The therapeutic role of exercise training in heart failure patients: A narrative review

Cardiac rehabilitation (CR) is a complex intervention that improves functional capacity and quality of life in patients with heart failure (HF). Besides exercise training (ET), CR includes aggressive risk factor management, education about medication adherence, stress management, and psychological support. Current guidelines strongly recommend CR as an integral part of chronic and stable HF patient care. However, CR programs are underused for multiple reasons, namely, low physician referral and patient adherence, high cost, and lack of awareness. In this review, we present existing evidence of the beneficial effects of ET and CR in HF with reduced and preserved ejection fraction, the underlying pathophysiologic mechanisms by which exercise might alleviate symptoms, and the different types of exercise that can be used in HF. Current guidelines supporting the use of CR, reasons for its underutilization, and home-based CR as an alternative or adjunct to traditional center-based programs are also described.