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  • Review Article
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Physical function and exercise training in older patients with heart failure

Nature Reviews Cardiology volume 14, pages 550–559 (2017)Cite this article

Subjects

Key Points

  • Older patients (aged ≥70 years) with heart failure (HF) have substantially impaired physical function and poor clinical outcomes

  • A comprehensive assessment of physical function is strongly recommended in this cohort, and should ideally include assessment of aerobic performance as well as peripheral and respiratory muscle strength and endurance

  • Physical activity and exercise training are important for improving outcomes in patients with HF, especially elderly patients, but uptake remains poor

  • To improve long-term compliance with exercise training, there is a need to improve two-way communication between clinicians and patients, including comprehension of health information such as exercise training

  • Improving health literacy, defined as 'the motivation, confidence, physical competence, knowledge, and understanding to maintain physical activity throughout the life course', is essential for improving exercise adherence in elderly patients with HF

Abstract

Heart failure (HF) is a common end point for numerous cardiovascular conditions, including coronary artery disease, valvular disease, and hypertension. HF predominantly affects older individuals (aged ≥70 years), particularly those living in developed countries. The pathophysiological sequelae of HF progression have a substantial negative effect on physical function. Diminished physical function in older patients with HF, which is the result of combined disease-related and age-related effects, has important implications on health. A large body of research spanning several decades has demonstrated the safety and efficacy of regular physical activity in improving outcomes among the HF population, regardless of age, sex, or ethnicity. However, patients with HF, especially those who are older, are less likely to engage in regular exercise training compared with the general population. To improve initiation of regular exercise training and subsequent long-term compliance, there is a need to rethink the dialogue between clinicians and patients. This Review discusses the need to improve physical function and exercise habits in patients with HF, focusing on the older population.

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Figure 1: Decision tree integrating the assessment, discussion, and prescription of physical activity and exercise in clinical practice.

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Authors and Affiliations

  1. Monash University, Clayton Campus, Melbourne, 3800, Victoria, Australia

    Andrew J. Stewart Coats

  2. University of Warwick, Kirby Corner Road, Coventry, CV4 8UW, UK

    Andrew J. Stewart Coats

  3. Section of Geriatric Cardiology, University of Pittsburgh Medical Center, VA Pittsburgh Healthcare System, 259 Mt Nebo Pointe Drive, Pittsburgh, 15213, Pennsylvania, USA

    Daniel E. Forman

  4. College of Nursing and Health Innovation, University of Texas at Arlington, 411 South Nedderman Drive, Arlington, 76019, Texas, USA

    Mark Haykowsky

  5. Department of Internal Medicine, Cardiovascular Medicine Section, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, 27157, North Carolina, USA

    Dalane W. Kitzman

  6. Department of Physical Therapy, Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Chicago, 60612, Illinois, USA

    Amy McNeil & Ross Arena

  7. Department of Psychology, University of Calgary, 2500 University Drive North West, Calgary, T2N 1N4, Alberta, Canada

    Tavis S. Campbell

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A.J.S.C. researched data and wrote the article. A.J.S.C. and D.E.F. contributed to discussion of content. All authors reviewed and edited the manuscript before submission.

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Coats, A., Forman, D., Haykowsky, M. et al. Physical function and exercise training in older patients with heart failure. Nat Rev Cardiol 14, 550–559 (2017). https://doi.org/10.1038/nrcardio.2017.70

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