Heart Failure Reviews

, Volume 13, Issue 1, pp 61–68 | Cite as

Principles of exercise prescription for patients with chronic heart failure

  • Jonathan MyersEmail author


Chronic heart failure (CHF) is a common and debilitating condition characterized by reduced exercise tolerance. While exercise training was once thought to be contraindicated for patients with CHF, a substantial body of data has been published over the last two decades to support the use of exercise programs for these patients. Improvements in exercise capacity, quality of life, and mortality have been demonstrated among patients with CHF who have participated in formal exercise programs. Exercise prescription is a means of assessing and interpreting clinical information and applying the principles of training to develop an appropriate regimen so that these benefits are achieved. The major principles of the exercise prescription are the mode, frequency, duration, and intensity. Importantly, safe and effective exercise prescription for patients with CHF requires more than the application of these principles; it also requires careful consideration of the individual patients’ functional status, comorbid conditions, medications, contraindications, and personal goals and preferences. Recent studies have demonstrated that a wide spectrum of patients with CHF benefit from appropriately applied exercise training, including those with both systolic and diastolic dysfunction, atrial fibrillation, pacemakers, implantable cardioversion devices, and post-cardiac transplantation. Increasingly, the principles of exercise prescription are included as a component of comprehensive CHF management programs. Evidence has accumulated that CHF patients who participate in rehabilitation programs have better health outcomes in terms of reduced morbidity and mortality, as well as lower hospitalization rates and lower overall health care costs.


