Exercise-based Cardiac Rehabilitation in Heart Failure

Heart failure is one of the common causes of morbidity, mortality, and socioeconomic burdens. Heart failure is treated by medications or assistive devices according to the current evidence-based guideline, thus the mortality due to heart failure is decreasing but the long-term mortality is still high and patients with heart failure show poor quality of life. Exercise-based cardiac rehabilitation (CR) along with optimal medical therapy can decrease hospital readmissions, long-term mortality and promote health-related quality of life. Therefore, exercise-based CR in heart failure is strongly recommended by international guidelines for heart failure. In Korea, the national medical insurance coverage for CR was started in 2017 but CR for heart failure is definitely underutilized. To promote CR in heart failure, health care professionals in CR providers should fully understand the benefits and clinical application of CR and can convince other medical staff or patients with heart failure based on their solid knowledge. In this narrative brief review for CR in heart failure, I will cover the following topics: 1) mechanisms of exercise-based CR on beneficial effects in heart failure, 2) clinical evidence of CR in heart failure, 3) exercise prescription in heart failure, 4) CR barriers and strategies to promote CR.