Exercise in Heart Failure—What Is the Optimal Dose to Improve Pathophysiology and Exercise Capacity?

Purpose of Review: In this review, our aim is to summarize the evidence of exercise interventions in heart failure. Addressing pathophysiology, we discuss training modalities and optimal dose finding in exercising patients with reduced (HFrEF) and preserved ejection fraction (HFpEF). Recent Findings: While smaller studies showed a trend towards improved exercise capacity by high-intensity interval training in comparison with moderate continuous training in HFrEF, recent multicenter randomized trials were unable to confirm these findings. Considering the lack of effective drug therapies in HFpEF, exercise training plays an even more important role in this particular population. Summary: Exercise training in heart failure is beneficial in addition to medical and device therapy. Data are still mostly limited to HFrEF. Intensity should primarily be moderate at a daily base. The concept of “the higher the better” could not be confirmed for HFrEF. The overall concept of training is to maximally strain the periphery without straining the myocardium.