

Main Methods:

• Literature search using PubMed, Medline, and EMBASE.
• Analysis of central and peripheral adaptations to ET in HF.
• Focus on patient-tailored approaches and an algorithmic framework for ET prescription.

Main Results:

• ET induces central and peripheral adaptations leading to anti-remodeling effects, improved functional capacity, and reduced morbidity/mortality.
• Patient-tailored ET is essential, particularly for frail elderly HF patients.
• An algorithm considering clinical characteristics, frailty, and patient preferences aids ET prescription.

Conclusions:

• Combining and tailoring diverse ET modalities is mandatory for complex HF management.
• Addressing challenges in long-term adherence and reaching frail patients is critical for future ET initiatives.
• Personalized ET strategies, guided by clinical assessment, are key to improving outcomes in heart failure.