Heart failure Rehabilitation Exercise testing Heart disease 


  1. 1.
    Pina IL, Apstein CS, Balady GJ, Bellardinelli R, Chaitman B, Duscha BD, Fletcher BJ, Fleg JL, Myers JN, Sullivan MJ (2003) Exercise and heart failure: a statement from the American heart association committee on exercise, rehabilitation, and prevention. Circulation 107(8):1210–1225PubMedCrossRefGoogle Scholar
  2. 2.
    Myers J, Froelicher VF (1991) Hemodynamic determinants of exercise capacity in chronic heart failure. Ann Intern Med 115:377–386PubMedGoogle Scholar
  3. 3.
    Kitzman DW (2005) Exercise intolerance. Prog Cardiovasc Dis 47:367–379PubMedCrossRefGoogle Scholar
  4. 4.
    Drexler H, Coats AJS (1996) Explaining fatigue in congestive heart failure. Annu Rev Med 47:241–256PubMedCrossRefGoogle Scholar
  5. 5.
    Larsen AI, Dickstein K (2005) Exercise training in congestive heart failure. A review of the current status. Minerva Cardioangiol 53:275–286PubMedGoogle Scholar
  6. 6.
    Franklin BA (2005) Cardiovascular events associated with exercise. The risk-protection paradox. J Cardiopulm Rehabil 25:189–195PubMedCrossRefGoogle Scholar
  7. 7.
    Franklin BA (2003) Myocardial infarction. In: Durstine JL Moore GE (eds) ACSMs Exercise Management for Persons with Chronic Diseases and Disabilities, 2nd edn. Human Kinetics, Champaign pp 24–31Google Scholar
  8. 8.
    Myers JN, Brubaker PH (2003) Chronic Heart Failure. In: Durstine JL, Moore GE (eds) ACSMs exercise management for persons with chronic diseases and disabilities, 2nd edn. Human Kinetics, Champaign, pp 64–69Google Scholar
  9. 9.
    Haykowsky MJ, Ezekowitz JA, Armstrong PW (2004) Therapeutic exercise for individuals with heart failure: special attention to older women with heart failure. J Cardiac Fail 10:165–173CrossRefGoogle Scholar
  10. 10.
    Myers J, Salleh A, Buchanan N et al (1992) Ventilatory mechanisms of exercise intolerance in chronic heart failure. Am Heart J 124:710–729PubMedCrossRefGoogle Scholar
  11. 11.
    Recommendations for exercise training in chronic heart failure patients (2001) Working group on cardiac rehabilitation & exercise physiology and working group on heart failure of the European society of cardiology. Eur Heart J 22:125–135CrossRefGoogle Scholar
  12. 12.
    Myers J (2000) Effects of exercise training on abnormal ventilatory responses to exercise in patients with chronic heart failure. Congest Heart Fail 6:243–249PubMedCrossRefGoogle Scholar
  13. 13.
    Piepoli MF, Cavos C, Francis DP et al (2004) Exercise training meta-analysis of trials in patients with chroinic heart failure (ExTraMATCH). BMJ 328:711CrossRefGoogle Scholar
  14. 14.
    Olson TP, Snyder EM, Johnson BD (2006) Exercise-disordered breathing in chronic heart failure. Exerc Sport Sci Rev 34:194–201PubMedCrossRefGoogle Scholar
  15. 15.
    Arena R, Guazzi M, Myers J (2007) Ventilatory abnormalities during exercise in heart failure: a mini review. Current Respiratory Med Rev 3:179–187CrossRefGoogle Scholar
  16. 16.
    Clark AL, Poole-Wilson PA, Coats AJ (1996) Exercise limitation in chronic heart failure: central role of the periphery. J Am Coll Cardiol 28:1092–1102PubMedCrossRefGoogle Scholar
  17. 17.
    Defoor J, Schepers D, Reybrouck T et al (2006) Oxygen uptake efficiency slope in coronary artery disease: clinical use and response to training. Int J Sports Med 27:730–737PubMedCrossRefGoogle Scholar
  18. 18.
    Goebbels U, Myers J, Dziekan G et al (1998) A randomized comparison of exercise training in patients with normal vs. reduced ventricular function. Chest 113:1387–1393PubMedGoogle Scholar
  19. 19.
    Wenger NK, Froelicher ES, Smith LK et al (1995) Cardiac rehabilitation: clinical practice guidelines. Agency for health care policy and research and the national heart, lung and blood institute, Rockville, MDGoogle Scholar
  20. 20.
    Kennedy MD, Haykowsky M, Humphrey R (2003) Function, eligibility, outcomes, and exercise capacity associated with left ventricular assist devices: exercise rehabilitation and training for patients with ventricular assist devices. J Cardiopulm Rehabil 23:208–217PubMedCrossRefGoogle Scholar
  21. 21.
    Belardinelli R, Capestro F, Misiani A et al (2006) Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy. Eur J Cardiovasc Prev Rehabil 13:818–825PubMedCrossRefGoogle Scholar
  22. 22.
    Kamke W, Dovifat C, Schranz M et al (2003) Cardiac rehabilitation in patients with implantable defibrillators. Feasibility and complications. Z Kardiol 92:869–875PubMedCrossRefGoogle Scholar
  23. 23.
    Vanhees L, Kornaat M, Defoor J et al (2004) Effect of exercise training in patients with an implantable cardioverter defibrillator. Eur Heart J 25:1120–1126PubMedCrossRefGoogle Scholar
