Skip to main content
Log in

Exercise training in patients with heart failure: clinical outcomes, safety, and indications

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

Heart failure (HF) patients are often counseled to limit their physical activity, however, this advice may not be appropriate. Data has accumulated supporting the effectiveness of exercise training to improve fitness levels and symptoms. There are also data suggesting that training may reduce mortality and morbidity in HF patients. Studies have demonstrated that exercise training can be performed safely in appropriately evaluated HF patients. The literature would support the prescribing of exercise training to NYHA II–III HF patients. Consideration could also be given to training stable NYHA IV HF patients who are not symptomatic at rest. This article reviews the effects of exercise training on clinical outcomes and addressing the safety of exercise training and the indications for training in HF patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. McKelvie RS, McCartney N, Teo KK, Humen D, Montague T, Yusuf S (1995) Effects of exercise training in patients with congestive heart failure: a critical Review. J Am Coll Cardiol 25:789–796

    Article  PubMed  CAS  Google Scholar 

  2. Pina IL, Apstein CS, Balady GJ et al (2003) A statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation 107:1210–1225

    Article  PubMed  Google Scholar 

  3. Piepoli M, Clark AL, Volterrani M, Adamopoulos S, Sleight P, Coats A (1996) Contribution of muscle afferents to the hemodynamic, autonomic, and ventilatory responses to exercise in patients with chronic heart failure. Effects of physical training. Circulation 93:940–952

    PubMed  CAS  Google Scholar 

  4. Ponikowski P, Chua TP, Francis DP, Capucci A, Coats AJ, Piepoli MF et al (2001) Muscle ergoreceptor overactivity reflects deterioration in clinical status and cardiorespiratory reflex control in chronic heart failure. Circulation 104:2324–2330

    Article  PubMed  CAS  Google Scholar 

  5. Scott A, Wensel R, Davos CH, Kemp M, Kaczmarek A, Hooper J et al (2002) Chemical mediators of the muscle ergoreflex in chronic heart failure: a putative role for prostaglandins in reflex ventilatory control. Circulation 106:214–220

    Article  PubMed  CAS  Google Scholar 

  6. Belardinelli R, Georgiou D, Cianci G et al (1999) Randomized, controlled trial of long-term moderate exercise training in chronic heart failure. Effects on functional capacity, quality of life, and clinical outcome. Circulation 99:1173–1182

    PubMed  CAS  Google Scholar 

  7. Lloyd-Williams F, Mair FS, Leitner M (2002) Exercise training and heart failure: a systematic review of current evidence. Br J Gen Pract 52:47–55

    PubMed  Google Scholar 

  8. McKelvie RS, Teo KK, Roberts R, McCartney N, Humen D, Montague T et al (2002) Effects of exercise training in patients with heart failure: The Exercise Rehabilitation Trial (EXERT). Am Heart J 144:23–30

    Article  PubMed  Google Scholar 

  9. Smart N, Marwick TH (2004) Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity. Am J Med 116:693–706

    Article  PubMed  Google Scholar 

  10. Piepoli MF, Davos C, Francis DP, Coats AJS (2004) Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ 328:189–191

    Article  PubMed  CAS  Google Scholar 

  11. Gianuzzi P, Tavazzi L, Meyer K, Drexler H, Dubach P, Meyers J et al (2001) Recommendations for exercising training in chronic heart failure patients. Eur Heart J 22:125–135

    Article  Google Scholar 

  12. Keteyian SJ, Levine AB, Brawner CA, Katacha T, Rogers FJ, Schairer JR et al (1996) Exercise training in patients with heart failure. A randomized controlled trial. Ann Int Med 124:1051–1057

    PubMed  CAS  Google Scholar 

  13. Hambrecht R, Offner B, Schuler G, Niebauer J, Fiehn E, Kalberer B et al (1995) Physical training in patients with stable chronic heart failure: effects on cardiorespiratory fitness and ultrastructural abnormalities of leg muscles. J Am Coll Cardiol 25:1239–1249

    Article  PubMed  CAS  Google Scholar 

  14. Belardinelli R, Georgiou D, Scocco V, Barstow TJ, Purcaro A (1995) Low intensity exercise training in patients with chronic heart failure. J Am Coll Cardiol 26:975–982

    Article  PubMed  CAS  Google Scholar 

  15. Dubach P, Meyers J, Dziekan G, Goebbels U, Reinhart W, Moller P et al (1997) Effect of high intensity exercise training on central hemodynamic responses to exercise in man with reduced left ventricular function. J Am Coll Cardiol 29:1591–1598

