Mapping of Early Exercise-Based Interventions for Patients Recovering From Acute Heart Failure: A Scoping Review

Studies have established the safety and benefits of exercise training in patients admitted with acute heart failure, yet heterogeneity in exercise delivery patterns exists. Hence, a scoping review was undertaken to map the evidence on early exercise-based interventions (early mobilization with/without exercise training) in patients recovering from acute heart failure (admission to up to 2 weeks post-hospitalization), for geographic distribution, exercise prescription, and exercise initiation time. A systematic search was conducted across 5 databases until September 2024. Studies, including protocols, providing early exercise-based intervention anytime between admission and up to 2 weeks from discharge, in any setting, were included. Data were extracted from 30 included studies, and the obtained evidence was mapped. This study uses the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-Extension for Scoping Reviews. The review included 1,54 980 participants with acute heart failure, and 26.6% (8 of 30) of the studies focused on the older adult population. Early exercise-based interventions, ie, early mobilization (n=12), exercise training (n=5), or combined (n=13), were limited to higher- (n=23) and upper-middle-income (n=6) countries and were primarily observational (n=19) in design. The median (Q1-Q3) initiation time to exercise was 3.8 days (2.8-5.5), with a dose of eight sessions (4.7-21). The intensity ranged from very low to moderate intensity, with the duration per session ranging from 10 to 60 minutes. The use of pre-specified, well-developed initiation, monitoring, and termination criteria was not common. Early exercise-based interventions were comprehensive, multi-modal, and of low-moderate intensity, initiated within 4 days of admission.