Physical Training and Cardiac Rehabilitation in Heart Failure Patients

  • Cesare de GregorioEmail author
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1067)


Regardless of advances in medical and interventional treatment of cardiovascular disease (CVD), a limited number of patients attend a cardiac rehabilitation (CR) programme on a regular basis. Due to modern therapies more individuals will be surviving an acute cardiovascular event, but the expected burden of chronic heart failure will be increasing worldwide.

However, both in high- and low-income countries, secondary prevention after an acute myocardial infarction or stroke has been implemented in less than a half of eligible patients.

Combined interventions are still needed to reduce decompensations, hospitalizations and mortality in heart failure patients from any origin. In addition to medical treatments, regular exercise has been demonstrated to improve metabolic and hemodynamic conditions in both asymptomatic risk factor carriers and cardiac patients. Risk factor control and exercise should gather together for an effective management of patients.

Exercise-based training is a core component of primary and secondary prevention. It should involve healthy carriers of cardiovascular risk factors, and patients with cardiomyopathy as well. The supposed attenuated effect of CR in the era of advanced revascularization and structural interventions is due to the heterogeneity of training models and physical training in the literature. Moreover, lifestyle modification, psycho-social challenges and patient’s compliance are potential confounders.

In this chapter the most recent evidences about training modalities and potential benefit of CR in heart failure patients are discussed.


Cardiac rehabilitation Cardiovascular disease Exercise Functional evaluation Heart failure Clinical outcomes Physical training 



Atrial Fibrillation


Cardiopulmonary Exercise Test


Chronic/Congestive Heart Failure


Carbon Dioxide Oxygen


Cardiac Rehabilitation


Continuous Training




Cardiovascular Disease


Heart Rate


Intracardiac Implantable Defibrillator


Inspiratory Muscle Training


Interval Training


Left Ventricle/Ventricular




Oxygen Consumption


Strength-exercise Training


Transcatheter Aortic Valve Implantation


Conflict of Interest

None to declare.


