Guiding the failing heart to exercise

[...]it is much more detailed than usual cardiology guidelines in the practical aspects of patient functional assessment, patient education and empowerment, and the actual training program [5, 6]. Patient assessment can help to identify patients who benefit from these program components (i.e. Pimax < 70 % predicted, significant muscle wasting, high anxiety levels). (iv) Exercise training is only effective as long as it is maintained. [...]continuation of regular physical activity and training after the cardiac rehabilitation phase needs to be encouraged and - if possible - monitored. Notwithstanding the medical conditions required to qualify for training therapy, it is essential for physicians not to withhold the benefits of rehabilitation from their patients. [...]current referral rates for cardiac rehabilitation range between 12 % in US Medicare patients and 70 % in middle European countries with well-developed rehabilitation systems [9, 10]. [...]it is up to us to educate all patients with CHF that there is a clear dose–response relation between training intensity (as measured by MET-hours per week) and outcome improvement indicating significant reductions in adjusted hazard ratios for all cause/cardiac mortality or all-cause/cardiac hospitalisation between 3 and 7 MET-hours per week [13].