From the Guidelines
Regular aerobic exercise is recommended to increase ejection fraction and improve functional capacity and symptoms in patients with heart failure, as supported by the 2016 ESC guidelines 1. The most recent and highest quality study, the 2016 ESC guidelines, suggests that regular aerobic exercise can effectively increase ejection fraction, which is the percentage of blood pumped out of the heart with each contraction. Start with moderate aerobic exercise like walking, swimming, or cycling for 20-30 minutes, 3-5 times per week, gradually increasing duration and intensity as tolerated. Aim for a target heart rate of 50-75% of your maximum heart rate (calculated as 220 minus your age). Complement aerobic exercise with light resistance training 2-3 times weekly, focusing on major muscle groups with light weights and higher repetitions. Begin each session with a 5-minute warm-up and end with a 5-minute cool-down. Consistency is more important than intensity, especially when starting. Exercise improves ejection fraction by strengthening the heart muscle, enhancing its contractility, reducing peripheral resistance, and improving overall cardiovascular efficiency. It also helps manage conditions that negatively impact heart function, such as hypertension and diabetes. If you have heart failure or a significantly reduced ejection fraction, consult with your cardiologist before starting an exercise program, as they may recommend a supervised cardiac rehabilitation program tailored to your specific condition, as recommended by the American Heart Association 1. Some key points to consider when starting an exercise program include:
- Starting slowly and gradually increasing intensity and duration
- Listening to your body and resting when needed
- Staying hydrated and fueling your body with a balanced diet
- Monitoring your progress and adjusting your program as needed
- Working with a healthcare professional to develop a personalized exercise plan.
From the Research
Increase Ejection Fraction with Exercise
- Exercise training has been shown to improve ejection fraction in patients with heart failure, as demonstrated by studies such as 2 and 3.
- A study published in the Journal of the American College of Cardiology found that exercise training improved exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction 4.
- Another study published in Advances in Experimental Medicine and Biology found that exercise training can help restore physiological function and increase aerobic capacity in patients with heart failure with preserved ejection fraction 5.
- The benefits of exercise training on ejection fraction are thought to be due to improvements in cardiac function, including increased stroke volume and cardiac output.
Mechanisms of Improvement
- Exercise training has been shown to improve left ventricular diastolic function, as measured by E/e' and left atrial volume index 4.
- The improvement in diastolic function is associated with an increase in peak oxygen consumption (peak VO2) and improved physical functioning score 4.
- Exercise training may also improve aerobic capacity by increasing convective and diffusive O2 transport, leading to improved quality of life in patients with heart failure with preserved ejection fraction 5.
Comparison with Other Treatments
- Beta-blocker treatment has also been shown to improve ejection fraction in patients with heart failure, with a mean increase in EF of 7.4 EF units with metoprolol and 5.7 EF units with carvedilol 3.
- High-dose beta-blocker use has been associated with a significantly lower risk of death in patients with heart failure with preserved ejection fraction and elevated heart rate 6.
- However, the mechanisms of improvement with beta-blocker treatment are thought to be different from those of exercise training, and may involve reductions in heart rate and blood pressure rather than improvements in cardiac function.