  1. Abell B, Glasziou P, Hoffmann T (2017) The contribution of individual exercise training components to clinical outcomes in randomised controlled trials of cardiac rehabilitation: a systematic review and meta-regression. Sports Med Open 3:19. Scholar
  2. Aguilar D, Bozkurt B, Ramasubbu K, Deswal A (2009) Relationship of hemoglobin A1C and mortality in heart failure patients with diabetes. J Am Coll Cardiol 54:422–428. Scholar
  3. Ambrosetti M, Doherty P, Faggiano P, Corrà U, Vigorito C, Hansen D et al (2017) Characteristics of structured physical training currently provided in cardiac patients: insights from the Exercise Training in Cardiac Rehabilitation (ETCR) Italian survey. Monaldi Arch Chest Dis 87(1):778. Scholar
  4. Anderson L, Sharp GA, Norton RJ, Dalal H, Dean SG, Jolly K, et al (2017a) Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev. Issue 6. Art. No.: CD007130.
  5. Anderson L, Nguyen TT, Dall CH, Burgess L, Bridges C, Taylor RS (2017b) Exercise-based cardiac rehabilitation in heart transplant recipients. Cochrane Database Syst Rev 4:CD012264. Scholar
  6. Arena R, Sietsema KE (2011) Cardiopulmonary exercise testing in the clinical evaluation of patients with heart and lung disease. Circulation 123:668–680. Scholar
  7. Arena R, Myers J, Williams MA et al (2007) Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation 116:329–343. Scholar
  8. Balady GJ, Williams MA, Ades PA, Bittner V, Comoss P, Foody JA et al (2007) Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 115:2675–2682. Scholar
  9. Balady G, Arena R, Sietsema KE, Myers J, Coke L, Fletcher GF et al (2010) American Heart Association scientific statement: a clinician’s guide to cardiopulmonary exercise testing in adults. Circulation 122:191–225. Scholar
  10. Belardinelli R, Capestro F, Misiani A, Scipione P, Georgiou D (2006) Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy. Eur J Cardiovasc Prev Rehabil 13:818–825. Scholar
  11. Bertini M, Mele D, Malagù M, Fiorencis A, Toselli T, Casadei F et al (2016) Cardiac resynchronization therapy guided by multimodality cardiac imaging. Eur J Heart Fail 18:1375–1382. Scholar
  12. Borg G, Hassmen P, Langerstrom M (1984) Perceived exertion in relation to heart rate and blood lactate during arm and leg exercise. Eur J Appl Physiol 65:679–685Google Scholar
  13. Borghi-Silva A, Carrascosa C, Oliveira CC, Barroco AC, Berton DC, Vilaça D et al (2008) Effects of respiratory muscle unloading on leg muscle oxygenation and blood volume during high-intensity exercise in chronic heart failure. Am J Physiol Heart Circ Physiol 294(6):H2465–H2472. Scholar
  14. Bosnak-Guclu M, Arikan H, Savci S, Inal-Ince D, Tulumen E, Aytemir K et al (2011) Effects of inspiratory muscle training in patients with heart failure. Respir Med 105(11):1671–1681. Scholar
  15. Cahalin LP, Mathier MA, Semigran MJ, Dec GW, Di Salvo TG (1996) The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure. Chest 110(2):325–332CrossRefPubMedGoogle Scholar
  16. Chiaranda G, Bernardi E, Codecà L, Conconi F, Myers J, Terranova F et al (2013) Treadmill walking speed and survival prediction in men with cardiovascular disease: a 10-year follow-up study. BMJ Open 3(10):e003446. Scholar
  17. Commissioning guidance for rehabilitation. NHS England (2016). Publications Gateway Ref No. 04919Google Scholar
  18. Cornelis J, Beckers P, Taeymans J, Vrints C, Vissers D (2016) Comparing exercise training modalities in heart failure: a systematic review and meta-analysis. Int J Cardiol 221:867–876. Scholar
  19. Corrà U, Agostoni PG, Anker SD, Coats AJS, Crespo Leiro MG, de Boer RA et al (2017) Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on exercise physiology and training of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail.
  20. Davids JS, McPherson CA, Earley C, Batsford WP, Lampert R (2005) Benefits of cardiac rehabilitation in patients with implantable cardioverter-defibrillators: a patient survey. Arch Phys Med Rehabil 86:1924–1928. Scholar
  21. Day ML, McGuigan MR, Brice G, Foster C (2004) Monitoring exercise intensity during resistance training using the session RPE scale. J Strength Cond Res 18(2):353–358. Scholar
