Exercise Training in Heart Failure: Clinical Benefits and Mechanisms

Clinical guidelines broadly recommend exercise training for patients with heart failure (HF). This review examines clinical benefits of exercise training across HF subtypes, focusing on clinical trials with key outcomes including mortality, hospitalization, exercise capacity, and quality of life. We also explore physiological and molecular mechanisms by which exercise training may improve HF, including organ-specific effects along the oxygen transport pathway from the cardiopulmonary system to the peripheral vasculature and skeletal muscles. We further review global mechanisms underlying the benefits of exercise training in HF, including antiinflammatory, immunomodulatory, and antioxidative effects, in addition to neurohormonal regulation and interorgan crosstalk. Finally, we identify future research directions to refine and support evidence-based exercise training prescriptions for HF management.