Clinical application of cardiopulmonary exercise stress test for the recommendations for physical activity in patients with chronic heart failure

Physical activity (PA) according to current guidelines is an important adjunctive therapy for patients with chronic heart failure (CHF) with reduced and preserved ejection fraction (HFrEF and HFpEF) which is level of evidence class 1A. However, as with any therapy, PA must be dosed according to the patient’s own characteristics, so an individual assessment and prescription of exercise intensity is necessary. Different types of PA (endurance and resistance) and intensity levels (mild, mild to moderate, and high to moderate) are used in programs in patients with CHF. The assessment can be carried out through indirect (heart rate reserve) or direct metabolic measures (VO2 reserve, anaerobic threshold) where precision is ensured by direct assessment of VO2 kinetics at constant work speed protocols of various loads - ergospirometry. Ergospirometry enables a direct assessment of the occurrence of anaerobic metabolism and real fatigue of the patient towards the limits of his position under different loads. In addition, the effect of exercise can be monitored on the basis of control tests. In this way, evidence-based efforts are prevented that a person with CHF cannot sustain or that would not lead to progress and improvement in symptoms and effort tolerance. Also, it enables a gradual increase in intensity and further progress in exercise.