Why Strength Training is Vital for Patients with Heart Failure


Heart failure (HF) is a multi-faceted and life-threatening syndrome characterised by significant morbidity and mortality, poor functional capacity and quality of life (QoL), and high costs. Accordingly, reducing its social and economic burden has become a major global public health priority. The magnitude of the problem of HF cannot be assessed with precision since reliable, population-based estimates of its prevalence, incidence, and prognosis are lacking, particularly epidemiological data on HF in developing countries, where HF has different characteristics compared with the Western world, are needed. Nevertheless, there are an estimated 64 million people with HF worldwide. Although incidence has remained stable or has even slightly declined over time, prevalence is increasing due to the ageing of the population and the prolongation of the lives of cardiac patients by modern therapeutic innovations (1).

As highlighted, HF is characterised by functional limitations and consequent loss of QoL and has a significant impact on prognosis. A systematic review and meta-analysis of 44 observational longitudinal cohort studies with a total of 22,598 patients with HF showed that patients with poor physical functional performance in the Six Minute Walking Test (6MWT), the Short Physical Performance Battery (SPPB), and the Gait Speed Test had worse prognosis in terms of larger risk of hospitalisation or mortality than patients with good physical functional performance (2). Another systematic review and meta-analysis also showed a strong relationship between physical performance and prognosis among patients with HF. Six-minute walk distance (6MD) test cut-off values were significantly associated with mortality (hazard ratio [HR], 2.04; 95% CI, 1.48-2.83; p < 0.001) and cardiovascular disease (HR, 2.18; 95% CI, 1.68-2.83; p < 0.001) (3).

An old couple doing strength training for heart failure.

In my post, ‘Exercise: The Medicine Since Antiquity’, I have discussed the role exercise has played in preserving health and preventing and managing various diseases since almost 600 BC. A systematic review showed that exercise also improves functional capacity and QoL in patients with heart failure (4).

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