Exercise guide
Keeping active is now part of treating heart failure, not something to avoid. In 60 trials, exercise-based cardiac rehabilitation probably cut hospital admissions (15.9% of people against 23.8%) and improved quality of life, and NICE (the National Institute for Health and Care Excellence) says everyone with heart failure should be offered it. Exercise doesn't cure heart failure or replace your medicines, but it can make everyday life easier.
This guide covers how to get cardiac rehab, how hard to work when breathlessness is part of daily life, strength training, heart failure with preserved ejection fraction, what to avoid, how exercise fits with weighing yourself and a fluid limit, and the signs that mean rest or get help. It includes a home workout you can do sitting or standing, with 3D demos of every move.
The British Heart Foundation (BHF) says people with heart failure used to be told to rest, but keeping active is now known to improve symptoms and quality of life. Exercise doesn't cure or reverse heart failure, and it doesn't replace your medicines, but it can make everyday activities easier.
Cardiac rehabilitation is a programme of exercise, education and support. NICE says everyone with heart failure should be offered an exercise-based programme, after an assessment, at home, in the community or in hospital. Only about 1 in 6 eligible people in England start one, so ask your GP (general practitioner), cardiologist or heart failure nurse to refer you.
Aim for moderate effort: you feel a bit warmer and breathe a bit more heavily, but can still talk. A few 5 to 10-minute sessions a day count, building gradually towards 150 minutes a week. Light strength work with bands, light weights or food tins helps too.
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Don't exercise on days you feel unwell or more tired or breathless than normal. Weigh yourself regularly: sudden weight gain can mean fluid is building up, and needs an urgent GP appointment or a call to NHS 111.
Beta blockers, ivabradine and digoxin slow the heart, so heart rate targets don't fit: go by how the effort feels. Keep taking your medicines. In trials they reduced deaths and hospital stays, while exercise made no clear difference to deaths in the short term.
In a trial of 261 people, hard intervals were no better than moderate training. Leave out heavy lifting, and talk to your heart failure team before interval training, swimming or competitive sport.
Heart failure is when your heart cannot pump blood properly. It does not mean your heart has stopped working or is about to stop working. There's no cure, but treatment and lifestyle changes can help, and symptoms can vary from day to day and week to week.
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Ejection fraction is the share of blood squeezed out of the heart's main pumping chamber with each beat, measured with a heart scan (echocardiogram); over 50% is considered normal. NICE describes three types: reduced ejection fraction (40% or less), mildly reduced (41% to 49%), and preserved (50% or more, with a structural problem in the heart such as a thickened wall).
More than 1 million people in the UK have heart failure, with at least 200,000 new diagnoses a year. Nearly half of people with heart failure in the community have the preserved type; they are often older, and their main symptom is that exercise is very hard.
Breathlessness with everyday activities or when lying down; feeling weak, light-headed or very tired, especially after moving; swollen feet, ankles, legs or tummy; sudden weight gain; and coughing at night or coughing up frothy pink phlegm.
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The BHF describes four stages: no symptoms during everyday activity; normal at rest, but physical activity causes symptoms; normal at rest, but a little activity causes symptoms; and symptoms with any activity, perhaps with discomfort at rest.
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When the heart isn't pumping as well as it should, your muscles and lungs get less oxygen, so activity feels harder. Keeping your body moving helps your muscles and lungs work better, which puts less strain on your heart. In trials with preserved ejection fraction, fitness improved without any change in heart scan measurements: the gains come mainly from the muscles and blood vessels.
Treatment includes medicines that remove extra fluid (diuretics such as furosemide), widen the blood vessels, or slow the heart (such as beta blockers), and for some people an implantable cardioverter defibrillator (ICD) or a cardiac resynchronisation therapy (CRT) device. For reduced ejection fraction, NICE recommends a combination of four types of medicine, which reduced deaths and hospital stays in trials. Cardiac rehabilitation sits alongside all of these.
Cardiac rehabilitation is a programme of exercise, education and support. For heart failure, NICE says it should be personalised, start with an assessment to make sure it suits you, include psychological and educational support, and be offered at home, in the community or in hospital, whichever is easiest for you. The NHS says it can be face to face or online.
The NHS says everyone diagnosed with heart failure should be offered cardiac rehabilitation. The British Association for Cardiovascular Prevention and Rehabilitation (BACPR) lists heart failure as a priority group, whatever your age.
A UK trial, REACH-HF, tested a home programme with a manual and a choice of chair-based exercise or progressive walking, at least 3 times a week, starting from each person's own level and building up over 2 to 3 months. In the Cochrane review, home and centre programmes gave similar results, so choose the one you'll keep going with.
In England in 2024, only 16.4% of eligible people with heart failure started rehab. If you haven't been offered it, ask your GP, cardiologist or heart failure nurse to refer you. The BHF's Heart Helpline, 0808 802 1234 (Monday to Friday, 9am to 5pm), can answer questions.
Most trials were in men with reduced ejection fraction; women, older people and preserved ejection fraction are less well studied.
A 2024 Cochrane review of 60 trials (8,728 people, mostly followed for about 6 months) found that exercise-based rehab probably reduced hospital admissions for any reason (15.9% of people against 23.8%) and improved quality of life by a meaningful amount (moderate-certainty evidence). Home and centre programmes, and cardio alone or with strength work, gave similar results.
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In the Cochrane review, rehab made no clear difference to deaths over the short term (low-certainty evidence). In the largest trial, HF-ACTION (2,331 people with reduced ejection fraction, followed for a median of 30 months), deaths or hospital stays fell only a little, and the difference was significant only after adjusting for other factors.
