What lifestyle modifications should be included in the cardiac rehabilitation plan for patients with heart failure?

Cardiac rehabilitation for patients with heart failure should include personalised, exercise-based programmes tailored to the individual's clinical stability and comorbidities, with the aim to improve functional capacity and quality of life NICE NG106. Exercise training is a core component and should be adapted by qualified professionals to accommodate any clinical conditions that may worsen during physical activity NICE NG106 de Gregorio 2018. The programme should be accessible in various settings such as home, community, or hospital, and include a psychological and educational component to support self-management and understanding of the condition NICE NG106.

Lifestyle modifications integral to cardiac rehabilitation include:

• Encouraging regular, moderate physical activity tailored to the patient’s capacity and comorbidities, which has been shown to improve exercise tolerance and reduce symptoms Passantino et al. 2021.
• Providing education on symptom monitoring and when to seek medical advice, empowering patients to participate actively in their care NICE NG106.
• Incorporating stress management techniques as part of comprehensive rehabilitation to address psychological wellbeing NICE NG106 Passantino et al. 2021.
• Offering dietary advice consistent with heart failure management, such as sodium restriction and fluid management, although specific dietary guidelines should be personalised Camafort et al. 2023.
• Supporting smoking cessation and moderation of alcohol intake, as these lifestyle factors impact heart failure progression Camafort et al. 2023.
• Addressing social determinants and barriers to attendance, including transport and cultural sensitivity, to improve engagement and adherence NICE NG106.

Overall, cardiac rehabilitation for heart failure patients should be holistic, combining physical training with education, psychological support, and lifestyle counselling to optimise outcomes NICE NG106 de Gregorio 2018Passantino et al. 2021Camafort et al. 2023.