Heart Failure Reviewshttp5/doi.org/10.1007/s10741-023-10310-9Practical guidelines for exercise prescription in patients with chronicheart failureJenna L.Taylor1.2.Jonathan Myers3.Amanda R.BonikowskeAccepted:27 March 2023The Author(s),under exclusive licence to Springer Science+Business Media,LLC,part of Springer Nature 2023AbstractChronic heart failure (HF)is a major cause of morbidity,mortality,disability,and health care costs.A hallmark feature of HFis severe exercise intolerance,which is multifactorial and stems from central and peripheral pathophysiological mechanisms.Exercise training is internationally recognized as a Class 1 recommendation for patients with HF,regardless of whether ejec-tion fraction is reduced or preserved.Optimal exercise prescription has been shown to enhance exercise capacity,improvequality of life,and reduce hospitalizations and mortality in patients with HF.This article will review the rationale and cur-rent recommendations for aerobic training,resistance training,and inspiratory muscle training in patients with HF.Further-more,the review provides practical guidelines for optimizing exercise prescription according to the principles of frequency,intensity,time (duration),type,volume,and progression.Finally,the review addresses common clinical considerations andstrategies when prescribing exercise in patients with HF,including considerations for medications,implantable devices,exercise-induced ischemia,and/or frailty.Keywords Cardiac rehabilitation.Aerobic training.Resistance training.Inspiratory muscle training.Cardiorespiratoryfitness.Physical therapyIntroductionejection fraction ranges [3].Approximately 50%of patientshave HFrEF with a relatively stable prevalence compared toChronic heart failure is a major global public health problemthe rapidly increasing prevalence of HFpEF which is pro-affecting over 64 million people worldwide and over 6 mil-jected to become the most common form of HF [1].HFpEFlion in the USA [1,2].Heart failure (HF)is associated withis more likely to affect older individuals as well as womensignificant morbidity,mortality,and health care costs [1].with significant and severe comorbidities,and to date,thereAdditionally,the prevalence of HF is projected to increaseare no effective treatments for HFpEF,which contributes todue to the aging of the population and improved survivalits high morbidity and mortality [4,5].HF is defined as adue to improved treatment of ischemic heart disease and evi-clinical syndrome encompassing structural and functionaldence-based treatments including guideline-directed medi-abnormalities,elevated brain natriuretic peptide,and pul-cal therapy [1].The phenotype of HF has expanded to HFmonary or systemic congestion [3].The hallmark symptomwith preserved ejection fraction(HFpEF),HF with mildlyof HFrEF and HFpEF phenotypes is severe exercise intol-reduced ejection fraction (HFmrEF)along with HF witherance,which is multifactorial and stems from central andreduced ejection fr
