Inpatient-initiated and home-based exercise training reduces heart failure hospitalization and reverses frailty: a prospective randomized study

Background Frailty progression and functional decline substantially contribute to recurrent hospitalization and poor outcomes in heart failure (HF). While exercise-based rehabilitation is recommended, its impact on frailty trajectory, cognitive function, and clinical events in real-world HF populations remains incompletely defined. Methods In this prospective randomized study, 100 patients with chronic HF were allocated 1:1 to a structured exercise program (initiated during hospitalization and continued as supervised home-based training) or standard care. Clinical, functional, and cognitive assessments were performed at baseline and 6 months. Evaluations included grip strength, 2.5-m gait speed, frailty status, peak oxygen consumption (peak VO2), and cognitive function (K-MMSE). The primary clinical endpoint was HF-related hospitalization during 6-month follow-up. Results At 6 months, the exercise arm demonstrated significant improvement in muscle strength (grip strength: 28.9→32.0 kg; Δ +3.1 kg, p=0.013) and a marked reduction in frailty score (1.63→1.23; Δ −0.40, p=0.001). Cognitive performance improved significantly (K-MMSE: 27.98→28.79; Δ +0.81, p=0.004). Peak VO2 was preserved in the exercise group, whereas the control arm exhibited a clinically meaningful decline (≈≥20% from baseline). Importantly, HF-related hospitalization was significantly lower in the exercise arm compared with standard care (p=0.01). No improvement in frailty or cognitive parameters was observed in the control group. Conclusions A combined inpatient-initiated and home-based exercise strategy improves muscle strength, reverses frailty, preserves cardiopulmonary fitness, and reduces HF hospitalization. These findings suggest that early structured rehabilitation may modify the trajectory of functional decline and clinical vulnerability in HF beyond symptomatic management.HF exercise program