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Exercise training in heart failure
  1. Grace Olivia Dibben1,
  2. Jennifer R Hannay2,
  3. Rod S Taylor1
  1. 1 School of Health and Wellbeing, University of Glasgow, Glasgow, UK
  2. 2 Wirral Community Cardiology Service, Wirral Community Health and Care NHS Foundation Trust, Birkenhead, UK
  1. Correspondence to Grace Olivia Dibben, University of Glasgow, Glasgow G12 8QQ, UK; grace.dibben{at}

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Learning objectives

  • To understand the importance of exercise and physical activity in the general management and well-being of people with heart failure (HF).

  • To understand the key principles of exercise training prescription in people with HF.

  • To be familiar with the specific considerations of exercise training prescription in specific HF population groups including HF with preserved ejection fraction.

  • To be aware of needs and requirements of remote delivery (home and digital supported) models of exercise training for people with HF.


Management of heart failure (HF) requires multidisciplinary, pharmacological and non-pharmacological strategies, one component of which is exercise training. Consistent evidence from meta-analyses and clinical trials shows that exercise training improves exercise tolerance, rates of hospitalisation and health-related quality of life (HRQoL) in patients with HF,1 although there remains some uncertainty around the effects of exercise on mortality.2 This article aims to highlight and summarise the role of exercise training in the management of HF, and the key principles, considerations and practicalities of exercise-based cardiac rehabilitation (ExCR) or exercise training in people with HF. While we emphasise the importance of integrating both exercise training and physical activity promotion as part of a comprehensive approach to the management and rehabilitation of people with HF, this paper will focus on the specific considerations for exercise training. Discussion will include (1) definitions, importance and current recommendations for exercise, physical activity and ExCR; (2) exercise prescription and considerations for alternative exercise modalities; (3) considerations for different types of patients with HF; and (4) delivery models and related practicalities.

Exercise, physical activity and cardiac rehabilitation: definitions, importance and current recommendations

Although exercise and physical activity are terms often used interchangeably, there are key distinctions. Physical activity is defined as any bodily movement produced by skeletal muscles, resulting in energy expenditure beyond resting expenditure, and includes occupational, household, leisure time and transportation activity as well as sports and …

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  • Contributors GOD, JRH and RST contributed equally to the planning and design of the work. All authors agreed on the final version.

  • Funding No funding was received to assist with the preparation of this manuscript.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note References which include a * are considered to be key references.