Exercise for Older People with Heart Failure and Frailty: Should We Even Try?

Abstract

The benefits of exercise in older patients with heart failure (HF) and frailty are twofold: (i) improvement in cardiopulmonary capacity, thus reducing HF-related sequelae; (ii) attenuation of decline in physical function, thus improving frailty status. Despite the clear benefits, exercise training (ET) remains underutilised as a treatment modality in this patient population. Guidelines on the specific type of exercise intervention best suited for this population are still lacking. In this review, we discuss (i) pathophysiology underlying exercise intolerance in patients with HF; (ii) impact of frailty on HF and exercise capacity; (iii) benefits and safety of ET; (iv) recommended ET programme for this population; (v) mode of delivery and (vi) potential barriers in the uptake of ET and strategies to overcome them. An effective ET intervention in this population warrants individualisation to patient's physical capacity, while addressing possible barriers to uptake so as to ensure sustained participation in the programme.