{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T21:55:03Z","timestamp":1782510903116,"version":"3.54.5"},"reference-count":65,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Background: Heart failure with reduced ejection fraction (HFrEF) markedly impairs quality of life (QoL) and life expectancy. The main therapeutic goals are to reduce mortality, improve functional capacity, and enhance QoL. Exercise training is an evidence-based, non-pharmacological component of standard care that improves functional capacity and clinical outcomes in HFrEF. This review examines the effects of endurance and resistance training on peak oxygen uptake (VO2peak), ventilatory efficiency (VE\/VCO2 slope), health-related QoL, and cardiovascular outcomes in patients with HFrEF. Methods: A structured narrative review was conducted using comprehensive searches of PubMed, EMBASE, and the Cochrane Library for English-language studies published between January 2004 and October 2024. Eligible studies included adult HFrEF populations undergoing aerobic and\/or resistance training with reported effects on VO2peak, ventilatory efficiency, QoL, or clinical outcomes. Given the heterogeneity of interventions, comparators, and outcome metrics, data were synthesized descriptively. Results: Across 18 studies (plus one sub-analysis) including 3401 patients, 17 trials assessed VO2peak and 16 reported significant improvements, with an average increase of approximately 2 mL\u00b7kg\u22121\u00b7min\u22121. Six studies assessed ventilatory efficiency, and five demonstrated reductions in VE\/VCO2 slope averaging 4.4 units. Eleven studies analyzed QoL, and nine reported significant improvements corresponding to an \u22485-point decrease in the Minnesota Living with Heart Failure Questionnaire (MLHFQ). In the largest trial, exercise training was associated with modest but statistically significant reductions in all-cause mortality or hospitalization (HR 0.89) and cardiovascular mortality or heart-failure hospitalization (HR 0.85) after adjustment for baseline prognostic factors. Conclusions: Structured exercise training improves aerobic capacity, ventilatory efficiency, and QoL in patients with HFrEF, with supportive evidence for reduced morbidity and mortality. These findings underscore the value of structured exercise as a core component of modern HFrEF management.<\/jats:p>","DOI":"10.3390\/jfmk10040483","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T09:15:21Z","timestamp":1766049321000},"page":"483","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of Endurance and Resistance Training on Cardiovascular Outcomes and Quality of Life in Patients with Heart Failure with Reduced Ejection Fraction: A Structured Narrative Review"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4097-6291","authenticated-orcid":false,"given":"Michael","family":"Stiefel","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5923-4798","authenticated-orcid":false,"given":"Jamie","family":"O\u2019Driscoll","sequence":"additional","affiliation":[{"name":"Leicester Lifestyle and Health Research Group, Leicester Diabetes Centre, University of Leicester, Leicester LE5 4PW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0268-6567","authenticated-orcid":false,"given":"Hadassa","family":"Brito da Silva","sequence":"additional","affiliation":[{"name":"Hochgebirgsklinik Davos, Medicine Campus Davos, 7265 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0197-0722","authenticated-orcid":false,"given":"Tristan","family":"Ramcharan","sequence":"additional","affiliation":[{"name":"Cardiovascular Clinical Academic Group, City St George\u2019s, University of London, London EC1V 0HB, UK"},{"name":"Heart Unit, Birmingham Children\u2019s Hospital, Birmingham B4 6NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Papadakis","sequence":"additional","affiliation":[{"name":"Cardiovascular Clinical Academic Group, City St George\u2019s, University of London, London EC1V 0HB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1093\/eurheartj\/eht066","article-title":"Incidence and epidemiology of new onset heart failure with preserved vs. reduced ejection fraction in a community-based cohort: 11-year follow-up of PREVEND","volume":"34","author":"Brouwers","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1007\/s00392-014-0788-x","article-title":"Sex differences in new-onset heart failure","volume":"104","author":"Meyer","year":"2015","journal-title":"Clin. Res. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Fonarow, G.C., Ahmad, F.S., Ahmad, T., Albert, N.M., Alexander, K.M., Baker, W.L., Bozkurt, B., Breathett, K., Carter, S., and Cheng, R.K. (2025). HF STATS 2025: Heart Failure Epidemiology and Outcomes Statistics an Updated 2025 Report from the Heart Failure Society of America. J. Card. Fail.","DOI":"10.1016\/j.cardfail.2025.07.007"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"GBD 2017 Disease and Injury Incidence and Prevalence Collaborators (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 392, 1789\u20131858. Erratum in Lancet 2019, 393, E44. https:\/\/doi.org\/10.1016\/S0140-6736(19)31047-5.","DOI":"10.1016\/S0140-6736(19)31047-5"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.jchf.2018.03.006","article-title":"Temporal Trends in the Incidence of and Mortality Associated with Heart Failure with Preserved and Reduced Ejection Fraction","volume":"6","author":"Tsao","year":"2018","journal-title":"JACC Heart Fail."