Rehabilitation Exercise in Persons with Stable Heart Failure

Main Article Content

Ammarawadee Boonyarat


The purpose of this article was to review, analyze, and summarize research
studies and articles related to the benefits, guidelines, and methods of rehabilitation
exercise in patients with stable heart failure. The literature used for this article was
reviewed and selected from reliable evidence studies aiming to recommend practice
guidelines for rehabilitating stable heart failure patients. The review revealed that
rehabilitative exercise is reasonable and beneficial for persons with stable heart failure.
An appropriate and safe exercise includes three phases: 1) the warm-up phase, 2) the
conditioning phase, and 3) the cool-down phase. The criteria to recruit heart failure
patients eligible to follow this protocol were those who can perform functional ability
at the New York Heart Association (NYHA) class II-III, and 2) those who do not have
any apnea during resting or exercising period for at least 3-5 days prior to rehabilitation.
The type of exercise includes: 1) aerobic exercise, 2) resistance training, and 3) a
combination of aerobic exercise and resistance training. The goal of intensity is at the
low to moderate levels, 40% to 85% of maximum heart rate at exercise or 50% to 85%
of maximal oxygen consumption or the Borg Scale of Perceived Exertion as the score
of 12-16. The exercise duration should be 20 to 40 minutes. At first, the exercise
should take a shorter period of time. In another word, the exercise should last at least
10 minutes at the beginning and the duration and intensity of the exercise should gradually
increase until the target goal is reached. The frequency of exercise should be 3 to 7 days
per week and continuously done for at least 4 weeks. To be productive, in terms of
reducing the hospital readmission and mortality rates, persons with stable heart failure
should exercise for a continuous period of at least 6 months to 1 year and should be
under the supervision of healthcare providers who have knowledge in this area. This
literature review is expected to be useful to clinical application in educating, promoting,
supporting and caring for persons with heart failure to achieve better health status and
quality of life.

Keywords: Congestive Heart Failure, Type of exercise, Intensity of exercise,
Frequency of exercise, Duration of exercise

Article Details

How to Cite
Boonyarat A. Rehabilitation Exercise in Persons with Stable Heart Failure. Nurs Res Inno J [Internet]. 2018 Jul. 16 [cited 2024 Jun. 17];24(1):13-24. Available from:


1. National Statistical Office. National Center for Chronic Disease Prevention and Health Promotion. Heart failure;
2016[cited 2017 Jan22]. Available from: http://statbbi. (in thai)

2. Ko JK, McKelvie RS. The role of exercise training for patients with heart failure. Eura Medicophys. 2005;41(1): 35-47.

3. Ministry of Public Health. Health statistics Office of Policy and Strategy, The Ministry of Public Health; 2015. (in thai)

4. Lehnbom EC, Bergkvist AC, Gränsbo K. Heart failure exacerbation leading to hospital admission: a cross-sectional
study. Pharmacy World & Science. 2009;31(5): 572-9.

5. Aroongsang P. Nursing of patients with cardiovascular disease.10th ed. Konkaen: Kangnanawitaya; 2013.(in thai)

6. Thompson P. Exercise-based, comprehensive cardiac rehabilitation. Braunwald's heart disease: atextbook of
cardiovascular medicine.10th ed Philadelphia, PA: Elsevier Saunders. 2015.

7. Chapa DW, Akintade B, Son H, Woltz P, Hunt D, Friedmann E, et al. Pathophysiological relationships between heart
failure and depression and anxiety. Critical Care Nurse. 2014;34(2):14-25.

8. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Journal of the American College of Cardiology. 2013;62(16):1495-539.

9. Nicholson C. Chronic heart failure: pathophysiology, diagnosis and treatment. Nursing Older People. 2014; 26(7):29-38.

10. Piepoli M. Exercise training in chronic heart failure: mechanisms and therapies. Netherlands Heart Journal.

11. Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010;16(6): e1-194.

12. Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update: ACCF/AHA
guidelines for the diagnosis and management of heart failure in adults. Circulation. 2009;119(14):1977-2016.

13. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for
developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Medicine And
Science In Sports And Exercise [serial on the Internet]. (1998, June), [cited March 12, 2017]; 30(6): 975-991.
Available from MEDLINE Complete.