  22. de Gregorio C (2016) Investigating the left atrial function by strain echocardiography: modern answers to old questions? J Clin Exp Cardiolog 7:11. Scholar
  23. de Gregorio C, Magaudda L (2017) Blunt thoracic trauma and cardiac injury in the athlete: contemporary management. J Sports Med Phys Fitness.
  24. de Gregorio C, Patanè S, Buda D, Campisi A, De Luca G (2015) on behalf of the Local Healthcare Authority. Percorso diagnostico-terapeutico-assistenziale nello scompenso cardiaco nella provincia di Messina (2015). Messina (Italy) [Italian]; Single issue; Research Gate, pp 1–66.
  25. de Gregorio C, Dattilo G, Casale M, Terrizzi A, Donato R, Di Bella G (2016) Left atrial morphology, size and function in patients with transthyretin cardiac amyloidosis and primary hypertrophic cardiomyopathy. Comparative strain imaging study. Circ J 80(8):1830–1837. Scholar
  26. Dickerson JA, Raman SV, Baker PM, Leier CV (2013) Relationship of cardiac magnetic resonance imaging and myocardial biopsy in the evaluation of nonischemic cardiomyopathy. Congest Heart Fail 19:29–38. Scholar
  27. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J et al (2001) Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 104:1694–1740CrossRefPubMedGoogle Scholar
  28. Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA et al (2013) Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 128:873–934. Scholar
  29. Goode KM, John J, Rigby AS, Kilpatrick ES, Atkin SL, Bragadeesh T et al (2009) Elevated glycated haemoglobin is a strong predictor of mortality in patients with left ventricular systolic dysfunction who are not receiving treatment for diabetes mellitus. Heart 95:917–923. Scholar
  30. Grace SL, Russell KL, Reid RD, Oh P, Anand S, Rush J, Cardiac Rehabilitation Care Continuity through Automatic Referral Evaluation (CRCARE) Investigators et al (2011) Effect of cardiac rehabilitation referral strategies on utilization rates: a prospective, controlled study. Arch Intern Med 171:235–241. Scholar
  31. Gravely S, Anand SS, Stewart DE, Grace SL, CRCARE Investigators (2014) Effect of referral strategies on access to cardiac rehabilitation among women. Eur J Prev Cardiol 21(8):1018–1025. Scholar
  32. Grazzi G, Casoni I, Mazzoni G, Uliari S, Conconi F (2005) Protocol for the Conconi test and determination of the heart rate deflection point. Physiol Res 54(4):473–475PubMedGoogle Scholar
  33. Hansen JE, Sue DJ, Wasserman K (1984) Predicted values for clinical exercise testing. Am Rev Respir Dis 129(2P2):S49–S55CrossRefPubMedGoogle Scholar
  34. Hansen TB, Berg SK, Sibilitz KL, Søgaard R, Thygesen LC, Yazbeck AM et al (2015) Availability of, referral to and participation in exercise-based cardiac rehabilitation after heart valve surgery: results from the national Copen Heart survey. Eur J Prev Cardiol 22(6):710–718. Scholar
  35. Hermann TS, Dall CH, Christensen SB, Goetze JP, Prescott E, Gustafsson F (2011) Effect of high intensity exercise on peak oxygen uptake and endothelial function in long-term heart transplant recipients. Am J Transplant 11:536–541. Scholar
  36. Hollings M, Mavros Y, Freeston J, Fiatarone Singh M (2017) The effect of progressive resistance training on aerobic fitness and strength in adults with coronary heart disease: a systematic review and meta-analysis of randomised controlled trials. Eur J Prev Cardiol 24(12):1242–1259. Scholar
  37. Hunt SA (2006) American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2005; 46(6):e1–82. Erratum in: J Am Coll Cardiol 47(7):1503–1505.
  38. Hussain N, Gersh BJ, Gonzalez Carta K, Sydó N, Lopez-Jimenez F, Kopecky SL et al (2018) Impact of cardiorespiratory fitness on frequency of atrial fibrillation, stroke, and all-cause mortality. Am J Cardiol 121(1):41–49. Scholar
  39. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J et al (2014) Evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the eighth Joint National Committee (JNC 8). JAMA 311:507–520. Scholar
  40. Jetté M, Sidney K, Blumchen G (1990) Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity. Clin Cardiol 13:555–565. Scholar
  41. Kämpfer J, Yagensky A, Zdrojewski T, Windecker S, Meier B, Pavelko M et al (2017) Long-term outcomes after acute myocardial infarction in countries with different socioeconomic environments: an international prospective cohort study. BMJ Open 7(8):e012715. Scholar
