Exercise-Based Rehabilitation for Heart Failure

A Cochrane review [Abstract] 1 included 60 studies with a total of 8 728 subjects with heart failure (HF), predominantly with HF due to reduced ejection fraction (HFrEF) and NYHA classes II and III. Nine studies included an (undefined) proportion of people with heart failure with preserved ejection fraction (HFpEF). Programmes were typically based on aerobic exercise training with or without a resistance exercise element. All included studies employed a usual-care control group with a formal no-exercise training intervention together with a wide range of active interventions, such as education, psychological intervention, and medical care.

There was no difference in mortality between exercise-based rehabilitation versus no exercise control (table T1). Compared with control, exercise training reduced the rate of overall hospitalisation. The observed reduction in and HF specific hospital admissions was not statistically significant. Exercise also resulted in a clinically important improvement in the Minnesota Living with Heart Failure questionnaire - a disease specific health-related quality of life measure. However, levels of statistical heterogeneity across studies in this outcome were substantial (I² =82%).

Exercise-based cardiac rehabilitation effects appeared to be consistent across different models of delivery: centre- versus home-based, exercise dose, exercise only versus comprehensive programmes, and aerobic training alone versus aerobic plus resistance programmes.