LaMonte Michael J
Department of Epidemiology & Environmental Health, School of Public Health and Health Professions, University at Buffalo - SUNY, Buffalo, NY, 14214, USA.
Sports Med Health Sci. 2025 Jul 17;7(5):375-383. doi: 10.1016/j.smhs.2025.07.005. eCollection 2025 Sep.
Heart failure (HF) poses a serious threat to public health in an aging population. HF with reduced ejection fraction (HFrEF) historically was the focus for developing prevention and management strategies, including exercise training in HFrEF patients. However, HF with preserved ejection fraction (HFpEF) is increasingly common among older adults. There are no well-established treatment options making its primary prevention critical. This article reviews the role of exercise in the prevention and management of HF. Selected published articles informed discussion of HF etiology, evidence for the role of exercise in HF, and the biologic mechanisms linking exercise with HF development and prognosis. HF is a complex syndromic condition that manifests with severe exercise intolerance. Several causes of HF-related exercise intolerance respond to exercise training and two randomized controlled exercise interventions in HFrEF patients have demonstrated safety and efficacy for improved physical work capacity, quality of life, and mortality endpoints in medically stable HF patients. At present, only epidemiological cohort data are available for HFpEF outcomes, but the data are generally consistent in supporting lower risk of HFpEF development with levels of lifestyle physical activity meeting recommended amounts. Clinical trial evidence is needed to support this observation in HFpEF. Exercise training is established as part of guideline directed treatment of HFrEF patients. Lifestyle physical activity at guideline recommended amounts appears to be associated with lower risk of developing both HFrEF and HFpEF. There has yet to be a definitive clinical trial on exercise training and HFpEF treatment.
心力衰竭（HF）对老龄化人口的公共卫生构成严重威胁。射血分数降低的心力衰竭（HFrEF）历来是制定预防和管理策略的重点，包括对HFrEF患者进行运动训练。然而，射血分数保留的心力衰竭（HFpEF）在老年人中越来越常见。目前尚无成熟的治疗方案，因此其一级预防至关重要。本文综述了运动在心力衰竭预防和管理中的作用。通过选取已发表的文章，对心力衰竭的病因、运动在心力衰竭中的作用证据以及将运动与心力衰竭发生和预后联系起来的生物学机制进行了讨论。心力衰竭是一种复杂的综合征，表现为严重的运动不耐受。与心力衰竭相关的运动不耐受的几个原因对运动训练有反应，并且在HFrEF患者中进行的两项随机对照运动干预已证明，对于改善医学上稳定的心力衰竭患者的体力工作能力、生活质量和死亡率终点具有安全性和有效性。目前，关于HFpEF结局只有流行病学队列数据，但这些数据总体上一致支持，进行达到推荐量的生活方式体力活动可降低发生HFpEF的风险。在HFpEF中需要临床试验证据来支持这一观察结果。运动训练已被确立为HFrEF患者指南指导治疗的一部分。达到指南推荐量的生活方式体力活动似乎与发生HFrEF和HFpEF的较低风险相关。关于运动训练和HFpEF治疗尚未有明确的临床试验。
