Regional differences in exercise training implementation in heart failure: findings from the Exercise Training in Heart Failure (ExTraHF) survey

on behalf of the Committee on Exercise Physiology & Training of the Heart Failure Association of the European Society of Cardiology, Massimo F. Piepoli, Simone Binno, Andrew J.S. Coats, Alain Cohen-Solal, Ugo Corrà, Constantinos H. Davos, Tiny Jaarsma, Lars Lund, David Niederseer, Francesco Orso, Giovanni Q. Villani, Piergiuseppe Agostoni, Maurizio Volterrani, Petar Seferovic

Research output: Contribution to journalArticlepeer-review


Background: Exercise training programmes (ETPs) are a crucial component in cardiac rehabilitation in heart failure (HF) patients. The Exercise Training in HF (ExTraHF) survey has reported poor implementation of ETPs in countries affiliated to the European Society of Cardiology (ESC). The aim of the present sub-analysis was to investigate the regional variations in the implementation of ETPs for HF patients. Methods and results: The study was designed as a web-based survey of cardiac units, divided into five areas, according to the geographical location of the countries surveyed. Overall, 172 centres replied to the survey, in charge of 78 514 patients, differentiated in 52 Northern (n = 15 040), 48 Southern (n = 27 127), 34 Western (n = 11 769), 24 Eastern European (n = 12 748), and 14 extra-European centres (n = 11 830). Greater ETP implementation was observed in Western (76%) and Northern (63%) regions, whereas lower rates were seen in Southern (58%), Eastern European (50%) and extra-European (36%) regions. The leading barrier was the lack of resources in all (83–65%) but Western region (37%) where patients were enrolled in dedicated settings and specialized units (75%). In 40% of centres, non-inclusion of ETP in the national or local guideline pathway accounted for the lack of ETP implementation. Conclusion: Exercise training programmes are poorly implemented in the ESC affiliated countries, mainly because of the lack of resources and/or national and local guidelines. The linkage with dedicated cardiac rehabilitation centres (as in the Western region) or the model of local rehabilitation services adopted in Northern countries may be considered as options to overcome these gaps.
Original languageEnglish
Pages (from-to)1142-1148
Number of pages7
JournalEuropean Journal of Heart Failure
Issue number9
Publication statusPublished - Sep 1 2019


  • Cardiac rehabilitation
  • Exercise training
  • Guidelines
  • Heart failure
  • Implementation


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