Exercise in Chronic Heart Failure

Regular physical exercise has been implemented into current guidelines as a class IA recommendation for all patients with clinically stable heart failure. Exercise significantly increases exercise capacity and health-related quality of life, whereas improvements in ventricular function as well as reductions of hospitalization rates and mortality have not clearly been shown. For both heart failure with reduced and preserved ejection fraction, moderate continuous endurance training still represents the gold standard. This is usually performed on ergometers or similar devices at 50 - 80% of a maximal parameter chosen for prescription (e.g. peak oxygen uptake, maximal heart rate). Moderate resistance exercise improves muscular strength and is recommended as an adjunct. In contrast, high-intensity interval training has not been shown to be more effective at least in heart failure patients with reduced ejection fraction and is thus currently not recommended as a primary strategy.