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1001\/jamainternmed.2015.0924","article-title":"A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010","volume":"175","author":"Gerber","year":"2015","journal-title":"JAMA Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1001\/archinte.162.15.1682","article-title":"Representation of the elderly, women, and minorities in heart failure clinical trials","volume":"162","author":"Heiat","year":"2002","journal-title":"Arch. Intern. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1093\/eurheartj\/ehaa071","article-title":"The association of long-term outcome and biological sex in patients with acute heart failure from different geographic regions","volume":"41","author":"Akiyama","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1093\/eurheartj\/eht278","article-title":"Heart failure in young adults: 20-year trends in hospitalization, aetiology, and case fatality in Sweden","volume":"35","author":"Barasa","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1136\/hrt.2003.025270","article-title":"Clinical epidemiology of heart failure","volume":"93","author":"Mosterd","year":"2007","journal-title":"Heart"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","article-title":"2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease","volume":"42","author":"Pelliccia","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/S0140-6736(12)60954-4","article-title":"Stressing harms of physical inactivity to promote exercise","volume":"380","author":"Wen","year":"2012","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0140-6736(12)61031-9","article-title":"Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy","volume":"380","author":"Lee","year":"2012","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e031156","DOI":"10.1161\/JAHA.123.031156","article-title":"Prospective Associations of Accelerometer-Measured Machine-Learned Sedentary Behavior with Death Among Older Women: The OPACH Study","volume":"13","author":"Nguyen","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_16","first-page":"51","article-title":"Physical exercise and cognitive performance in the elderly: Current perspectives","volume":"9","author":"McGough","year":"2013","journal-title":"Clin. Interv. Aging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.psychsport.2018.08.011","article-title":"Physical activity and mental health in children and adolescents: An updated review of reviews and an analysis of causality","volume":"42","author":"Biddle","year":"2019","journal-title":"Psychol. Sport Exerc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1016\/j.jacc.2022.05.031","article-title":"Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex","volume":"80","author":"Kokkinos","year":"2022","journal-title":"J. Am. Coll. Cardiol"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1056\/NEJMoa011858","article-title":"Exercise Capacity and Mortality among Men Referred for Exercise Testing","volume":"346","author":"Myers","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e653","DOI":"10.1161\/CIR.0000000000000461","article-title":"Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement from the American Heart Association","volume":"134","author":"Ross","year":"2016","journal-title":"Circulation"},{"key":"ref_21","first-page":"39","article-title":"Peak VO2 and VE\/VCO2 slope in betablockers era in patients with heart failure: A Brazilian experience","volume":"91","author":"Ferreira","year":"2008","journal-title":"Arq. Bras Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1152\/japplphysiol.00049.2015","article-title":"Determinants of exercise intolerance in patients with heart failure and reduced or preserved ejection fraction","volume":"119","author":"Haykowsky","year":"2015","journal-title":"J. Appl. Physiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"H1419","DOI":"10.1152\/ajpheart.00469.2015","article-title":"Exercise training in chronic heart failure: Improving skeletal muscle O2 transport and utilization","volume":"309","author":"Hirai","year":"2015","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.ijcard.2019.02.050","article-title":"Effect of combined aerobic and resistance training on peak oxygen consumption, muscle strength and health-related quality of life in patients with heart failure with reduced left ventricular ejection fraction: A systematic review and meta-analysis","volume":"293","author":"Roever","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s40798-022-00464-5","article-title":"Exercise Training in Heart failure with Preserved and Reduced Ejection Fraction: A Systematic Review and Meta-Analysis","volume":"8","author":"Edwards","year":"2022","journal-title":"Sports Med. Open"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1001\/jama.2009.454","article-title":"Efficacy and safety of exercise training in patients with chronic heart failure HF-ACTION randomized controlled trial","volume":"301","author":"Whellan","year":"2009","journal-title":"JAMA"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1001\/jama.2009.457","article-title":"Effects of exercise training on health status in patients with chronic heart failure HF-ACTION randomized controlled trial","volume":"301","author":"Flynn","year":"2009","journal-title":"JAMA"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1161\/CIRCULATIONAHA.116.022924","article-title":"High-Intensity Interval Training in Patients with Heart Failure with