Is It Safer and More Beneficial to Work Heart Failure Patients Harder? An Editorial Commentary

Exercise training is undoubtedly beneficial to heart failure patients in terms of improved physical fitness and quality of life, although a clear survival benefit has yet to be demonstrated. The results of some previously published exercise training trials may have been affected by several factors. First, exercise adherence is often below desired targets, which may lead to much smaller improvements than expected. Second, studies may have been affected by crossover to the exercise intervention in up to one-third of sedentary controls, which was the case in the largest trial to date, HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training). Finally, moderate-intensity continuous exercise has historically been the cornerstone of exercise programming, although a small volume of recent work has shown high-intensity interval exercise training to be superior for eliciting improvements in peak VO2 and systolic heart function.