14. Piepoli M, Davos C, Francis D, Coats A. Exercise training meta-analysis of trials in patients with chronic heart failure
(ExTraMATCH). BMJ (Clinical Research Ed.) [serial on the Internet]. (2004, Jan 24), [cited Oct 02, 2017];
328(7433): 189. Available from MEDLINE Complete.

15. Davies EJ, Moxham T, Rees K, Singh S, Coats AJ, Ebrahim S, et al. Exercise training for systolic heart failure:
cochrane systematic review and meta‐analysis. European Journal of Heart Failure. 2010;12(7):706-15.

16. Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal HM, Lough F, et al. Exercise-based rehabilitation for heart
failure: systematic review and meta-analysis. Open Heart. 2015;2(1):e000163.

17. Il P, Apstein C, Balady G, Belardinelli R, Chaitman B, Duscha B, et al. Exercise and heart failure: a statement
from the American Heart Association Committee on Exercise. Rehabilitation and Prevention Circulation.

18. Chen Y, Li Z, Zhu M, Cao Y. Effects of exercise training on left ventricular remodelling in heart failure patients: an
updated meta-analysis of randomised controlled trials. International Journal of Clinical Practice [serial on the
Internet]. (2012, Aug), [cited April 24, 2018]; 66(8): 782-91. Available from MEDLINE Complete.

19. Pandey A, Parashar A, Kumbhani D, Agarwal S, Garg J, Berry J, et al. Exercise training in patients with heart failure
and preserved ejection fraction: meta-analysis of randomized control trials. Circulation. Heart Failure [serial
on the Internet]. (2015, Jan), [cited Oct 15, 2017]; 8(1):33-40. Available from MEDLINE Complete.

20. Smart N, Marwick TH. Exercise training for patients with heart failure: a systematic review of factors that improve
mortality and morbidity. American Journal of Medicine. 2004;116(10):693-706.

21. Lewinter C, Doherty P, Gale CP, Crouch S, Stirk L, Lewin RJ, et al. Exercise-based cardiac rehabilitation in patients
with heart failure: a meta-analysis of randomised controlled trials between 1999 and 2013. European Journal of
Preventive Cardiology. 2015;22(12):1504-12.

22. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC guidelines for the diagnosis
and treatment of acute and chronic heart failure 2012. European Journal of Heart Failure. 2012;14(8): 803-69.

23. Chan E, Giallauria F, Vigorito C, Smart NA. Exercise training in heart failure patients with preserved ejection
fraction: a systematic review and meta-analysis. Monaldi Archives for Chest Disease. 2016;86(1-2).

24. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription: Lippincott Williams
& Wilkins; 2013.

25. Heart Failure Society of America. Executive summary: HFSA 2010 comprehensive heart failure practice guideline.
J Card Fail. 2010;16(6):475-539.

26. Graetz B, Sullivan M, Robertson T, Reeve J. Do hydrotherapy exercise programmes improve exercise tolerance and
quality of life in patients with chronic heart failure?: a systematic review. New Zealand Journal of Physiotherapy.
2015;43(2): 64-71. doi: 10.15619/NZJP/43.2.07

27. 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. Journal of Physiotherapy. 2010;56(2):87-96.

28. Jewiss D, Ostman C, Smart N. The effect of resistance training on clinical outcomes in heart failure: a systematic
review and meta-analysis. International Journal of Cardiology. 2016;221:674-81.

29. Giuliano C, Karahalios A, Neil C, Allen J, Levinger I. The effects of resistance training on muscle strength, quality
of life and aerobic capacity in patients with chronic heart failure—a meta-analysis. International Journal of Cardiology.

30. Selig SE, Carey MF, Menzies DG, Patterson J, Geerling RH, Williams AD, et al. Moderate-intensity resistance
exercise training in patients with chronic heart failure improves strength, endurance, heart rate variability, and forearm
blood flow. Journal of Cardiac Failure. 2004;10(1):21-30.

31. Ramos JS, Dalleck LC, Tjonna AE, Beetham KS, Coombes JS. The impact of high-intensity interval training versus
moderate-intensity continuous training on vascular function: a systematic review and meta-analysis. Sports Medicine.