CARDIAC REHABILITATION

EXERCISE IN
HEART FAILURE
Present by Supak Kanchanaporn M.D.
WHAT WE'LL
DISCUSS TODAY

Cardiac rehab in ACC/AHA

guidelines in management of
heart failure 2022

Physiology of exercise
limitations in HF

Exercise training in heart

failure
from theory to practice

 Guidelines for management of

Heart Failure
2022 Recommendations for Management of Stage C HF:

ACC/AHA Activity, Exercise Prescription, and Cardiac

Rehabilitation
 Guidelines for management of
Chronic Heart Failure
2021 ESC Recommendations for exercise rehabilitation in patients
optimization of standard therapies for HFrEF to
determine the need with chronic heart failure
ACTIVITY, EXERCISE PRESCRIPTION,
AND CARDIAC REHABILITATION

Most studies and meta-analyses have not shown

significant changes in all-cause mortality.2,12,14–22
except for a few showing mortality benefit with
longer follow-up6,7 Other benefits of exercise
training include improved endothelial function,
blunted catecholamine spillover, increased
peripheral oxygen extraction, and improvement in
peak oxygen consumption.

an early, transitional, tailored, progressive

rehabilitation intervention that included multiple
physical-function domains (strength, balance,
mobility, and endurance) initiated during, or early
after hospitalization for HF, and continued after
discharge, resulted in greater improvement in
physical function than usual care

PHYSIOLOGY OF
EXERCISE LIMITATIONS

The hallmark symptom of

chronic heart failure (HF) is
severe exercise intolerance.
Impaired perfusive and
diffusive O2transport are two
of the major determinants of
reduced physical capacity and
lowered maximal O2 uptake
in patients with HF
PATHOPHYSIOLOGY OF
EXERCISE INTOLERANCE
PHYSIOLOGY OF
EXERCISE LIMITATIONS

aspects of HF-induced
skeletal muscle dysfunction
including blunted
endothelium-dependent
arteriolar vasodilation,
capillary involution and
cessation of red blood cell
flux in many capillaries,
increased muscle
deoxygenation, fiber atrophy
and weakness, mitochondrial
rarefaction, and
compromised metabolism.
ASSESS OF EXERCISE
CAPACITY
PHYSIOLOGY OF
EXERCISE LIMITATIONS

Recent advances in HF
treatment targeting skeletal
muscle include

1) application of high-intensity
interval training to achieve larger
increases in V̇ o2max (106, 128),

2) combination of aerobic and

resistance exercise to improve
V̇ o2max and increase muscle
mass (40),

3) exploration of small muscle

mass exercise and training
PHYSIOLOGY OF
EXERCISE LIMITATIONS
 Transitional Phase

BOTH CLINICAL STABILITY AND EARLY MOBILIZATION ARE

IMPORTANT HELP ACHIEVE FUNCTIONAL SELF-SUFFICIENCY
AND TRUST PRIOR TO
CONDUCTING REGULAR EXERCISE

GRADUAL MOBILIZATION/CALISTHENICS, RESPIRATORY

TRAINING, AND SMALL MUSCLE STRENGTH EXERCISE CAN BE
CONSIDERED
Calisthenic Exercise
Respiratory Training
Resistance training