The role of physical exercise in management of patients with chronic heart failure

Chronic heart failure is common among the population. In addition to the necessary drug treatment of this disease, non-drug approaches to management and rehabilitation of patients are also of great importance. One of the main approaches is physical training which can be divided into several types: high-intensity interval training, moderateintensity aerobic training, and resistance training. A search for literature reviews, systematic reviews and meta-analyses from 2023–2024 was performed in the eLibrary, Google Scholar and PubMed databases using relevant keywords. An analysis of the identified sources was performed, the results of which were also compared with the studies published in 2010–2014. All types of physical training had positive effect on the health of the patients. The advantage of high-intensity interval training and resistance training over moderate-intensity aerobic training in the short and intermediate term was shown, which was later smoothed out, probably due to a decrease in patient adherence to non-pharmacological treatment and kinesiophobia. At the same time, the greatest efficacy of the rehabilitation process and positive impact were achieved by combining different types of training, taking into account cognitive, mental and physiological characteristics of the patient, as well as their social, household, and economic capabilities. Telemedicine technologies and personalized selection of treatment tactics taking into account the stages of treatment and rehabilitation the patient was at, as well as a number of measures such as raising awareness and training the patient, improving their communication and interactions with medical personnel, psychological support and treatment of anxiety and depressive disorders helped to improve compliance.

1. Хроническая сердечная недостаточность. Клинические рекомендации 2020. Российский кардиологический журнал 2020;25(11):4083. DOI: 10.15829/1560-4071-2020-4083 2020 Clinical practice guidelines for Chronic heart failure. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology 2020;25(11):4083. (In Russ.). DOI: 10.15829/1560-4071-2020-4083

2. Lv J., Li Y., Shi S. et al. Skeletal muscle mitochondrial remodeling in heart failure: an update on mechanisms and therapeutic opportunities. Biomed Pharmacother 2022;155:113833. DOI: 10.1016/j.biopha.2022.113833

3. Беграмбекова Ю.Л., Каранадзе Н.А., Орлова Я.А. Нарушения системы дыхания при хронической сердечной недостаточности. Кардиология 2019;59(2S):15–24. DOI: 10.18087/cardio.2626 Begrambekova Yu.L., Karanadze N.A., Orlova Ya.A. Alterations of the respiratory system in heart failure. Kardiologiya = Cardiology 2019;59(2S):15–24. (In Russ.). DOI: 10.18087/cardio.2626

4. Ismail H., McFarlane J.R., Nojoumian A.H. et al. Clinical outcomes and cardiovascular responses to different exercise training intensities in patients with heart failure: a systematic review and meta-analysis. JACC Heart Fail 2013;1(6):514–22. DOI: 10.1016/j.jchf.2013.08.006

5. Gallagher H., Hendrickse P.W., Pereira M.G., Bowen T.S. Skeletal muscle atrophy, regeneration, and dysfunction in heart failure: impact of exercise training. J Sport Health Sci 2023;12(5):557–67. DOI: 10.1016/j.jshs.2023.04.001

6. Danduboyina A., Panjiyar B.K., Borra S.R., Panicker S.S. Cardiovascular benefits of resistance training in patients with heart failure with reduced ejection fraction: a systematic review. Cureus 2023;15(10):e47813. DOI: 10.7759/cureus.47813

7. Bozkurt B., Fonarow G.C., Goldberg L.R. et al. Cardiac rehabilitation for patients with heart failure: JACC expert panel. J Am Coll Cardiol 2021;77(11):1454–69. DOI: 10.1016/j.jacc.2021.01.030

8. Борцова М.А., Демченко Е.А., Баутин А.Е. и др. Влияние физических тренировок на функциональные и гемодинамические показатели пациентов с хронической сердечной недостаточностью III–IV функционального класса в зависимости от потребности в инотропной поддержке. Артериальная гипертензия 2020;26(5):526–42. DOI: 10.18705/1607-419X-2020-26-5-526-542

9. Yamamoto S., Okamura M., Akashi Y.J. et al. Impact of long-term exercise-based cardiac rehabilitation in patients with chronic heart failure – a systematic review and meta-analysis. Circ J 2024;88(9): 1360–71. DOI: 10.1253/circj.CJ-23-0820

10. El-Malahi O., Mohajeri D., Mincu R. et al. Beneficial impacts of physical activity on heart rate variability: a systematic review and meta-analysis. PLoS One 2024;19(4):e0299793. DOI: 10.1371/journal.pone.0299793

