The Effects and Safety of Exercise Training in Subjects With Chronic Heart Failure—Do Elder Subjects Gain Similar Benefits?

Traditionally, chronic heart failure (CHF) subjects are often recommended to rest and restrict physical activity; however, this advice may exacerbate the disease. Exercise training is associated with many central and peripheral adaptations that improve clinical outcomes. Exercise training can restore the abnormal autonomic function, attenuate the production of proinflammatory cytokines and the N-terminal precursor of brain natriuretic peptide (NT-pro-BNP), and improve the endothelial dysfunction and the oxidative capacity of peripheral muscle. The current evidence supports the concept that exercise training can effectively improve the exercise capacity and quality of life of subjects with CHF, to some extent, as well as reduce hospitalization and risk of mortality. Structured exercise training is proved to be safe for CHF subjects. Exercise training had no detrimental effects on the left ventricular remodeling. Ultimately, trained subjects showed a significant improvement in left ventricle function. An important limitation of current published studies is that only a few have included significant proportions of elderly subjects with CHF. The limited data available suggests that elderly subjects derive similar benefits from exercise training as younger subjects. In summary, exercise training is an inexpensive and effective intervention for subjects with CHF. This article reviews the current knowledge of the effects of exercise training on the exercise capacity, quality of life, and mortality and morbidity of subjects with CHF and elderly subjects. A major challenge for the future is the inclusion of representative proportions of elderly and frail subjects in heart failure training trials.