  42. Karagiannis C, Savva C, Mamais I, Efstathiou M, Monticone M, Xanthos T (2017) Eccentric exercise in ischemic cardiac patients and functional capacity: a systematic review and meta-analysis of randomized controlled trials. Ann Phys Rehabil Med 60:58–64. Scholar
  43. Kervio G, Carre F, Ville NS (2003) Reliability and intensity of the six-minute walk test in healthy elderly subjects. Med Sci Sports Exerc 35:169–174. Scholar
  44. Kivimäki M, Kuosma E, Ferrie JE, Luukkonen R, Nyberg ST, Alfredsson L et al (2017) Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120,813 adults from 16 cohort studies from the USA and Europe. Lancet Public Health 2:e277–e285. Scholar
  45. Kjertakov M, Dalip M, Hristovski R, Epstein Y (2016) Prediction of lactate threshold using the modified Conconi test in distance runners. Physiol Int 103(2):262–270. Scholar
  46. Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M et al (2009) Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301:2024–2035. Scholar
  47. Kraal JJ, Van den Akker-Van Marle ME, Abu-Hanna A, Stut W, Peek N, Kemps HM (2017) Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: results of the FIT@Home study. Eur J Prev Cardiol 24(12):1260–1273. Scholar
  48. Kraschnewski JL, Sciamanna CN, Poger JM, Rovniak LS, Lehman EB, Cooper AB et al (2016) Is strength training associated with mortality benefits? A 15 year cohort study of US older adults. Prev Med 87:121–127. Scholar
  49. Lampert R, Olshansky B, Heidbuchel H, Lawless C, Saarel E, Ackerman M et al (2013) Safety of sports for athletes with implantable cardioverter-defibrillators: results of a prospective, multinational registry. Circulation 127(20):2021–2030. Scholar
  50. Lavie CJ, Milani RV, Mehra MR (2004) Peak exercise oxygen pulse and prognosis in chronic heart failure. Am J Cardiol 93:588–593. Scholar
  51. Lavie CJ, Pandey A, Lau DH, Alpert MA, Sanders P (2017) Obesity and atrial fibrillation prevalence, pathogenesis, and prognosis: effects of weight loss and exercise. J Am Coll Cardiol 70:2022–2035. Scholar
  52. Li M, Lu Y, Fang C, Zhang X (2017) Correlation between myocardial deformation on three-dimensional speckle tracking echocardiography and cardiopulmonary exercise testing. Echocardiography 34:1640–1648. Scholar
  53. Lund K, Sibilitz KL, Berg SK, Thygesen LC, Taylor RS, Zwisler AD (2016) Physical activity increases survival after heart valve surgery. Heart 102(17):1388–1395. Scholar
  54. MacDonald MR, Eurich DT, Majumdar SR, Lewsey JD, Bhagra S, Jhund PS et al (2010) Treatment of type 2 diabetes and outcomes in patients with heart failure: a nested case-control study from the U.K. General Practice Research Database. Diabetes Care 33:1213–1218. Scholar
  55. Malmo V, Nes BM, Amundsen BH, Tjonna AE, Stoylen A, Rossvoll O et al (2016) Aerobic interval training reduces the burden of atrial fibrillation in the short term: a randomized trial. Circulation 133(5):466–473. Scholar
  56. Marzolini S, Grace SL, Brooks D, Corbett D, Mathur S, Bertelink R et al (2015) Time-to-referral, use, and efficacy of cardiac rehabilitation after heart transplantation. Transplantation 99:594–601. Scholar
  57. McGregor G, Nichols S, Hamborg T, Bryning L, Tudor-Edwards R, Markland D et al (2016) High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes (HIIT or MISS UK): study protocol for a multicentre randomised controlled trial and economic evaluation. BMJ Open 6:e012843. Scholar
  58. Medvedofsky D, Mor-Avi V, Amzulescu M, Fernández-Golfín C, Hinojar R, Monaghan MJ et al (2017) Three-dimensional echocardiographic quantification of the left-heart chambers using an automated adaptive analytics algorithm: multicentre validation study. Eur Heart J Cardiovasc Imaging.
  59. Merom D, Ding D, Stamatakis E (2016) Dancing participation and cardiovascular disease mortality: a pooled analysis of 11 population-based British cohorts. Am J Prev Med 50(6):756–760. Scholar
  60. Mezzani A, Hamm LF, Jones AM, McBride PE, Moholdt T, Stone JA et al (2013) Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation. Eur J Prev Cardiol 20:442–467. Scholar
