Heart failure (HF) is a chronic, progressive, and inexorable syndrome affecting
worldwide billion of patients (equally distributed among men and women), with
prevalence estimate of 1–3% in developed countries. HF leads to enormous direct
and indirect costs, and because of ageing population, the total number of HF
patients keep rising, approximately 10% in patients 65 years old. Exercise
training (ET) is widely recognized as an evidence-based adjunct treatment
modality for patients with HF, and growing evidence is emerging among elderly
patients with HF. We used relevant data from literature search (PubMed, Medline,
EMBASE) highlighting the epidemiology of HF; focusing on central and peripheral
mechanisms underlying the beneficial effect of ET in HF patients; and on frail HF
elderly patients undergoing ET. Since many Countries ordered a lockdown in early
stages pandemic trying to limit infections, COVID-19 pandemic, and its limitation
to exercise-based cardiac rehabilitation operativity was also discussed. ET
exerts both central and peripheral adaptations that clinically translate into
anti-remodeling effects, increased functional capacity and reduced morbidity and
mortality. Ideally, ET programs should be prescribed in a patient-tailored
approach, particularly in frail elderly patients with HF. In conclusion, given
the complexity of HF syndrome, combining, and tailoring different ET modalities
is mandatory. A procedural algorithm according to patient’s baseline clinical
characteristics [i.e., functional capacity, comorbidity, frailty status (muscle
strength, balance, usual daily activities, hearing and vision impairment,
sarcopenia, and inability to actively exercise), logistics, individual
preferences and goals] has been proposed. Increasing long-term adherence and
reaching the frailest patients are challenging goals for future initiatives in
the field.