Exercise Training Safely Boosts Fitness in Heart Failure and Cardiomyopathy

If breathlessness or fatigue limits your day, the right kind of exercise can help you do more with less strain.

What the new review asked, and why it matters

This week, a team led by Macy Stahl and Nathan Weeldreyer pulled together decades of research on exercise for heart failure (HF) and related heart muscle diseases (cardiomyopathies). They asked three simple things: Is exercise safe? Does it work? And what kind of training helps whom?

Plain-English version of the methods: this is a big review of clinical trials and guidelines, not a single lab experiment. Think of it as a road atlas, not a dash‑cam.

Headline findings:

Exercise is safe for most people with heart failure when supervised and tailored.
It improves peak oxygen uptake (your “fitness score”, or VO2peak) by roughly 1–3 ml/kg/min in many trials—enough to turn stairs from a slog into a stroll.
Quality of life improves, and hospital admissions drop. Short‑term deaths do not seem to change, but longer, larger trials are still needed.
For hypertrophic cardiomyopathy (HCM), moderate and even vigorous exercise looks safer than once feared.
Newer ideas focus on training the muscles, not just the heart, to break the cycle of fatigue.

What this means for you: practical takeaways

Rest is not best. Supervised, regular exercise is now a class‑leading treatment for heart failure.
Small fitness gains matter. A 10–17% bump in VO2peak (seen in several trials, especially in HFpEF) can turn daily tasks from “near‑max effort” into manageable work.
Hospital visits can fall. Large reviews show fewer admissions in people who do cardiac rehab versus those who do not.

Simple decoder ring:

VO2peak = how much oxygen your body can use at top effort. Higher is better for walking, climbing, living.
HF types: HFrEF = reduced squeeze (≤40% ejection fraction); HFpEF = preserved squeeze (≥50%); HFmrEF = the “middle zone”.

Start safely: a week-by-week action plan

First, speak to your GP or heart team. In the UK, ask about an NHS cardiac rehabilitation programme—these exist for heart failure in many areas.

Week 1–2: build the habit
5–10 minutes of easy walking, 1–2 times per day.
Light sit‑to‑stand from a chair, 2–3 sets of 8–12 reps.
Aim to finish feeling “I could do more.”
Week 3–4: add gentle muscle work
Two short resistance sessions per week: light bands or 1–3 kg weights for arms, legs, and calves; 2–3 sets of 8–12 reps.
Optional “PRIME‑style” blocks: pick one muscle group (e.g., quads on a seated leg extension or slow sit‑to‑stands) at a very light load for up to 3–5 minutes continuous work. Breathing steady, talkable pace.
Week 5–8: sprinkle intervals (if your team agrees)
On 2–3 walks per week, try 1 minute brisk / 2 minutes easy, repeat 4–6 times. Stop if symptoms flare.
Keep resistance training twice weekly.

Red flags—stop and seek advice:

Chest pain, unusual breathlessness at rest, dizziness, palpitations that worry you, or swollen ankles getting worse.

Busting old assumptions (with data)

“Bed rest protects a weak heart.” No. The timeline on page 2 shows we left that behind decades ago. Exercise is now a front‑line therapy.
“Weights are dangerous in heart failure.” Modern studies (and the review’s resistance‑training section) show light‑to‑moderate strength work improves function and does not harm the heart when supervised.
“Only long, steady cardio works.” Intervals can be useful, especially because everyday tasks already feel like “high effort” for many with HF. Trials in HFrEF and HFpEF found benefits from both moderate continuous training and high‑intensity intervals; neither is universally “best”.

HIIT, steady cardio, and the muscle-first idea

What the evidence says:

In HFrEF, both steady and interval training improve fitness; some analyses suggest intervals may edge ahead for VO2peak and heart function, but big head‑to‑heads are mixed.
In HFpEF, several trials showed modest VO2peak gains with both styles; one large study found no clear winner on clinical outcomes, but fitness and symptoms improved with training.
The PRIME approach (see the model on page 8) targets peripheral muscles with low heart strain and has early, promising results in older HFrEF patients.

What to do with that:

Choose the style you can stick with. If brisk 1‑minute bursts feel good and are approved by your clinician, great. If you prefer steady walks and light circuits, also great.
Blend them. Many programmes periodise: a few weeks of muscle‑focused work, then add intervals or longer steady bouts.

HCM and ANOCA: what’s different, what’s safe

Hypertrophic cardiomyopathy (HCM): new prospective studies show moderate—and even vigorous—exercise can be as safe as being sedentary for many. Fitness improves by about 1–2 ml/kg/min in trials. But people with high‑risk features (e.g., certain gene variants, prior exertional faints) need specialist assessment and shared decision‑making before harder training.
Angina with non‑obstructive coronary arteries (ANOCA): small studies suggest structured aerobic and resistance exercise can improve symptoms, fitness, and blood vessel function. Early high‑intensity interval programmes looked feasible and safe, but larger trials are needed.

Always get personalised clearance if you have HCM or ANOCA before ramping up intensity.

Why this review stands out—and what we still don’t know

What’s new here:

It treats exercise as “unifying therapy” across heart failure types—HFrEF, HFpEF, and the middle group (HFmrEF)—and extends to HCM and ANOCA.
It spotlights the skeletal muscle: improving blood flow and muscle metabolism may matter as much as changing the heart itself. The “Deleterious Cycle” diagram on page 6 makes this plain.
It introduces pragmatic, low‑strain strategies like PRIME for older, deconditioned patients who find daily tasks near maximal effort.

Open questions:

Hard outcomes: we need larger, longer trials to confirm effects on deaths and long‑term hospitalisations.
Real‑world patients: many past trials skew younger and male; older adults and women are under‑represented. The review calls this out and urges change.
Best dose and mix: intervals versus steady work, how much resistance training, and how to tailor by sex, age, and HF subtype remain active research areas.

As the authors put it, with proper checks, “exercise is a unifying therapy across most heart failure conditions regardless of ejection fraction,” improving function and quality of life—while bigger trials tackle the rest.

Quick checklist you can use today

Ask your GP about NHS cardiac rehabilitation for heart failure.
Start small, most days; finish with air in the tank.
Do two light strength sessions per week: legs, arms, and calves.
Consider gentle intervals only with clinical approval.
Track symptoms, not just steps: breathlessness, fatigue, ankle swelling.
Keep meds, diet, and sleep on point—exercise complements, not replaces, your treatment.

Source and further reading

Exercise Rehabilitation for Heart Failure and Associated Cardiomyopathies (Stahl, Weeldreyer and colleagues), Current Cardiology Reports, 2025. Open‑access PDF: https://link.springer.com/content/pdf/10.1007/s11886-025-02313-9.pdf

Note: This article is informational and not a medical diagnosis. Always follow advice from your cardiology team.