Reduced Ejection Fraction","volume":"135","author":"Ellingsen","year":"2017","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1177\/2047487318806358","article-title":"The effects and costs of home-based rehabilitation for heart failure with reduced ejection fraction: The REACH-HF multicentre randomized controlled trial","volume":"26","author":"Dalal","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1007\/s00421-014-2913-y","article-title":"Modified high-intensity interval training increases peak cardiac power output in patients with heart failure","volume":"114","author":"Huang","year":"2014","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/PHM.0000000000000312","article-title":"Aerobic Interval Training Elicits Different Hemodynamic Adaptations between Heart Failure Patients with Preserved and Reduced Ejection Fraction","volume":"95","author":"Fu","year":"2016","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1982","DOI":"10.1111\/j.1532-5415.2009.02499.x","article-title":"Endurance exercise training in older patients with heart failure: Results from a randomized, controlled, single-blind trial","volume":"57","author":"Brubaker","year":"2009","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/HCR.0000000000000252","article-title":"Cardiac Rehabilitation Participation Rates and Outcomes for Patients with Heart Failure","volume":"38","author":"Rengo","year":"2018","journal-title":"J. Cardiopulm. Rehabil. Prev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1177\/2047487317690458","article-title":"Inflammatory biomarkers and effect of exercise on functional capacity in patients with heart failure: Insights from a randomized clinical trial","volume":"24","author":"Rigaud","year":"2017","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"29","DOI":"10.31083\/j.rcm2401029","article-title":"Does the Addition of Strength Training to a High-Intensity Interval Training Program Benefit More the Patients with Chronic Heart Failure?","volume":"24","author":"Alshamari","year":"2023","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_36","first-page":"159","article-title":"Effects of an eccentric training personalized by a low rate of perceived exertion on the maximal capacities in chronic heart failure: A randomized controlled trial","volume":"52","author":"Casillas","year":"2015","journal-title":"Eur. J. Phys. Rehabil. Med"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1093\/eurjhf\/hfp168","article-title":"Impact of gender on benefits of exercise training on sympathetic nerve activity and muscle blood flow in heart failure","volume":"12","author":"Melo","year":"2010","journal-title":"Eur. J. Heart Fail."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1007\/s00421-019-04165-y","article-title":"High-intensity interval training in cardiac resynchronization therapy: A randomized control trial","volume":"119","author":"Abreu","year":"2019","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Sales, A.R., Azevedo, L.F., Silva, T.O., Rodrigues, A.G., Oliveira, P.A., Jord\u00e3o, C.P., Andrade, A.C., Urias, U., Guimaraes, G.V., and Bocchi, E.A. (2020). High-Intensity Interval Training Decreases Muscle Sympathetic Nerve Activity and Improves Peripheral Vascular Function in Patients with Heart Failure with Reduced Ejection Fraction. Circ. Heart Fail., 13.","DOI":"10.1161\/CIRCHEARTFAILURE.120.007121"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2019\/1718281","article-title":"Impact of a supervised twelve-week combined physical training program in heart failure patients: A randomized trial","volume":"2019","author":"Fabri","year":"2019","journal-title":"Cardiol. Res. Pr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1016\/j.hrthm.2022.03.1217","article-title":"Exercise training in heart failure with reduced ejection fraction and permanent atrial fibrillation: A randomized clinical trial","volume":"19","author":"Alves","year":"2022","journal-title":"Heart Rhythm."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.ijcard.2021.08.050","article-title":"Effects of the exercise training on skeletal muscle oxygen consumption in heart failure patients with reduced ejection fraction","volume":"343","author":"Ribeiro","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e2550","DOI":"10.6061\/clinics\/2021\/e2550","article-title":"Home-based training program in patients with chronic heart failure and reduced ejection fraction: A randomized pilot study","volume":"76","author":"Umeda","year":"2021","journal-title":"Clinics"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1954","DOI":"10.1111\/jgs.16428","article-title":"PRIME-HF: Novel Exercise for Older Patients with Heart Failure. A Pilot Randomized Controlled Study","volume":"68","author":"Giuliano","year":"2020","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1016\/j.jacc.2011.07.024","article-title":"Exercise training in heart failure with preserved ejection fraction: Beyond proof-of-concept","volume":"58","author":"Kitzman","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_46","first-page":"95","article-title":"Impact of Exercise Training on Peak Oxygen Uptake and its Determinants in Heart Failure with Preserved Ejection Fraction","volume":"2","author":"Tucker","year":"2016","journal-title":"Card. Fail. