Exercise and Heart Failure

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Background

Heart failure is a common disease, whose prevalence increases with ageing of the population. In spite of new treatments and updated clinical management, heart failure is still characterized by high rates of mortality and morbidity. Dyspnea, defined as the subjective experience of breathing difficulty or discomfort, is a pivotal symptom of chronic heart failure and it seriously compromises patients’ exercise performance, capability to accomplish standard activities of daily living, quality of life, and prognosis. The functional status of the patient, and therefore their exercise performance, is influenced by the presence of any comorbidities, concomitant therapies, presence of devices, etc. For this reason, the functional assessment of the patient must be made taking into account the impact of all these variables.

It is of crucial importance to study and collect all the information on the interconnections between the pathology (heart failure), the comorbidities and the therapies that are available to date, with a view to improving the functional capacity of the heart failure patient.

Cardiopulmonary exercise test (CPET) is the gold standard for the functional evaluation of the patient and it provides a global assessment of the integrative exercise responses involving the pulmonary, cardiovascular, hematopoietic, neuropsychological, and skeletal muscle systems. This noninvasive, dynamic, physiologic overview, allows the evaluation of both submaximal and peak exercise responses, providing the physician with relevant information for clinical decision-making. Moreover, it is a good model to study the physiopathology of exercise in heart failure. Besides CPET, the six-minute walking test is another tool used at present for measuring functional capacity in heart failure, but recently the investigations are also being extended to the use of portable or wearable devices capable of measuring exercise capacity in non-standard activities.

In this Research Topic, we want to collect studies that analyze the reciprocal influence between heart failure disease and any other factors that may affect performance, with a view to considering the functional assessment of the patient as a central point for deciding strategies for improving not only the prognosis, but also the quality of life of subjects affected by this pathology. We would like to encourage review papers, that present an overview of existing knowledge on the reciprocal relationships between exercise, heart failure and other concomitant factors, but also original papers that provide new evidence on these issues.

Our message is: in order to assess the patient correctly, it is necessary to assess the active patient, while exercising, not the patient in the hospital bed. The ability to perform activities adequately is not only more complete from a clinical point of view, but is also aimed at considering quality of life a crucial goal of patient care.

Keywords: Heart failure, Exercise, Cardiopulmonary exercise test, Exercise Physiology, Therapy

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