心力衰竭(HF)是一种慢性,进步,和影响全球数十亿患者的不可阻挡的综合征(男女平均分布),发达国家的患病率估计为1-3%。HF导致巨大的直接和间接成本,由于人口老龄化,HF患者的总人数不断上升,>65岁的患者约占10%。运动训练(ET)被广泛认为是HF患者的一种基于证据的辅助治疗方式,越来越多的证据出现在老年HF患者中。我们使用了文献检索的相关数据(PubMed,Medline,EMBASE)强调HF的流行病学;重点关注ET对HF患者有益作用的中枢和外周机制;以及脆弱的HF老年患者接受ET。由于许多国家在大流行的早期阶段下令封锁,试图限制感染,COVID-19大流行,并讨论了其对基于运动的心脏康复操作的局限性。ET发挥中枢和外周适应性,临床转化为抗重塑作用,增加功能能力,降低发病率和死亡率。理想情况下,ET计划应按照患者量身定制的方法进行,特别是在虚弱的老年HF患者中。总之,考虑到HF综合征的复杂性,合并,定制不同的ET模式是强制性的。根据患者的基线临床特征[即,功能能力,合并症,虚弱状态(肌肉力量,balance,日常活动,听力和视力障碍,少肌症,并且无法积极锻炼),物流,个人偏好和目标]已经提出。提高长期依从性和达到最脆弱的患者是该领域未来举措的挑战性目标。
Heart failure (HF) is a chronic, progressive, and inexorable syndrome affecting worldwide billion of patients (equally distributed among men and women), with prevalence estimate of 1-3% in developed countries. HF leads to enormous direct and indirect costs, and because of ageing population, the total number of HF patients keep rising, approximately 10% in patients > 65 years old. Exercise training (ET) is widely recognized as an evidence-based adjunct treatment modality for patients with HF, and growing evidence is emerging among elderly patients with HF. We used relevant data from literature search (PubMed, Medline, EMBASE) highlighting the epidemiology of HF; focusing on central and peripheral mechanisms underlying the beneficial effect of ET in HF patients; and on frail HF elderly patients undergoing ET. Since many Countries ordered a lockdown in early stages pandemic trying to limit infections, COVID-19 pandemic, and its limitation to exercise-based cardiac rehabilitation operativity was also discussed. ET exerts both central and peripheral adaptations that clinically translate into anti-remodeling effects, increased functional capacity and reduced morbidity and mortality. Ideally, ET programs should be prescribed in a patient-tailored approach, particularly in frail elderly patients with HF. In conclusion, given the complexity of HF syndrome, combining, and tailoring different ET modalities is mandatory. A procedural algorithm according to patient\'s baseline clinical characteristics [i.e., functional capacity, comorbidity, frailty status (muscle strength, balance, usual daily activities, hearing and vision impairment, sarcopenia, and inability to actively exercise), logistics, individual preferences and goals] has been proposed. Increasing long-term adherence and reaching the frailest patients are challenging goals for future initiatives in the field.