11. Аронов Д.М., Бубнова М.Г. Клинические эффекты применения тренировочных программ при кардиореабилитации. Опыт разных стран. Кардиоваскулярная терапия и профилактика. 2024;23(2):3936. DOI: 10.15829/1728-8800-2024-3936 Aronov D.M., Bubnova M.G. Clinical effects of training programs in cardiac rehabilitation. Experience from different countries. Kardiovaskularnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention 2024;23(2):3936. (In Russ.). DOI: 10.15829/1728-8800-2024-3936

12. Li J., Chen L., Wang L. Impact of different exercise modalities on physical function and quality of life in patients with heart failure. J Multidiscip Healthc 2024;17:2551–9. DOI: 10.2147/JMDH. S465578

13. Barriault A., Iftikhar U., Stone J.A. Cardiac rehabilitation in heart failure with reduced ejection fraction: pathophysiology, benefits and precautions. Can J Cardiol 2025;41(3):443–55. DOI: 10.1016/j.cjca.2024.10.014

14. Morris B.A., Sinaei R., Smart N.A. Resistance is not futile: a systematic review of the benefits, mechanisms and safety of resistance training in people with heart failure. Heart Fail Rev 2024;29(4):827–39. DOI: 10.1007/s10741-024-10402-0

15. Gu S., Du X., Wang D. et al. Effects of high intensity interval training versus moderate intensity continuous training on exercise capacity and quality of life in patients with heart failure: a systematic review and meta-analysis. PLoS One 2023;18(8):e0290362. DOI: 10.1371/journal.pone.0290362

16. Yang C., Zhang L., Cheng Y. et al. High intensity interval training versus moderate intensity continuous training on aerobic capacity and functional capacity in patients with heart failure: a systematic review and meta-analysis. Front Cardiovasc Med 2024;11:1302109. DOI: 10.3389/fcvm.2024.1302109

17. Baral R., Ho J.S.Y., Soroya A.N. et al. Exercise training improves exercise capacity and quality of life in heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials. Eur Heart J Open 2024;4(4):oeae033. DOI: 10.1093/ehjopen/oeae033

18. Callum K., Swinton P., Gorely T. et al. Physiological and psychological outcomes of high intensity interval training in patients with heart failure compared to moderate continuous training and usual care: a systematic review with meta-analysis. Heart Lung 2024;64:117–27. DOI: 10.1016/j.hrtlng.2023.12.002

19. Lai P., Xue J.H., Xie M.J. et al. High-intensity and moderateintensity interval training in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023;102(8):e33010. DOI: 10.1097/MD.0000000000033010

20. Sebastian S.A., Padda I., Johal G. Supervised exercise training in heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials. Curr Probl Cardiol 2024;49(4):102426. DOI: 10.1016/j.cpcardiol.2024.102426

21. Mueller S., Kabelac M., Fegers-Wustrow I. et al. Comparison of exercise training modalities and change in peak oxygen consumption in heart failure with preserved ejection fraction: a secondary analysis of the OptimEx-Clin trial. Eur J Prev Cardiol 2024;zwae332. DOI: 10.1093/eurjpc/zwae332

22. Azambuja A.C.M., de Oliveira L.Z., Sbruzzi G. Inspiratory muscle training in patients with heart failure: what is new? Systematic review and meta-analysis. Phys Ther 2020;100(12):2099–109. DOI: 10.1093/ptj/pzaa171

23. Siddiqi A.K., Shahzad M., Kumar A. et al. The efficacy of inspiratory muscle training in improving clinical outcomes in heart failure patients: an updated systematic review and meta-analysis. J Cardiol 2025;85(5):374–85. DOI: 10.1016/j.jjcc.2025.01.016

24. O’Connor C.M., Whellan D.J., Lee K.L. et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 2009;301(14):1439–50. DOI: 10.1001/jama.2009.454

25. Kitzman D.W., Whellan D.J., Duncan P. et al. Physical rehabilitation for older patients hospitalized for heart failure. N Engl J Med 2021;385(3):203–16. DOI: 10.1056/NEJMoa2026141

26. Taylor R.S., Walker S., Ciani O. et al. Exercise-based cardiac rehabilitation for chronic heart failure: the EXTRAMATCH II individual participant data meta-analysis. Health Technol Assess 2019;23(25):1–98. DOI: 10.3310/hta23250

27. Taylor R.S., Long L., Mordi I.R. et al. Exercise-based rehabilitation for heart failure: cochrane systematic review, meta-analysis, and trial sequential analysis. JACC Heart Fail 2019;7(8):691–705. DOI: 10.1016/j.jchf.2019.04.023

28. Molloy C.D., Long L., Mordi I.R. et al. Exercise-based cardiac rehabilitation for adults with heart failure – 2023 Cochrane systematic review and meta-analysis. Eur J Heart Fail 2023;25(12):2263–73. DOI: 10.1002/ejhf.3046

