Exercise Training in Heart Failure, Clinical Evidences and Areas of Uncertainty

Exercise training, as a part of a comprehensive rehabilitation program, is currently recommended in combination with pharmacological therapy in patients with chronic heart failure. Benefits of exercise training that have been evidenced by scientific literature include improvements in various aspects of physiological function, aerobic exercise capacity and quality of life. Despite exercise training has been included in European and American guidelines as class IA recommendation, at least three important aspects need to be clarified. First of all, the effectiveness of exercise training in improving long term prognosis of patients with chronic heart failure still remains a debatable point. Secondly, the majority of studies have investigated the effects of a particular modality of exercise: continuous aerobic training performed at mild to moderate intensity. On the contrary, the effects of other exercise modalities such as intermittent training, resistance training or hydrotherapy on chronic heart failure haven’t been fully understood yet. Finally, patients included in clinical trials evaluating the effects of exercise training are, almost exclusively, those with reduced ejection fraction. Consequently very few data are, until now, available with regard to subjects with heart failure with preserved ejection fraction. This article summarizes the evidences and mechanisms by which exercise training can improve symptoms of heart failure. Moreover, it underlines current limits of knowledge in the prescription of exercise training in patients with chronic heart failure.