    Article  PubMed  CAS  Google Scholar 

  16. Dubach P, Myers J, Dziekan G, Goebbels U, Reinhart W, Vogt P et al (1997) Effect of exercise training on myocardial remodeling in patients with reduced left ventricular function after myocardial infarction: application of magnetic resonance imaging. Circulation 95:2060–2067

    PubMed  CAS  Google Scholar 

  17. Kiilavuory K, Sovijarvi A, Navery H, Ikonen T, Leinonen H (1996) Effect of physical training on exercise capacity and gas exchange in patients with chronic heart failure. Chest 110:985–991

    Google Scholar 

  18. Belardinelli R, Georgiou D, Cianci G, Purcaro A (1996) Effects of exercise training on left ventricular filling at rest and during exercise in patients with ischemic cardiomyopathy and severe left ventricular systolic dysfunction. Am Heart J 132:61–70

    Article  PubMed  CAS  Google Scholar 

  19. Sullivan MJ, Higginbotham MB, Cobb F (1988) Exercise training in patients with severe left ventricular dysfunction: hemodynamic and metabolic effects. Circulation 78:506–515

    PubMed  CAS  Google Scholar 

  20. Hornig B, Maier V, Drexler H (1996) Physical training improves endothelial function in patients with chronic heart failure. Circulation 93:210–214

    PubMed  CAS  Google Scholar 

  21. Hambrecht R, Fiehn E, Weigl C, Gielen S, Hamann C, Kaiser R et al (1998) Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure. Circulation 98:2709–2715

    PubMed  CAS  Google Scholar 

  22. Katz A, Yuen J, Bijou R (1997) Training improves endothelium-dependent vasodilation in resistance vessels of patients with heart failure. J Appl Physiol 82:1488–1492

    Article  PubMed  CAS  Google Scholar 

  23. Hambrecht R, Adams V, Erbs S, Linke A, Krankel N, Shu Y et al (2003) Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation 107:3152–3158

    Article  PubMed  CAS  Google Scholar 

  24. Fisher D, Rossa S, Landmesser U, Spiekermann S, Engberding N, Horning B et al (2005) Endothelial dysfunction in patients with chronic heart failure is independently associated with increased incidence of hospitalization, cardiac transplantation, or death. Eur Heart J 26:65–69

    Article  Google Scholar 

  25. Katz S, Hryniewicz K, Hriljac I, Balidemaj K, Dimayuga C, Hudaihed A et al (2005) Vascular endothelial dysfunction and mortality risk in patients with chronic heart failure. Circulation 111(3):310–314

    Article  PubMed  Google Scholar 

  26. Minotti JR, Johnson EC, Hudson TL, Zuroske G, Murata G, Fukushina E et al (1990) Skeletal muscle response to exercise training in congestive heart failure. J Clin Invest 86:751–758

    Article  PubMed  CAS  Google Scholar 

  27. Hambrecht R, Fiehn E, Jiangtao Y, Niebauer J, Weigl C, Hilbrich L et al (1997) Effects of endurance training on mitochondrial ultra structure and fiber type distribution in skeletal muscle of patients with stable chronic heart failure. J Am Coll Cardiol 29:1067–1073

    Article  PubMed  CAS  Google Scholar 

  28. Coats AJS, Adamopoulos S, Radaelli A et al (1992) Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function. Circulation 85:2119–2131

    PubMed  CAS  Google Scholar 

  29. Kiilavuori K, Toivonen L, Naveri H et al (1995) Reversal of autonomic derangements by physical training in chronic heart failure assessed by heart rate variability. Eur Heart J 16:490–495

    PubMed  CAS  Google Scholar 

  30. Roveda F, Middlekauff HR, Urbana M et al (2003) The effects of exercise training on sympathetic neural activation in advanced heart failure. J Am Coll Cardiol 42:854–860

    Article  PubMed  Google Scholar 

  31. Conraads VM, Beckers P, Vaes J, Martin M, Van Hoof V, DeMaeyer C et al (2004) Combined endurance/resistance training reduces NT proBNP levels in patients with chronic heart failure. Eur Heart J 25:1797–1805

    Article  PubMed  CAS  Google Scholar 

  32. Levine B, Kalman J, Mayer L, Fillit HM, Packer M (1990) Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 323:236–244

