Benefits of Exercise in Patients with Congestive Heart Failure

A large majority of individuals with CHF suffer from fatigue and poor exercise capacity, the underlying cause of which is multi-factorial. These include central mechanisms such as cardiac dysfunction and poor cardiac output as well as peripheral maladaptations such as neurohormonal activation and abnormalities in skeletal muscle structure and metabolism. Studies in the last decades have shown that exercise training can reverse some of these adverse pathophysiological effects, which are both associated with poor exercise capacity and poor overall prognosis in CHF. Data from the EXERT study and other small clinical studies indicate that exercise training, based on individualized protocols and approaches geared toward each individual’s capacity, is safe in selected patients. Although EXERT remains the largest randomized control trial of exercise training in CHF, these studies demonstrating the benefits of exercise are small. Conclusions on whether or not these observations can be translated into reductions in morbidity and mortality, despite the promise shown in the reversal of the pathophysiological mechanisms, remain unclear. Large adequately powered randomized controlled trials are needed to address this important question. Meanwhile, the traditional advice to CHF patients “to avoid physical exertion” should not longer be applied to all affected individuals.