Supervised Exercise Training for Chronic Heart Failure With Preserved Ejection Fraction

Authoring Organizations

Publication Month/Year

March 21, 2023

Last Updated Month/Year

August 8, 2023

Supplemental Implementation Tools

Document Type


Country of Publication


Document Objectives

Heart failure with preserved ejection fraction (HFpEF) is one of the most common forms of heart failure; its prevalence is increasing, and outcomes are worsening. Affected patients often experience severe exertional dyspnea and debilitating fatigue, as well as poor quality of life, frequent hospitalizations, and a high mortality rate. Until recently, most pharmacological intervention trials for HFpEF yielded neutral primary outcomes. In contrast, trials of exercise-based interventions have consistently demonstrated large, significant, clinically meaningful improvements in symptoms, objectively determined exercise capacity, and usually quality of life. This success may be attributed, at least in part, to the pleiotropic effects of exercise, which may favorably affect the full range of abnormalities—peripheral vascular, skeletal muscle, and cardiovascular—that contribute to exercise intolerance in HFpEF. Accordingly, this scientific statement critically examines the currently available literature on the effects of exercise-based therapies for chronic stable HFpEF, potential mechanisms for improvement of exercise capacity and symptoms, and how these data compare with exercise therapy for other cardiovascular conditions. Specifically, data reviewed herein demonstrate a comparable or larger magnitude of improvement in exercise capacity from supervised exercise training in patients with chronic HFpEF compared with those with heart failure with reduced ejection fraction, although Medicare reimbursement is available only for the latter group. Finally, critical gaps in implementation of exercise-based therapies for patients with HFpEF, including exercise setting, training modalities, combinations with other strategies such as diet and medications, long-term adherence, incorporation of innovative and more accessible delivery methods, and management of recently hospitalized patients are highlighted to provide guidance for future research.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings


Intended Users

Nurse, nurse practitioner, physician, physician assistant


Management, Prevention, Rehabilitation

Diseases/Conditions (MeSH)

D006333 - Heart Failure, D015444 - Exercise, D005081 - Exercise Therapy


exercise, heart failure, chronic heart failure, preserved ejection fraction, HFpEF, exercise training

Source Citation

Sachdev V, Sharma K, Keteyian S, et al. Supervised Exercise Training for Chronic Heart Failure With Preserved Ejection Fraction: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. null2023, 0 (0) .https://doi.org/10.1016/j.jacc.2023.02.012

Supplemental Methodology Resources

Data Supplement