  61. Milani RV, Mehra MR, Reddy TK, Lavie CJ, Ventura HO (1996) Ventilation/carbon dioxide production ratio in early exercise predicts poor functional capacity in congestive heart failure. Heart 76(5):393–396CrossRefPubMedPubMedCentralGoogle Scholar
  62. Mont L, Elosua R, Brugada J (2009) Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter. Europace 11:11–17. Scholar
  63. Mozaffarian D, Furberg CD, Psaty BM, Siscovick D (2008) Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation 118:800–807. Scholar
  64. Naci H, Ioannidis JP (2013) Comparative effectiveness of exercise and drug interventions on mortality outcomes: meta-epidemiological study. BMJ 347:f5577. Scholar
  65. Noble BJ, Robertson RJ (1996) Perceived exertion. Human Kinetics, ChampaignGoogle Scholar
  66. O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, HF-ACTION Investigators et al (2009) Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 301:1439–1450. Scholar
  67. Olsen SJ, Schirmer H, Bønaa KH, Hanssen TA (2017) Cardiac rehabilitation after percutaneous coronary intervention: results from a nationwide survey. Eur J Cardiovasc Nurs 1:1474515117737766. Scholar
  68. Osbak PS, Mourier M, Henriksen JH, Kofoed KF, Jensen GB (2012) Effect of physical exercise training on muscle strength and body composition, and their association with functional capacity and quality of life in patients with atrial fibrillation: a randomized controlled trial. J Rehabil Med 44:975–979. Scholar
  69. Pathak RK, Elliott A, Middeldorp ME, Meredith M, Mehta AB, Mahajan R et al (2015) Impact of CARDIO-respiratory FITness on arrhythmia recurrence in obese individuals with atrial fibrillation: the CARDIO-FIT study. J Am Coll Cardiol 66:985–996. Scholar
  70. Patwala AY, Woods PR, Sharp L, Goldspink DF, Tan LB, Wright DJ (2009) Maximizing patient benefit from cardiac resynchronization therapy with the addition of structured exercise training: a randomized controlled study. J Am Coll Cardiol 53:2332–2339. Scholar
  71. Peterzan MA, Rider OJ, Anderson LJ (2016) The role of cardiovascular magnetic resonance imaging in heart failure. Card Fail Rev 2:115–122. Scholar
  72. Piepoli MF, Conraads V, Corrà U, Dickstein K, Francis DP, Jaarsma T et al (2011) Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Failure 13:347–357. Scholar
  73. Piepoli MF, Corrà U, Adamopoulos S, Benzer W, Bjarnason-Wehrens B, Cupples M et al (2014) Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: A policy statement from the Cardiac Rehabilitation Section of the European Association for Cardiovascular Prevention & Rehabilitation Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology. Eur J Prev Cardiol 21(6):664–681. Scholar
  74. Piepoli MF, Corrà U, Dendale P, Frederix I, Prescott E, Schmid JP et al (2017) Challenges in secondary prevention after acute myocardial infarction: a call for action. Eur Heart J Acute Cardiovasc Care 6(4):299–310. Scholar
  75. Pollock ML, Franklin BA, Balady GJ, Chaitman BL, Fleg JL, Fletcher B et al (2000) AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: an advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology. American Heart Association; position paper endorsed by the American College of Sports Medicine. Circulation 101:828–833CrossRefPubMedGoogle Scholar
  76. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18(8):891–975. Scholar
  77. Prahm KP, Witting N, Vissing J (2014) Decreased variability of the 6-minute walk test by heart rate correction in patients with neuromuscular disease. PLoS One 9(12):e114273. Scholar
  78. Pressler A, Christle JW, Lechner B, Grabs V, Haller B, Hettich I et al (2016) Exercise training improves exercise capacity and quality of life after transcatheter aortic valve implantation: a randomized pilot trial. Am Heart J 182:44–53. Scholar
  79. Pulignano G, Tinti MD, Del Sindaco D, Tolone S, Minardi G, Lax A et al (2016) Barriers to cardiac rehabilitation access of older heart failure patients and strategies for better implementation. Monaldi Arch Chest Dis 84:732. Scholar
  80. Randolph TC, Hellkamp AS, Zeitler EP, Fonarow GC, Hernandez AF, Thomas KL et al (2017) Utilization of cardiac resynchronization therapy in eligible patients hospitalized for heart failure and its association with patient outcomes. Am Heart J 189:48–58. Scholar
