Exercise & Sports Science Australia Position Statement on exercise training in patients with chronic heart failure: 2025 update

Chronic heart failure (CHF) is a complex syndrome characterised by cardiac dysfunction, impaired exercise tolerance and reduced quality of life. Regular exercise participation has been shown to be a safe and effective adjunct to medical management in the majority of patients with CHF. Accordingly, exercise training is now acknowledged as an important component of multidisciplinary management for patients with CHF. The volume and intensity of exercise for patients with CHF should be individualised, guided by factors including the severity of heart failure, current symptoms, clinical stability, medication regimen, co-morbidities, exercise environment and patient preferences. Historically, exercise prescription has focussed on low to moderate intensity aerobic (endurance) exercise. More recently, research supporting the safety and efficacy of resistance (strength) training has resulted in this mode of exercise becoming a standard component of exercise rehabilitation. The previously conservative approach to aerobic exercise has been challenged by studies reporting that high intensity interval training (HIIT) may improve aerobic capacity to a greater extent than moderate intensity continuous exercise, without compromising safety. Moreover, the characterisation of CHF has changed, now defined as heart failure with reduced ejection fraction (HFrEF), heart failure with mildly-reduced ejection fraction (HFmrEF), heart failure with preserved ejection fraction (HFpEF) and heart failure with improved ejection fraction (HFimpEF). This update to the 2010 exercise training in patients with CHF position statement provides evidence-based recommendations and practical strategies to guide exercise practitioners and health professionals in the safe and effective prescription and supervision of exercise across the contemporary classifications of CHF.