• cardiac rehabilitation
• cardiopulmonary exercise training
• exercise training
• heart failure
• stress test

HF has been reported as the most common cause of hospital admissions in people over the age of 65 and a leading cause of all hospital admissions for all age groups. In 2015, 1.7 million hospital admissions for HF in the European Union (EU) alone [9]. This disease is the most common reason for hospitalization among people over 65 [10,11]. Moreover, about 50% of patients with HF are re-hospitalized within six months, 20-25% of patients within 30 days after discharge from the hospital [12]. 70% of repeated hospitalizations are associated with decompensation of HF [13]. Further increase number of patients with HF is expected due to the ageing of the population, an increase in the prevalence of cardiac risk factors, and an improvement in the survival of patients with various cardiovascular pathologies. Incidence and HF prevalence in the ageing US population will increase by 46% between 2012 and 2030. Older adults diagnosed with HF have 5-year mortality approaching 50%. HF's total direct medical costs were estimated at $30.7 billion in 2012 and will increase by ≈127% to $69.7 billion by 2030 [14, 15].
Exercise training in HF: Numerous studies demonstrate the positive impact of exercise training on the clinic, the course of the disease, and the cardiovascular response [156]. The positive impact of exercise on long-term disease prognosis has been repeatedly confirmed by data from the American Heart Association (AHA), the American Association for Cardiovascular and Pulmonary Rehabilitation (AACVPR), and the Agency for Health Care Policy and Research (AHCPR). Further research to identify specific components of cardiac rehabilitation for patients with CHF will further optimise the rehabilitation program in reducing the risk of cardiovascular diseases, reducing disability, contributing to changing to an active, healthy lifestyle and helping maintain a healthy lifestyle after the completion of rehabilitation programs [112].

Aim of the thesis: To evaluate the effect of specific training protocol (8 weeks with 2 training sessions per week) in heart failure patients following standard medical therapy (including ARNI, SGLT2 inhibitors).
Materials and methods: 64 patients with HF were enrolled in the department of Sports Medicine and Internal medicine of Santa Chiara hospital at the University of Pisa. All examined patients underwent clinical studies before and after the completing of the training program, which included the following: BMI assessment, anthropometric studies, blood samples (including glucose, troponin, NT-proBNP, eGFR, etc.), lipid and hormonal status, rest and exercise ECG, Echocardiography, Stress Echocardiography, CPET, spirometry.

Results: The anthropometric assessment, BMI before and after the training program, was slightly reduced in the group of patients with HFpEF (27.24±3.46 versus 25.73±3.72 kg/m2; * P<0.05). In the group of patients with HFmrEF (28.08±6.96 vs 26.98±4.38 kg/m2; P>0.05) and HFrEF (28.63±7.52 vs 27.39±3.43 kg/m2; P>0.05), there was also a downward trend in BMI. Slight fluctuations in BMI in the examined patients are associated not only with the loss of free fat mass but also with the increase in muscle mass of the body during physical activity.
After eight weeks of physical training in all groups with CHF (HFpEF, HFmrEF, HFrEF), there was a trend towards a decrease in markers of myocardial damage (Troponin T (pg/ml)) and progression of CHF (NT-proBNP in pg/ml and Aldosterone (ng/dl)). Even a slight decrease in these parameters against the background of physical training in patients with CHF of varying severity indicates a decrease in the progression of the disease.