Priority 2 from the Advanced Heart Failure PSP

UNCERTAINTY: What amount and type of exercise is safe and effective for people with advanced heart failure?   (JLA PSP Priority 2)
Overall ranking 2
JLA question ID 0098/02
Explanatory note

There is a large body of evidence for rehabilitation/supervised exercise as well as 'informal exercise' such as tai chi  functional measures e.g. heart capabilities  and to a lesser extent quality of life measures but no guidance on which/how much/how often - this lack of evidence is reflected in clinical guidelines. Equally there is no guidance for everyday actitivies for people with advanced heart failure e.g. going to shops, walking up hills
Evidence

Three recent reviews:

1. Clin Rehabil. 2018 Nov;32(11):1482-1492. doi: 10.1177/0269215518784345. Epub 2018 Jul 9.The impact of high-intensity inspiratory muscle training on exercise capacity and inspiratory muscle strength in heart failure with reduced ejection fraction: a systematic review and meta-analysis. Gomes Neto M, Ferrari F4,5, Helal L, Lopes A.

2. Int J Cardiol. 2018 Mar 1;254:224-229. doi: 10.1016/j.ijcard.2017.10.114. Epub 2018 Jan 28.Determinants of exercise intolerance in heart failure with preserved ejection fraction: A systematic review and meta-analysis.Montero D1, Diaz-Cañestro C2.

3. Arch Cardiol Mex. 2017 Oct - Dec;87(4):326-335. doi: 10.1016/j.acmx.2016.12.002. Epub 2017 Jan 5. [The exercise training restores the heart rate variability in heart failure patients. A systematic review]. [Article in Spanish] Segovia V1 .
Health Research Classification System category  Cardiovascular
Extra information provided by this PSP
  Could graded exercise be useful for heart failure patients? ~ In advanced heart failure some patients seem to have a period of stability when more care is provided, adaptations to the home and equipment is provided. Does rest in advanced heart failure improve cardiac function? ~ [What can help me with my tiredness and] will exercise help my heart failure? ~ What sort of exercise is safe to do? ~ How much exercise? How long for?
Submitted by  28 x patients, 22 x health professionals, 3 x carers , 1 x other 
PSP information
PSP unique ID 0098
PSP name Advanced Heart Failure
Total number of uncertainties identified by this PSP. 65  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 13 February 2019