  81. Rauch B, Davos CH, Doherty P, Saure D, Metzendorf MI, Salzwedel A et al (2016) The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: a systematic review and meta-analysis of randomized and non-randomized studies – the Cardiac Rehabilitation Outcome Study (CROS). Eur J Prev Cardiol 23:1914–1939. Scholar
  82. Ribeiro PA, Boidin M, Juneau M, Nigam A, Gayda M (2017) High-intensity interval training in patients with coronary heart disease: prescription models and perspectives. Ann Phys Rehabil Med 60:50–57. Scholar
  83. Schraufnagel DE, Agostoni P (2017) Cardiopulmonary exercise testing. Ann Am Thorac Soc 14(Suppl_1):S1–S2. Scholar
  84. Seguin R, Nelson ME (2003) The benefits of strength training for older adults. Am J Prev Med 25(3 Suppl 2):141–149. Scholar
  85. Sibilitz KL, Berg SK, Rasmussen TB, Risom SS, Thygesen LC, Tang L et al (2016) Cardiac rehabilitation increases physical capacity but not mental health after heart valve surgery: a randomised clinical trial. Heart 102(24):1995–2003. Scholar
  86. Squeri A, Censi S, Reverberi C, Gaibazzi N, Baldelli M, Binno SM et al (2017) Three-dimensional echocardiography in various types of heart disease: a comparison study of magnetic resonance imaging and 64-slice computed tomography in a real-world population. J Echocardiogr 15:18–26. Scholar
  87. Steca P, Monzani D, Greco A, Franzelli C, Magrin ME, Miglioretti M et al (2017) Stability and change of lifestyle profiles in cardiovascular patients after their first acute coronary event. PLoS One 12(8):e0183905. Scholar
  88. Stephens MB (2009) Cardiac rehabilitation. Am Fam Physician 80(9):955–959PubMedGoogle Scholar
  89. Supervía M, Medina-Inojosa JR, Yeung C, Lopez-Jimenez F, Squires RW, Pérez-Terzic CM et al (2017) Cardiac rehabilitation for women: a systematic review of barriers and solutions. Mayo Clin Proc 92(4):565–577. Scholar
  90. Suskin N, Sheth T, Negassa A, Yusuf S (2001) Relationship of current and past smoking to mortality and morbidity in patients with left ventricular dysfunction. J Am Coll Cardiol 37:1677–1682CrossRefPubMedGoogle Scholar
  91. Tabet JY, Meurin P, Driss AB, Weber H, Renaud N, Grosdemouge A et al (2009) Benefits of exercise training in chronic heart failure. Arch Cardiovasc Dis 102:721–730. Scholar
  92. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K et al (2004) Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 116:682–692. Scholar
  93. Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H et al (2014) Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev 4:CD003331. Scholar
  94. Tonella RM, Ratti LDSR, Delazari LEB, Da Silva PL, Herran ARDS, Dos Santos Faez DC et al (2017) Inspiratory muscle training in the intensive care unit: a new perspective. J Clin Med Res 9(11):929–934. Scholar
  95. van Deel ED, de Boer M, Kuster DW, Boontje NM, Holemans P, Sipido KR et al (2011) Exercise training does not improve cardiac function in compensated or decompensated left ventricular hypertrophy induced by aortic stenosis. J Mol Cell Cardiol 50:1017–1025. Scholar
  96. Wenger NK, Froelicher ES, Smith LK, Ades PA, Berra K, Blumenthal JA et al (1995) Cardiac rehabilitation as secondary prevention. Agency for health care policy and research and national Heart, Lung, and Blood Institute. Clin Pract Guide 17:1–23Google Scholar
  97. WislØff U, Stoylen A, Loennechen JP, Bruvold M, Rognmo Ø, Haram PM et al (2007) Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation 115:3086–3094. Scholar
  98. Wong CX, Sun MT, Odutayo A, Emdin CA, Mahajan R, Lau DH et al. (2016) Associations of epicardial, abdominal, and overall adiposity with atrial fibrillation. Circ Arrhythm Electrophysiol 9(12):e004378. Scholar
  99. Zipes DP, Link MS, Ackerman MJ, Kovacs RJ, Myerburg RJ, NAM E 3rd (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 9: arrhythmias and conduction defects: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 66(21):2412–2423. Scholar

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© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Clinical and Experimental Medicine – Cardiology UnitUniversity Hospital Medical School “Gaetano Martino”MessinaItaly

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