Key result
Exercise training improves cardiac function and exercise capacity in both HFrEF and HFpEF through distinct cellular and molecular mechanisms.
Why the study?
HFrEF and HFpEF have overlapping clinical features but distinct molecular mechanisms, and exercise training shows promise as therapy with unclear protective mechanisms.
Does exercise training improve exercise capacity and cardiac function in patients with HFrEF and HFpEF?
Does exercise training improve exercise capacity and cardiac function in patients with HFrEF and HFpEF?
Exercise training is a safe, accessible, and effective non-pharmacological therapy that addresses both central and peripheral limitations to improve functional capacity in HFrEF and HFpEF.
Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) are subtypes of heart failure with overlapping clinical features but have some distinct functional characteristics and cellular and molecular mechanisms. Exercise training is an accessible, non-pharmacological therapy recommended for the management of HFrEF and is increasingly showing promise for treating HFpEF. This review summarises the underlying pathophysiology of HFrEF and HFpEF and the evidence from clinical and preclinical studies showing that exercise training can improve cardiac function. The authors also summarise the underlying cellular and molecular mechanisms between HFrEF and HFpEF, with respect to cardiac remodelling, fibrosis, mitochondrial adaptations and metabolism, inflammation and inter-organ crosstalk, and provide evidence that exercise training elicits protective adaptations in HFrEF and HFpEF through some different signalling pathways targeted by exercise. Finally, the authors discuss the use of exercise training as a therapeutic intervention for HFrEF and HFpEF through personalised training by phenotype and in combination with emerging pharmacological treatments.
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Liu et al. (2026) conducted a review in Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Exercise training was evaluated. Exercise training improves cardiac function and exercise capacity in both HFrEF and HFpEF through distinct cellular and molecular mechanisms.
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