AHA Statement: Recommendations for Exercise Training With High-Risk Conditions

The American Heart Association (AHA) released a scientific statement in Circulation about exercise training in high-risk populations.

Cardiorespiratory fitness (CRF) prolongs survival and lowers risk for adverse cardiovascular (CV) events among both healthy individuals and those with chronic conditions. Exercise training improves CRF and quality of life. However, individuals with higher-risk, complex chronic diseases generally have a low likelihood of engaging in physical activities.

Individuals with higher-risk conditions, such as frailty, stroke, spinal cord injury, rheumatologic disease, and genetic cardiomyopathy, as well as recipients of cardiac implantable electronic devices and advanced heart failure (HF) therapies, likely do not participate in exercise training due to multiple reasons. These reasons may include kinesiophobia, physical limitations, and socioeconomic considerations, among others.

The AHA emphasized that engaging in exercise training can improve strength, mobility, peak oxygen consumption (VO₂), quality of life, and independence and reduce CV risk and health care utilization.

Additional research is urgently needed to identify a patient-centered approach to exercise training that accounts for patients’ unique needs, with a focus on implementation to equitably increase access to such programs for all individuals with the potential for benefit.

In order to achieve these benefits, the AHA encouraged primary care providers, neurologists, cardiologists, rheumatologists, orthopedists, and physical medicine and rehabilitation specialists to partner with exercise physiologists and/or physical therapists to tailor exercise training for specific patients and patient populations.

For example, older adults determined to be frail generally have a 30% to 70% reduction in peak VO₂, an 11% to 50% reduction in strength, up to a 40% reduction in balance, and reduced flexibility. To adapt exercise training for an older adult determined to be frail, the AHA recommended one-on-one therapist-delivered rehabilitation that emphasizes strength, aerobic, balance, and flexibility exercises delivered in a structured progression manner.

In stroke, cases demonstrate a decreased peak VO₂ to 26% to 87% of that seen in healthy adults, most cases have muscle weakness due to hemiparesis or paresis (≈65%) and balance difficulties (up to 83%), and a quarter of cases have reduced flexibility with spasticity (≈26%). The AHA recommended that patients with stroke participate in supervised aerobic exercise sessions supplemented with resistance and flexibility training.

The AHA highlighted gaps in knowledge about exercise training for high-risk populations, which involve determining best nutritional and dietary components that may preserve muscle mass and function, developing novel approaches to improve exercise program adherence, developing standard exercise protocols, exploring potential biomarkers for exercise outcomes, and assessing gender biases for exercise outcomes, among others.

The statement authors concluded, “Exercise training has demonstrated clinical benefit in diverse populations, including patients with frailty, stroke, SCI [spinal cord injury], rheumatologic conditions, CIEDs [cardiac implantable electronic devices], and some inherited cardiomyopathies and recipients of advanced HF therapies. Despite evidence to support the efficacy and safety of exercise training in the majority of conditions reviewed, these programs remain vastly underused. Additional research is urgently needed to identify a patient-centered approach to exercise training that accounts for patients’ unique needs, with a focus on implementation to equitably increase access to such programs for all individuals with the potential for benefit.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor