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Practical guidelines for exercise prescription in patients with chronic heart failure

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Abstract

Chronic heart failure (HF) is a major cause of morbidity, mortality, disability, and health care costs. A hallmark feature of HF is severe exercise intolerance, which is multifactorial and stems from central and peripheral pathophysiological mechanisms. Exercise training is internationally recognized as a Class 1 recommendation for patients with HF, regardless of whether ejection fraction is reduced or preserved. Optimal exercise prescription has been shown to enhance exercise capacity, improve quality of life, and reduce hospitalizations and mortality in patients with HF. This article will review the rationale and current recommendations for aerobic training, resistance training, and inspiratory muscle training in patients with HF. Furthermore, the review provides practical guidelines for optimizing exercise prescription according to the principles of frequency, intensity, time (duration), type, volume, and progression. Finally, the review addresses common clinical considerations and strategies when prescribing exercise in patients with HF, including considerations for medications, implantable devices, exercise-induced ischemia, and/or frailty.

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Funding

Jenna L. Taylor is supported by the National Institute on Aging (1R21AG073726) and Jonathon Myers is funded by the Department of Veterans Affairs, Veterans Health Administration, Rehabilitation Research & Development Service. Amanda R. Bonikowske is supported in part by a grant from Sleep Number Corporation to Mayo Clinic.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    Jenna L. Taylor & Amanda R. Bonikowske

  2. School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia

    Jenna L. Taylor

  3. Veterans Affairs Palo Alto Health Care System and Stanford University, Palo Alto, CA, USA

    Jonathan Myers

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Drs. Jenna Taylor and Amanda Bonikowske contributed to the conceptual design of the work, drafted the manuscript, and provided critical revision and editing of the final work. Dr. Jonathan Myers contributed to the draft of the manuscript and critical revision of the final work.

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Correspondence to Amanda R. Bonikowske.

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Taylor, J.L., Myers, J. & Bonikowske, A.R. Practical guidelines for exercise prescription in patients with chronic heart failure. Heart Fail Rev 28, 1285–1296 (2023). https://doi.org/10.1007/s10741-023-10310-9

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