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.jacc.2015.11.050","article-title":"Variables measured during cardiopulmonary exercise testing as predictors of mortality in chronic systolic heart failure","volume":"67","author":"Keteyian","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1161\/01.CIR.83.3.778","article-title":"Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure","volume":"83","author":"Mancini","year":"1991","journal-title":"Circulation"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s10741-012-9332-0","article-title":"A meta-analysis of the prognostic significance of cardiopulmonary exercise testing in patients with heart failure","volume":"18","author":"Cahalin","year":"2013","journal-title":"Heart Fail. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/j.jacc.2005.09.066","article-title":"The influence of age, gender, and training on exercise efficiency","volume":"47","author":"Woo","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"877","DOI":"10.2165\/00007256-200333120-00002","article-title":"Rate and Mechanism of Maximal Oxygen Consumption Decline with Aging: Implications for Exercise Training","volume":"33","author":"Hawkins","year":"2003","journal-title":"Sports Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"112962","DOI":"10.1016\/j.exger.2025.112962","article-title":"Effect of exercise interventions on oxygen uptake in healthy older adults: A network meta-analysis of randomized controlled trials","volume":"212","year":"2025","journal-title":"Exp. Gerontol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"112177","DOI":"10.1016\/j.exger.2023.112177","article-title":"Age-associated inflammation and implications for skeletal muscle responses to exercise","volume":"177","author":"Kunz","year":"2023","journal-title":"Exp. Gerontol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s40279-013-0023-3","article-title":"Effects of exercise training on chronic inflammation in obesity: Current evidence and potential mechanisms","volume":"43","author":"You","year":"2013","journal-title":"Sports Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"106908","DOI":"10.1016\/j.medcli.2025.106908","article-title":"Effects of exercise intervention on exercise capacity and cardiopulmonary function in patients with atrial fibrillation: A randomized controlled trial systematic review and meta-analysis","volume":"164","author":"Shuai","year":"2025","journal-title":"Med Clin."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1016\/S0735-1097(97)00078-8","article-title":"Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure","volume":"29","author":"Chua","year":"1997","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2803","DOI":"10.1161\/01.CIR.101.24.2803","article-title":"Impairment of ventilatory efficiency in heart failure: Prognostic impact","volume":"101","author":"Kleber","year":"2000","journal-title":"Circulation"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2410","DOI":"10.1161\/CIRCULATIONAHA.107.686576","article-title":"Development of a ventilatory classification system in patients with heart failure","volume":"115","author":"Arena","year":"2007","journal-title":"Circulation"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1002\/ehf2.13761","article-title":"Usefulness of ventilatory inefficiency in predicting prognosis across the heart failure spectrum","volume":"9","author":"Gong","year":"2022","journal-title":"ESC Heart Fail."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2200144","DOI":"10.1183\/13993003.00144-2022","article-title":"Excess ventilation and exertional dyspnoea in heart failure and pulmonary hypertension","volume":"60","author":"Neder","year":"2022","journal-title":"Eur. Respir. J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s12955-019-1104-2","article-title":"Responsiveness and minimal clinically important difference of the Minnesota living with heart failure questionnaire","volume":"17","author":"Bilbao","year":"2019","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1093\/eurjpc\/zwac199","article-title":"Sex and age as predictors of health-related quality of life change in Phase II cardiac rehabilitation","volume":"30","author":"Jellestada","year":"2023","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1139\/h2012-109","article-title":"Central hemodynamic responses during acute high-intensity interval exercise and moderate continuous exercise in patients with heart failure","volume":"37","author":"Gayda","year":"2012","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.jchf.2021.05.007","article-title":"Rehabilitation Intervention in Older Patients with Acute Heart Failure with Preserved Versus Reduced Ejection Fraction","volume":"9","author":"Mentz","year":"2021","journal-title":"JACC Heart Fail."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/j.apmr.2023.07.004","article-title":"Non-Pharmacological Interventions in Patients with Heart Failure with Reduced Ejection Fraction: A Systematic Review and Network Meta-analysis","volume":"105","author":"Li","year":"2024","journal-title":"Arch. Phys. Med. Rehabil."}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/10\/4\/483\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T08:49:30Z","timestamp":1766134170000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/10\/4\/483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,18]]},"references-count":65,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jfmk10040483"],"URL":"https:\/\/doi.org\/10.3390\/jfmk10040483","relation":{},"ISSN":["2411-5142"],"issn-type":[{"value":"2411-5142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,18]]}}}