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JACC Heart Fail. 2013 Dec;1(6):540-7. doi: 10.1016/j.jchf.2013.09.002. Epub 2013 Oct 24.

Cardiac rehabilitation exercise and self-care for chronic heart failure.

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Division of Cardiology, University of Vermont College of Medicine, Burlington, Vermont. Electronic address:
Division of Cardiology, Henry Ford Hospital, Detroit, Michigan.
Division of Cardiology, Boston University Medical Center, Boston, Massachusetts.
Department of Medicine, Stanford University School of Medicine, Stanford, California.
Division of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Division of Cardiology, Columbia University College of Medicine, New York, New York.
Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri.


Chronic heart failure (CHF) is highly prevalent in older individuals and is a major cause of morbidity, mortality, hospitalizations, and disability. Cardiac rehabilitation (CR) exercise training and CHF self-care counseling have each been shown to improve clinical status and clinical outcomes in CHF. Systematic reviews and meta-analyses of CR exercise training alone (without counseling) have demonstrated consistent improvements in CHF symptoms in addition to reductions in cardiac mortality and number of hospitalizations, although individual trials have been less conclusive of the latter 2 findings. The largest single trial, HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training), showed a reduction in the adjusted risk for the combined endpoint of all-cause mortality or hospitalization (hazard ratio: 0.89, 95% confidence interval: 0.81 to 0.99; p = 0.03). Quality of life and mental depression also improved. CHF-related counseling, whether provided in isolation or in combination with CR exercise training, improves clinical outcomes and reduces CHF-related hospitalizations. We review current evidence on the benefits and risks of CR and self-care counseling in patients with CHF, provide recommendations for patient selection for third-party payers, and discuss the role of CR in promoting self-care and behavioral changes.


cardiac rehabilitation; chronic heart failure; counseling; exercise training; self-care

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