IMR Press / RCM / Volume 23 / Issue 4 / DOI: 10.31083/j.rcm2304144
Open Access Review
Exercise Training in Patients with Heart Failure: From Pathophysiology to Exercise Prescription
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1 Department of Translational Medical Sciences, “Federico II" University of Naples, 80131 Naples, Italy
2 Division of Cardiology/UTIC, “Umberto I" Hospital, Nocera Inferiore (ASL Salerno), 84014 Nocera Inferiore (SA), Italy
3 Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Cecina Civil Hospital, 57023 LI Cecina, Italy
4 Department of Clinical Medicine and Surgery, “Federico II" University of Naples, 80131 Naples, Italy
*Correspondence: (Francesco Giallauria)
Academic Editors: Kazuhiro P. Izawa and Peter H. Brubaker
Rev. Cardiovasc. Med. 2022, 23(4), 144;
Submitted: 14 December 2021 | Revised: 24 January 2022 | Accepted: 28 January 2022 | Published: 12 April 2022
(This article belongs to the Special Issue Cardiac rehabilitation)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Heart failure (HF) is a chronic, progressive, and inexorable syndrome affecting worldwide billion of patients (equally distributed among men and women), with prevalence estimate of 1–3% in developed countries. HF leads to enormous direct and indirect costs, and because of ageing population, the total number of HF patients keep rising, approximately 10% in patients >65 years old. Exercise training (ET) is widely recognized as an evidence-based adjunct treatment modality for patients with HF, and growing evidence is emerging among elderly patients with HF. We used relevant data from literature search (PubMed, Medline, EMBASE) highlighting the epidemiology of HF; focusing on central and peripheral mechanisms underlying the beneficial effect of ET in HF patients; and on frail HF elderly patients undergoing ET. Since many Countries ordered a lockdown in early stages pandemic trying to limit infections, COVID-19 pandemic, and its limitation to exercise-based cardiac rehabilitation operativity was also discussed. ET exerts both central and peripheral adaptations that clinically translate into anti-remodeling effects, increased functional capacity and reduced morbidity and mortality. Ideally, ET programs should be prescribed in a patient-tailored approach, particularly in frail elderly patients with HF. In conclusion, given the complexity of HF syndrome, combining, and tailoring different ET modalities is mandatory. A procedural algorithm according to patient’s baseline clinical characteristics [i.e., functional capacity, comorbidity, frailty status (muscle strength, balance, usual daily activities, hearing and vision impairment, sarcopenia, and inability to actively exercise), logistics, individual preferences and goals] has been proposed. Increasing long-term adherence and reaching the frailest patients are challenging goals for future initiatives in the field.

heart failure
preserved ejection fraction
exercise training
cardiac rehabilitation
continuous training
interval training
strength training
respiratory training
inspiratory muscle training
functional electrical stimulation
Fig. 1.
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