Is ARIS (aerobic/resistance/inspiratory muscle training) the optimal exercise training programme for chronic heart failure patients?

This editorial refers to ‘Combined aerobic/resistance/inspiratory muscle training as the ‘optimum’ exercise program for patients with chronic heart failure: ARISTOS-HF randomized clinical trial’, by I. D Laoutaris et al. pp. 1626–1635. Exercise-based cardiac rehabilitation (EBCR) in chronic heart failure (CHF) has received the highest class of recommendation and level of evidence (IA) since 2008. This was reconfirmed in the 2016 update and the recent expert consensus report on clinical practice update (2019).1 Exercise training (ET) has been granted IA class of recommendation in the updated position paper from the Secondary Prevention and Rehabilitation section of the European Association of Preventive Cardiology.2 Although there is an agreement on the ET modes that have an effect on the patients’ exercise tolerance, muscular and cardiovascular improvement, well-being and quality of life (QoL), an inter-clinician variance, and disagreement exists on which ET mode or combination is the best and should be broadly prescribed. Moderate continuous aerobic training (MCAT) is the most established but high-intensity interval training (HIIT) has been proposed although not superior to MCAT.3 Additionally, resistance training (RT) may increase muscle strength, and aerobic capacity4 while inspiratory muscle training (IMT) improves exercise capacity and QoL.5 Exercise training combinations have been also investigated. The idea of settling down all arguments, proposing an optimal way to exercise patients, was well addressed but not completely resolved by the use of a digital training and decision support system; the EXPERT tool (https://www.escardio.org/Education/Practice-Tools/CVD-prevention-toolbox/expert-tool).6