29. Downing J., Balady G.J. The role of exercise training in heart failure. J Am Coll Cardiol 2011;58(6):561–9. DOI: 10.1016/j.jacc.2011.04.020

30. Hsu C.Y., Hsieh P.L., Hsiao S.F., Chien M.Y. Effects of exercise training on autonomic function in chronic heart failure: systematic review. Biomed Res Int 2015;2015:591708. DOI: 10.1155/2015/591708

31. Artero E.G., Lee D.C., Lavie C.J. et al. Effects of muscular strength on cardiovascular risk factors and prognosis. J Cardiopulm Rehabil Prev 2012;32(6):351–8. DOI: 10.1097/HCR.0b013e3182642688

32. Hwang C.L., Chien C.L., Wu Y.T. Resistance training increases 6-minute walk distance in people with chronic heart failure: a systematic review. J Physiother 2010;56(2):87–96. DOI: 10.1016/S1836-9553(10)70038-2

33. Gąsiorowski A., Dutkiewicz J. Comprehensive rehabilitation in chronic heart failure. Ann Agric Environ Med 2013;20(3): 606–12. PMID: 24069873

34. Piepoli M.F., Conraads V., Corrà U. et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail 2011;13(4):347–57. DOI: 10.1093/eurjhf/hfr017

35. Sachdev V., Sharma K., Keteyian S.J. et al American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; and American College of Cardiology. Supervised exercise training for chronic heart failure with preserved ejection fraction: a scientific statement from the American Heart Association and American College of Cardiology. Circulation 2023;147(16):e699–715. DOI: 10.1161/CIR.0000000000001122

36. Taylor R.S., Dalal H.M., Zwisler A.D. Cardiac rehabilitation for heart failure: “Cinderella” or evidence-based pillar of care? Eur Heart J 2023;44(17):1511–8. DOI: 10.1093/eurheartj/ehad118

37. Xiang Q., Xiong X.Y., Zhang M.J. et al. Incidence and influencing factors of kinesiophobia in patients with chronic heart failure: a scoping review. Front Psychol 2024;15:1395199. DOI: 10.3389/fpsyg.2024.1395199

38. Liu L., Yang Q., Li. T. et al. Prevalence and influencing factors of kinesiophobia in patients with heart disease: a meta-analysis and systematic review. Sci Rep 2024;14(1):18956. DOI: 10.1038/s41598-024-69929-9

39. Cotie L.M., Pakosh M., Ghisi G.L.M. Inpatient versus outpatient: a systematic review of information needs throughout the heart failure patient journey. J Clin Med 2024;13(4):1085. DOI: 10.3390/jcm13041085

40. Masotta V., Dante A., Caponnetto V. et al. Telehealth care and remote monitoring strategies in heart failure patients: a systematic review and meta-analysis. Heart Lung 2024;64:149–67. DOI: 10.1016/j.hrtlng.2024.01.003

41. Беграмбекова Ю.Л., Каранадзе Н.А., Плисюк А.Г., Орлова Я.А. Комплексная физическая реабилитация пациентов с хронической сердечной недостаточностью: влияние на клиникофункциональные показатели и анализ проблем, связанных с набором в исследование. Российский кардиологический журнал 2022;27(2):4814. DOI: 10.15829/1560-4071-2022-4814

42. Ефремова О.А., Дудченко О.В., Камышникова Л.А. и др. Клинические маркеры когнитивных нарушений у больных хронической сердечной недостаточностью ишемического генеза, находящихся на диспансерном наблюдении: поперечное исследование. Альманах клинической медицины 2024;52(1):35–44. DOI: 10.18786/2072-0505-2024-52-003

43. Babygeetha A., Devineni D. Social support and adherence to self-care behavior among patients with coronary heart disease and heart failure: a systematic review. Eur J Psychol 2024;20(1): 63–77. DOI: 10.5964/ejop.12131

44. Gore S., Khanna H., Kumar A. Effects of comprehensive outpatient cardiac rehabilitation on exercise capacity, functional status, and quality of life in people with heart failure: a systematic review and meta-analysis. Phys Ther 2023;103(11):pzad119. DOI: 10.1093/ptj/pzad119

45. Alnomasy N., Still C.H. Nonpharmacological interventions for preventing rehospitalization among patients with heart failure: a systematic review and meta-analysis. SAGE Open Nurs 2023;9:23779608231209220. DOI: 10.1177/23779608231209220

46. Ларина В.Н., Замятин К.А., Шерегова Е.Н., Кудинова М.А. Приверженность лечению как неотъемлемый компонент тактики ведения пациентов с хронической сердечной недостаточностью. Российский кардиологический журнал 2024;29(1):5690. DOI: 10.15829/1560-4071-2024-5690