Cardiac Rehabilitation in Patients With Heart Failure: New Perspectives in Exercise Training

Dear Colleagues, 

Heart failure (HF) is a distressing condition and is a leading cause of morbidity, affecting ~2% of the adult population in industrialized countries. HF can be defined as ‘a complex clinical syndrome with typical symptoms (e.g., dyspnea, fatigue) that can occur at rest or during effort’. Moreover, HF is characterized by objective evidence of an underlying structural abnormality or cardiac dysfunction that impairs the ability of the ventricle to fill with or eject blood. During exercise, these symptoms are more evident. Historically, patients with HF were excluded from exercise-based cardiac rehabilitation programs. In fact, it was thought that exercise might cause decompensation in an already weakened heart. In recent years, new evidence has suggested that exercise-based rehabilitation programs have beneficial effects for patients with HF, and thus, supervised exercise programs are routinely recommended for all HF patients as a fundamental part of their non-pharmacological management, as they are considered safe and to also reduce HF-related hospitalization, co-morbidities, and mortality rates in these patients. Moreover, exercise-based rehabilitation is known to improve quality of life and functional capacity for these patients. Evidence for the benefits of cardiac rehabilitation in heart failure patients is such that its systematic realization is recommended by international cardiologic societies with the higher level of evidence (I A). Despite this, few patients with heart failure currently benefit from this rehabilitation (less than 15%). However, there is still debate with regard to the optimal exercise regimen, the duration of the overall benefit, and whether certain types of HF etiologies or clinical stages (e.g., before or after valve surgery) are more beneficial. This heterogeneity, along with the small sample sizes used for most studies, make it very difficult to achieve solid conclusions and recommendations. Consequently, further research is warranted to assess the efficacy of different exercise training methods in HF patients, while also looking at novel ways to improve their adherence in exercise programs.

Prof. Hassane Zouhal
Prof. François Carré
Dr. Daniel A. Boullosa
Guest Editors

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