    Article  PubMed  CAS  Google Scholar 

  33. Adamopoulos S, Parissis J, Karatzas D, Kroupis C, Georgiadis M, Karavolias G et al (2002) Physical training modulates proinflammatory cytokines and the soluble Fas/soluble Faslingand system in patients with chronic heart failure. J Am Coll Cardiol 39:653–663

    Article  PubMed  CAS  Google Scholar 

  34. Whellan DJ, O’Connor CM, Lee KL et al (2007) Heart failure and a controlled trial investigating outcomes of exercise training (HF-ACTION): design and rationale. Am Heart J 153:201–211

    Article  PubMed  Google Scholar 

  35. European Heart Failure Training Group (1998) Experience from controlled treats of physical training in chronic heart failure. Protocol and patient factors in effectiveness in the improvement in exercise tolerance. Eur Heart J 19:466–475

    Article  Google Scholar 

  36. Van Tol BAF, Huijsmans RJ, Kroon DW et al (2006) Effects of exercise training on cardiac performance, exercise capacity and quality of life in patients with heart failure: a meta-analysis. Eur J Heart Fail 8:841–850

    Article  PubMed  Google Scholar 

  37. Parnell MM, Holst DP, Kaye DM (2002) Exercise training increases arterial compliance in patients with congestive heart failure. Clin Sci 102:1–7

    Article  PubMed  Google Scholar 

  38. Tyni-Lenne R, Gordon A, Sylven C (1996) Improved quality of life in chronic heart failure patients following local endurance training with leg muscles. J Card Fail 2:111–117

    Article  PubMed  CAS  Google Scholar 

  39. Giannuzzi P, Temporelli PL, Corra U et al (2003) Antiremodeling effect of long term exercise training in patients with stable chronic heart failure. Results of the ELVD-CHF Trial. Circulation 108:554–559

    Article  PubMed  Google Scholar 

  40. Koch M, Douard H, Broustet JP (1992) The benefit of graded physical exercise in chronic heart failure. Chest 101:231–235

    Article  Google Scholar 

  41. Oka RK, De Marco T, Haskell WL et al (2000) Impact of a home-based walking and resistance training program on quality of life in patients with heart failure. Am J Cardiol 85:365–369

    Article  PubMed  CAS  Google Scholar 

  42. Wielenga RP, Erdman RAM, Huisveld IA et al (1998) Effect of exercise training on quality of life in patients with chronic heart failure. J Psychosom Res 45:459–464

    Article  PubMed  CAS  Google Scholar 

  43. Koukouvou G, Kouidi E, Iacovides A et al (2004) Quality of life, psychological and physiological changes following exercise training in patients with chronic heart failure. J Rehabil Med 36:36–41

    Article  PubMed  Google Scholar 

  44. Keteyian SJ, Brawner CA, Schairer JR et al (1999) Effects of exercise training on chronotropic incompetence in patients with heart failure. Am heart J 138:233–240

    Article  PubMed  CAS  Google Scholar 

  45. Quittan M, Sturm B, Wiesinger GF et al (1999) Quality of life in patients with chronic heart failure: a randomized controlled trial of changes induced by a regular exercise program. Scand J Rehabil Med 31:223–228

    Article  PubMed  CAS  Google Scholar 

  46. Owen A, Croucher L (2000) Effect of an exercise programme for elderly patients with heart failure. Eur J Heart Fail 2:65–70

    Article  PubMed  CAS  Google Scholar 

  47. Hambrecht R, Gielen S, Linke A et al (2000) Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure. A randomized trial. JAMA 283:3095–3101

    Article  PubMed  CAS  Google Scholar 

  48. Fletcher GF, Balady GJ, Amsterdam EA et al (2001) Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 104:1694–1740

    Article  PubMed  CAS  Google Scholar 

  49. Haskell WL (1994) The efficacy and safety of exercise programs in cardiac rehabilitation. Med Sci Sports Exerc 26:815–823

    PubMed  CAS  Google Scholar 

  50. van Camp SP, Peterson RA (1986) Cardiovascular complications of outpatient cardiac rehabilitation programs. JAMA 256:1160–1163

    Article  PubMed  Google Scholar 

  51. Vongvanich P, Paul-Labrador MJ, Merz CN (1996) Safety of medically supervised exercise in a cardiac rehabilitation centre. Am J Cardiol 77:1383–1385

    Article  PubMed  CAS  Google Scholar 

  52. Mittleman MA, MaClure M, Tofler GH et al (1993) Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med 329:1677–1683

