Exercise in Specific Diseases: Heart Failure with Reduced Ejection Fraction

Abstract

Heart failure (HF) is a clinical syndrome defined by clinical symptoms and functional or structural cardiac abnormalities. Based on left ventricular ejection fraction, HF can be classified as reduced ejection fraction (HFrEF), mid-range ejection fraction (HFmrEF), or preserved ejection fraction (HFpEF). A hallmark feature of all of these forms of HF is reduced exercise capacity, measured as decreased peak exercise oxygen uptake (VO2peak). Every HFrEF and HFmrEF patient must be treated with optimal pharmacological therapy. Beside medical treatment, HF patients benefit from a healthy lifestyle which includes daily physical activity and a structured exercise training programme. Aerobic exercise training improves VO2peak and quality of life, and decreases hospitalization rates. The objective of this textbook chapter is to discuss the long-term benefits of exercise training and the optimal exercise prescription required to achieve these benefits in patients with HFrEF. In brief, an optimal exercise prescription includes exercising a minimum of 20 min each day at a moderate to high intensity, depending on their clinical status and exercise preferences. Exercise training should start with a short duration and low intensity during the first few weeks, which progressively increases over time while factoring patient tolerance and clinical status. HFrEF patients may also experience added benefits from the addition of resistance and respiratory training to basic aerobic training.