Exercise-based Rehabilitation in Chronic Heart Failure - A Narrative Review

Chronic heart failure is a widespread clinical condition associated with reduced exercise tolerance, impaired quality of life, and increased morbidity and mortality. Exercise-based cardiac rehabilitation represents an essential component of non-pharmacological management in patients with chronic heart failure; however, optimal training strategies and delivery models remain under discussion. This narrative review summarizes current evidence regarding the safety, efficacy, and feasibility of exercise-based rehabilitation across different heart failure phenotypes. The analysis includes conventional centre-based programs, home-based rehabilitation, telerehabilitation, and novel exercise modalities. Available evidence indicates that structured exercise training improves functional capacity, exercise tolerance, and health-related quality of life, regardless of rehabilitation setting. Combined aerobic and resistance training, as well as high-intensity interval training, appear to provide greater functional benefits than moderate continuous exercise, particularly under supervised conditions. Functional assessment using cardiopulmonary exercise testing remains the reference standard, while the six-minute walk test offers a practical alternative in routine clinical practice. Individualized, patient-centred rehabilitation strategies are crucial for optimizing outcomes and supporting long-term engagement in physical activity among patients with chronic heart failure.