Recommendations Summary

HF: Physical Activity (2017)

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  HF: Encourage Individualized Physical Activity Plan for Adults with Heart Failure (NYHA Classes I-IV/AHA Stages B, C and D)

  Unless medically contraindicated, the registered dietitian nutritionist (RDN) should encourage an individualized physical activity plan for adults with heart failure (NYHA Classes I–IV/AHA Stages B, C and D). Regular physical activity is recommended as safe and effective for patients with heart failure who are able to participate to improve functional status and cardiac rehabilitation can be useful in clinically stable patients with heart failure to improve functional capacity, exercise duration, health-related quality of life and mortality. 

  
  

  Rating: Strong
  Conditional

  • Risks/Harms of Implementing This Recommendation

    Physical activity in some individuals with heart failure may contribute to disability or death; thus, consultation with a physician prior to beginning an exercise program is recommended.

  • Conditions of Application

    The recommendation, HF: Encourage Individualized Physical Activity Plan for Adults with Heart Failure (NYHA Classes I–IV/AHA Stages B, C and D), applies to adults with heart failure unless medically contraindicated.

  • Potential Costs Associated with Application

    Costs of medical nutrition therapy (MNT) sessions and reimbursement vary, however MNT sessions are essential for improved outcomes.

  • Recommendation Narrative

    From the 2013 ACCF/AHA Guideline for the Management of Heart Failure (HF):
    
    7.3. Stage C
    7.3.1. Non-Pharmacological Interventions
    7.3.1.6. Activity, Exercise Prescription, and Cardiac Rehabilitation: Recommendations
    
    Class I

    • Exercise training (or regular physical activity) is recommended as safe and effective for patients with HF who are able to participate to improve functional status. (Level of Evidence: A)

    Class IIa

    • Cardiac rehabilitation can be useful in clinically stable patients with HF to improve functional capacity, exercise duration, HRQOL and mortality. (Level of Evidence: B)

    From the 2016 ESC Guideline for the Diagnosis and Treatment of Acute and Chronic Heart Failure:
    
    14. Multi-Disciplinary Team Management

    • It is recommended that regular aerobic exercise is encouraged in patients with HF to improve functional capacity and symptoms. (Class I, Level A)
    • It is recommended that regular aerobic exercise is encouraged in stable patients with HFrEF to reduce the risk of HF hospitalization. (Class I, Level A)

  • Recommendation Strength Rationale

    • The 2013 ACCF/AHA Guidelines for the Management of Heart Failure received Levels of Evidence A and B
    • The 2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure received Class I, Level A.

  • Minority Opinions

    Consensus reached.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  • References
  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    • Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, on behalf of 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. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016; May 20.
    • Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 128: e240-e327.