How best to improve physical activity in heart failure?

A meta-analysis

Aliya Amirova
3 min readJun 9, 2021

I am thrilled to share the findings of our research published in Open Heart [1].

Heart failure (HF) is a global health problem. It is the number one killer of people age 65 to 75. And if there is something that refutes the phrase ‘what does not kill us, makes us stronger’, it is HF. Currently, around 40 million people are living with this condition. They suffer symptoms like breathlessness, fatigue and liquid retention, accompanied by what an HF patient once described to me as a sensation of walking on balloons instead of legs. One promising remedy for this is daily physical activity.

Figure 1.

People with HF are advised to exercise as much and as often as they can. Among other strategies, pharmaceutical treatment and lifestyle change, they are offered cardiac rehabilitation, including an exercise programme (Figure 1). Albeit these programmes are poorly attended.

There is moderate evidence that CR participation increases physical activity levels in cardiovascular disease. However, it is not effective in increasing physical activity in HF [2].

Figure 2.

In search of an alternative, my colleagues and I reviewed existing randomised controlled trials investigating how best to improve everyday physical activity engagement in HF (Figure 2). The review, published in Open Heart, pin-pointed promising intervention features and components.

Figure 3.

We found that exercise combined with behavioural change intervention effectively promotes physical activity in HF in the short term [1]. There is a need for additional training for physiotherapists in delivering behaviour change intervention alongside an exercise programme (Figure 3).

An intervention is expected to be more efficacious than the usual care if it includes Prompts and cues to walk or exercise, like a phone call or a text message. We found that it is beneficial if a trusted clinician provides explicit advice to engage in physical activity (Credible source). Another highly effective strategy is to place objects that will serve as a cue to engage in physical activity in the patient's everyday environment (Adding object to the environment, e.g., exercise step or treadmill). Encouragement to walk or exercise in various settings beyond CR (e.g., home, neighbourhood, parks) is also promising.

Additional promising strategies are Graded tasks (e.g., gradual increase in intensity and duration of exercise training), Self-monitoring, Monitoring of physical activity by others without feedback, Action planning, and Goal-setting.

[1] Amirova, Aliya; Fteropoulli, Theodora; Williams, Paul; Haddad, Mark (2021–06–01). “Efficacy of interventions to increase physical activity for people with heart failure: a meta-analysis”. Open Heart. 8 (1): e001687. doi:10.1136/openhrt-2021–001687. ISSN 2053–3624. PMID 34108272

[2] Dibben, Grace Olivia; Dalal, Hasnain M.; Taylor, Rod S.; Doherty, Patrick; Tang, Lars Hermann; Hillsdon, Melvyn (2018–09–01). “Cardiac rehabilitation and physical activity: systematic review and meta-analysis”. Heart. 104 (17): 1394–1402. doi:10.1136/heartjnl-2017–312832. ISSN 1355–6037. PMID 29654095



Aliya Amirova

Research Associate, Institute of Psychiatry, Psychology & Neuroscience, King’s College London.