EXERCISE PRESCRIPTION FOR CARDIAC PATIENTS WITH MULTIPLE COMORBIDITIES

Abstract

Background: Modern cardiac caseloads are increasingly defined by clinical complexity rather than discrete pathology. Patients often present with intersecting conditions, such as heart failure with preserved ejection fraction (HFpEF), valvular disease, left ventricular hypertrophy, pulmonary hypertension, and geriatric syndromes like frailty and sarcopenia. Despite this shift, existing exercise data predominantly stems from cohorts with single diagnoses, leaving physiotherapists with limited guidance for patients managing multiple comorbidities. This scoping review aimed to critically evaluate current literature to map available evidence regarding exercise prescription for these complex cardiac populations, focusing specifically on optimal modalities, training intensities, safety protocols, and reported functional outcomes.

Methodology: A scoping review was carried out in accordance with JBI Manual for Evidence Synthesis and reported in accordance with PRISMA-ScR. Indexed literature was searched and screened from January 2020 to December 2025.

Results: Evidence suggests that supervised exercise improves peak oxygen uptake and quality of life in HFpEF; in certain patients, high-intensity interval training (HIIT) provides a little advantage over moderate continuous training (MCT); the strongest trial supports combined endurance-plus-resistance training. Exercise-based rehabilitation focuses on functional decline and frailty in valvular/post-TAVR populations. Individualised, resistance-inclusive prescriptions for elderly, fragile, multimorbid patients are consistent with guidelines and review sources. There is very little evidence specific to mixed comorbidity profiles (e.g., HFpEF with valvular illness and LVH).

Conclusion: Exercise remains highly beneficial across underlying cardiac conditions. A customised, frailty-aware, and resistance-inclusive prescription is well-supported by current literature. Nevertheless, the clinical literature suffers from a notable lack of targeted trials involving multi-comorbid cardiac patients, necessitating future research to better inform real-world rehabilitation strategies.