  24. 24.
    Parmley WW (1986) Position report on cardiac rehabilitation. Recommendations of the American college of cardiology. J Am Coll Cardiol 7(2):451–453PubMedCrossRefGoogle Scholar
  25. 25.
    Pollock ML, Gaesser GA, Butcher JD et al (1998) The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc 30:975–991CrossRefGoogle Scholar
  26. 26.
    Meyer T, Gorge G, Schwaab B et al (2005) An alternative approach for exercise prescription and efficacy testing in patients with chronic heart failure: a randomized controlled training study. Am Heart J 149:e1–e7PubMedCrossRefGoogle Scholar
  27. 27.
    Curnier D, Galinier M, Pathak A et al (2001) Rehabilitation of patients with congestive heart failure with or without beta-blockade therapy. J Card Fail 7:241–248PubMedCrossRefGoogle Scholar
  28. 28.
    Meyer K, Samek L, Schwaibold M et al (1996) Physical responses to different modes of interval exercise in patients with chronic heart failure—application to exercise training. Eur Heart J 17:1040–1047PubMedGoogle Scholar
  29. 29.
    Keteyian SJ, Levine AB, Brawner CA et al (1996) Exercise training in patients with heart failure. A randomized, controlled trail. Ann Intern Med 124:1051–1057PubMedGoogle Scholar
  30. 30.
    Schuchert A (2005) Atrial fibrillation and heart failure comorbidity. Minerva Cardioangiol 53:299–311PubMedGoogle Scholar
  31. 31.
    Volaklis KA, Tokmakidis SP (2005) Resistance exercise training in patients with heart failure. Sports Med 35:1085–1093PubMedCrossRefGoogle Scholar
  32. 32.
    Benton MJ (2005) Safety and efficacy of resistance training in patients with chronic heart failure: research-based evidence. Prog Cardiovasc Nurs 20:17–23PubMedCrossRefGoogle Scholar
  33. 33.
    Meyer K (2006) Resistance exercise in chronic heart failure—landmark studies and implications for practice. Clin Invest Med 29:166–169PubMedGoogle Scholar
  34. 34.
    Braith RW (1998) Exercise training in patients with CHF and heart transplant recipients. Med Sci Sports Exerc 30(10 Suppl):S367–S378PubMedGoogle Scholar
  35. 35.
    Mattauer B, Levy F, Richard R et al (2005) Exercising with a denervated heart after cardiac transplantation. Ann Transplant 10:35–42Google Scholar
  36. 36.
    Kavanagh T (1996) Physical training in heart transplant recipients. J Cardiovasc Risk 3:154–159PubMedCrossRefGoogle Scholar
  37. 37.
    Kobashigawa JA, Leaf DA, Lee N et al (1999) A controlled trial of exercise rehabilitation after heart transplantation. N Engl J Med 340:272–277PubMedCrossRefGoogle Scholar
  38. 38.
    Braith RW, Magyari PM, Fulton MN et al (2006) Comparison of calcitonin versus calcitonin + resistance exercise as prophylaxis for osteoporosis in heart transplant recipients. Transplantation 81:1191–1195PubMedCrossRefGoogle Scholar
  39. 39.
    Braith RW, Magyari PM (2001) Resistance training in organ transplant recipients. In: Graves JE, Franklin BA (eds) Resistance training for health and rehabilitation. Human Kinetics, Champaign, pp 253–273Google Scholar
  40. 40.
    Ades PA, Balady GJ, Berra K (2001) Transforming exercise-based cardiac rehabilitation programs into secondary prevention centers: a national imperative. J Cardiopulm Rehabil 21:263–272PubMedCrossRefGoogle Scholar
  41. 41.
    Ahmed A (2002) Quality and outcomes of heart failure care in older adults: role of multidisciplinary disease-management programs. J Am Geriatr Soc 50:1590–1593PubMedCrossRefGoogle Scholar
  42. 42.
    Whellan DJ, Hasselblad V, Peterson E et al (2005) Meta-analysis and review of heart failure disease management randomized controlled clinical trails. Am Heart J 149:722–729PubMedCrossRefGoogle Scholar
  43. 43.
    Roccaforte R, Demers C, Baldassarre F et al (2005) Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. a meta-analysis. Eur J Heart Fail 7:1077–1078CrossRefGoogle Scholar
  44. 44.
    Krumholz HM, Amatruda J, Smith GL et al (2002) Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. J Am Coll Cardiol 39:83–89PubMedCrossRefGoogle Scholar
  45. 45.
    Blair SN, LaMonte MJ, Nichman MZ (2004) The evolution of physical activity recommendations: how much is enough? Am J Clin Nutr 79:913S–920SPubMedGoogle Scholar
  46. 46.
    Brooks GA, Butte NF, Rand WM, Flatt JP, Caballero B (2004) Chronicle of the institute of medicine physical activity recommendation: how a physical activity recommendation came to be among dietary recommendations. Am J Clin Nutr 79:921S–930SPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Cardiology Division (111C), VA Palo Alto Health Care SystemStanford UniversityPalo AltoUSA

Personalised recommendations