A universal agreement on the best training modality in heart failure does not exist. But, rather, an individualized approach is recommended, based on clinical evaluation and personal preference.
Training protocols vary in a number of ways: intensity (aerobic and anaerobic), type (endurance, resistance), and method (continuous and interval) with improvements in aerobic exercise capacity (maximal oxygen uptake) increasing between 15-30% in the literature.
Cardiovascular exercise is recommended as a major focus of training with the following prescription variables:
- Frequency: 3-7 days per week
- Intensity: Moderate - 40-80% HRR (11 to 16 RPE)
- Time: 20-60 min
- Type: larger muscle group activities (walking, cycling)
While there are limited direct resistance training prescription guidelines in the literature, musculoskeletal recommendations are focused on resistance training and include:
- Frequency: 2-3 days per week
- Intensity: Light: 40-50% 1RM, Moderate: 60-70% 1RM
- Time: 1-4 sets, 8-12 exercises
- Type: often machine-based, functional activities
- Avoid isometric exercise as a result of its increase in blood pressure.
Individuals with heart failure may have severe exercise limitations. Indeed, functional capacity may be reduced to levels below those required to maintain activities of daily living, thus removing candidates from transplant lists. This functional limitation is the result of the impaired pumping capacity of the heart but is also the result of a coordinated maladaptation of all of the processes of oxygen transport over long-term disease progression.
A reduction in pump capacity leads to a decline in muscle oxygen extraction and a reduction in mitochondrial oxygen utilization.
A well-designed exercise training program can improve oxygen transport along all aspects of the oxygen delivery cascade improving functional capacity and disease risk.