    Article  PubMed  CAS  Google Scholar 

  53. Willich SN, Lewis M, Lowel H et al (1993) Physical exertion as a trigger of acute myocardial infarction: Triggers and Mechanisms of Myocardial Infarction Study Group. N Engl J Med 329:1684–1690

    Article  PubMed  CAS  Google Scholar 

  54. Burke AP, Farb A, Malcom GT et al (1999) Plaque rupture and sudden death related to exertion in men with coronary artery disease. JAMA 281:921–926

    Article  PubMed  CAS  Google Scholar 

  55. Berlin JA, Colditz GA (1990) A meta-analysis of physical activity in the prevention of coronary heart disease. Am J Epidemiol 132:612–628

    PubMed  CAS  Google Scholar 

  56. Oldridge NB, Guyatt GH, Fischer MS, Rimm AA (1988) Cardiac rehabilitation after myocardial infarction: combined experience of randomized clinical trials. JAMA 260:945–950

    Article  PubMed  CAS  Google Scholar 

  57. O’Connor GT, Buring JE, Yusuf S et al (1989) An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 80:234–244

    PubMed  CAS  Google Scholar 

  58. Lakka TA, Venalainen MD, Rauramaa R et al (1994) Relation of leisure-time physical activity and cardiorespiratory fitness to the risk of acute myocardial infarction in men. N Engl J Med 330:1549–1554

    Article  PubMed  CAS  Google Scholar 

  59. Tristani FE, Hughes CV, Archibald DG, Sheldahl LM, Cohn JN, Fletcher R (1987) Safety of graded symptom-limited exercise testing in patients with congestive heart failure. Circulation 76(Suppl 6):54–58

    Google Scholar 

  60. Jugdutt BI, Michorowski BL, Kappagoda CT (1988) Exercise training after anterior Q wave myocardial infarction: importance of regional function and topography. J Am Coll Cardiol 12:362–372

    Article  PubMed  CAS  Google Scholar 

  61. Giannuzzi P, Tavazzi L, Temporelli PL, Corra U, Imparato A, Gattone M et al (1993) Long term physical training and left ventricular remodeling after anterior myocardial infarction: results of the Exercise in Anterior Myocardial Infarction (EAMI) Study Group. J Am Coll Cardiol 22:1821–1829

    PubMed  CAS  Google Scholar 

  62. Belardinelli R, Georgiou D, Cianci G, Purcaro A (1999) Randomized, controlled trial of long-term moderate exercise training in chronic heart failure. Effects on functional capacity, quality of life, and clinical outcome. Circulation 99:1173–1182

    PubMed  CAS  Google Scholar 

  63. Kobashigawa JA, Leaf DA, Lee N et al (1999) A controlled trial of exercise rehabilitation after heart transplantation. N Engl J Med 340:272–277

    Article  PubMed  CAS  Google Scholar 

  64. Braith RW, Limarcher MC, Leggett SH et al (1993) Skeletal muscle strength in heart transplant recipients. J Heart Lung Transplant 12:1018–1023

    PubMed  CAS  Google Scholar 

  65. Cahalin LP, Semigran MJ, Dec GW (1997) Inspiratory muscle training in patients with chronic heart failure awaiting cardiac transplatiation: results of a pilot clinical trial. Phys Ther 77:830–838

    PubMed  CAS  Google Scholar 

  66. Kavanagh T, Yacoub MH, Mertens DJ et al (1988) Cardiorespiratory responses to exercise training after orthopic cardiac transplantation. Circulation 77:162–171

    PubMed  CAS  Google Scholar 

  67. Jaski BE, Kim J, Maly RS et al (1997) Effects of exercise during long-term support with a left ventricular assist device: results of the experience with left ventricular assist device with exercise (EVADE) pilot trial. Circulation 95:2401–2406

    PubMed  CAS  Google Scholar 

  68. Morrone TM, Buck LA, Catanese KA et al (1996) Early progressive mobilization of patients with left ventricular assist devices is safe and optimizes recover before heart transplantation. J Heart Lung Transplant 15:423–429

    PubMed  CAS  Google Scholar 

Download references

Acknowledgment

I would like to thank Ms. Mirela Lukac for her invaluable secretarial support in the preparation of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robert S. McKelvie.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McKelvie, R.S. Exercise training in patients with heart failure: clinical outcomes, safety, and indications. Heart Fail Rev 13, 3–11 (2008). https://doi.org/10.1007/s10741-007-9052-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-007-9052-z

Keywords

Navigation