Can regular exercise improve Ejection Fraction (EF) in a 38-year-old male with a reduced EF of 55%, and what are the recommended exercises and durations?

From the Guidelines

Regular exercise can increase ejection fraction (EF) in many individuals, and for a 38-year-old male with an EF of 55%, a combination of aerobic and resistance training is recommended to maintain or potentially improve cardiac function. According to the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1, exercise training improves functional status, exercise performance, and quality of life in patients with heart failure. For this individual, I recommend starting with 150 minutes of moderate-intensity aerobic exercise per week, such as 30 minutes of brisk walking, jogging, or cycling five days per week.

Some key points to consider when creating an exercise plan include:

• Incorporating resistance training 2-3 times weekly, focusing on major muscle groups with exercises like squats, push-ups, and rows using moderate weights for 2-3 sets of 10-15 repetitions 1
• Starting with low-impact exercises like walking, cycling, and swimming, which cause little stress on bones and joints 1
• Gradually increasing intensity over time, aiming for a moderate exertion level where you can talk but not sing during exercise
• Beginning each session with a 5-minute warm-up and ending with a 5-minute cool-down

The best exercises for improving EF include aerobic activities like brisk walking, jogging, cycling, swimming, and rowing, as well as resistance training exercises like squats, push-ups, and rows. These exercises work by strengthening the heart muscle, improving its pumping efficiency, reducing peripheral resistance, and enhancing overall cardiovascular health. Since the individual's current EF is normal, these exercises will help maintain heart function while providing broader health benefits like improved blood pressure control and reduced risk of heart disease. It is essential to consult with a healthcare provider before starting any new exercise program, especially for individuals with pre-existing medical conditions.

From the Research

Can Regular Exercise Increase EF

• Regular exercise can increase EF (ejection fraction) in patients with heart failure, as shown in studies 2, 3, 4, 5, 6.
• The type and intensity of exercise can vary, but high-intensity interval training (HIIT) and moderate continuous training (MCT) have been shown to be effective in improving EF and peak oxygen consumption (peak V̇o₂) in patients with heart failure 3, 4, 5, 6.

Best Exercises for EF

• High-intensity interval training (HIIT) involves short bursts of high-intensity exercise followed by periods of rest or low-intensity exercise 3, 4, 5, 6.
• Moderate continuous training (MCT) involves sustained periods of moderate-intensity exercise 3, 4, 5, 6.
• Guideline-based physical activity advice can also be effective in improving EF and peak V̇o₂ in patients with heart failure 6.

Example Exercises and Duration for a 38-year-old with EF of 55%

• High-intensity interval training (HIIT): 3-4 times per week, 20-30 minutes per session, with intervals of high-intensity exercise (e.g. sprinting, burpees) followed by periods of rest or low-intensity exercise (e.g. walking, jogging) 3, 4, 5, 6.
• Moderate continuous training (MCT): 5 times per week, 30-40 minutes per session, with sustained periods of moderate-intensity exercise (e.g. brisk walking, cycling) 3, 4, 5, 6.
• It is essential to consult with a healthcare professional before starting any new exercise program, especially for individuals with heart failure or other underlying medical conditions.