In HF-ACTION, exercise training was "well-tolerated and safe", and people's own ratings of their health improved a little more than with usual care, and stayed better. But exercise time fell from a median of 95 minutes a week in the early months to 74 minutes by the end of the first year.
In REACH-HF, 216 people (average age 70) given a home programme with support from a trained facilitator had a better quality of life a year later than those with usual care, but no difference in fitness or activity levels.
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In HF-ACTION's 1,053 people with an ICD, shocks were no more common with exercise training than without it (20% against 22%). The authors concluded that exercise "should not be prohibited" for people with heart failure and an ICD.
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In an older review of 9 trials (538 people, mostly with reduced ejection fraction), aerobic training raised ejection fraction by about 2.6 percentage points on average; combined cardio and strength training didn't. That is a small change in a measurement, not a reversal: the BHF says heart failure isn't reversible with exercise.
For reduced ejection fraction, NICE's combination of medicines reduced deaths and hospital stays in trials, and devices such as ICDs help selected people. Exercise adds fewer hospital stays and a better quality of life on top of them, never instead.
Doses are starting points, not prescriptions. Your rehab team's plan comes first.
The BHF describes moderate effort as feeling a bit warmer and breathing a bit more heavily, while still being able to talk. Listen to your body, and don't overdo it on good days, or you may wipe yourself out for the next few. Our zone 2 guide explains the talk test step by step.
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Rehab uses the Borg scale, which rates effort from 6 (no effort at all) to 20 (the hardest you could manage). UK cardiac rehab standards aim for 11 to 14: start near 11 and work up towards 14 over the weeks.
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A few 5 to 10-minute sessions over the day count towards 150 minutes a week. Exercise at the time of day you have most energy: some people need to rest after getting ready in the morning, while others tire later in the day.
REACH-HF asked people to exercise at least 3 times a week, starting from their own level and building up over 2 to 3 months. HF-ACTION started with 15 to 30 minutes of walking or cycling 3 times a week in a supervised class, building to 30 to 35 minutes, then 40 minutes 5 times a week at home.
If your team hasn't given you a plan: in weeks 1 and 2, 2 or 3 short walks or seated sessions a day of 5 to 10 minutes, at a level where you can talk in full sentences, on most days. From weeks 3 to 8, add a few minutes a week until one session reaches 20 to 30 minutes, on at least 3 days a week, with light strength work on 2 days. From 2 to 3 months, keep building towards 150 minutes a week. On a bad day, skip it or do the warm-up and cool-down only.
With a heart condition, the BHF advises a warm-up of at least 15 minutes and a cool-down of at least 10. Slow down gradually at the end, and don't lie down straight after exercise; after seated exercise, do some gentle toe tapping.
If it's too hot or too cold, your heart may be under more strain: do something gentler, such as stretching, instead.
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Start with 5 to 10 minutes at a talking pace, once to three times a day (BHF), and add a few minutes a week towards 20 to 30 minutes on at least 3 days (our editorial starting point). A walk outside counts the same as a treadmill; use the seated march on tired days.
3D demoTreadmill walkingBeginner · Cardio machine
3D demoStationary cyclingBeginner · Cardio machine
3D demoRecumbent exercise bikeBeginner · Cardio machine
3D demoSeated marchBeginner · A bench or box
3D demoStanding marchBeginner · No equipment
3D demoStanding punches (shadow boxing)Beginner · No equipment
3D demoLow step-upBeginner · A stepIn a review of trials in heart failure, resistance training improved leg and arm strength, fitness and walking distance (about 50 m more in 6 minutes) without harming heart function. Where people can't or don't want to do aerobic exercise, the authors say strength training alone is appropriate.
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UK cardiac rehab standards use 2 to 3 sessions a week, at least 48 hours apart: 1 set of 8 to 10 repetitions to start, building to 3 sets, with at least a minute's rest between sets. In plain terms (our suggestion): choose a weight you could lift at least 15 times, and stop at 8 to 10, with plenty left in reserve.
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Use light weights, resistance bands, or unopened food tins or water bottles. Move slowly, breathe out on the effort and never hold your breath. Strength work adds to cardio rather than replacing it, and if you're very weak, working one small muscle group at a time is a safe way to start.
The BHF says avoid lifting heavy weights, holding your breath, and using your whole body as a weight, such as press-ups or planks. Long holds such as the wall sit invite breath-holding too, so rehab leaves them out.
2 to 3 times a week: 1 set of 8 to 10 slow repetitions with a light weight, building to 3 sets, breathing out on the effort (UK cardiac rehab standards). Keep push-ups at the wall and stop lateral raises at shoulder height. In the first 6 weeks after a pacemaker or ICD, leave out the arm moves on that side.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoSit to stand, pushing on the thighsBeginner · A bench or box
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box
3D demoBand rowBeginner · A band + An anchor point
3D demoWall push-upBeginner · A wall
3D demoSeated dumbbell curlBeginner · A dumbbell + A bench or box
3D demoSeated dumbbell lateral raiseBeginner · A dumbbell + A bench or boxWith preserved ejection fraction, trials show exercise improves fitness. How big and how lasting the benefit is remains less certain.
In 8 trials (436 people), exercise raised peak oxygen uptake (the most oxygen your body can use, a measure of fitness) by about 1.7 ml/kg/min and 6-minute walking distance by about 34 m. A 2026 analysis of 15 trials (1,161 people, 63% women) found that combined cardio and strength training, interval training and steady moderate training all improved fitness. None changed ejection fraction or other heart scan measurements.
In the 8 trials, quality-of-life scores improved too, and a 2025 review of 6 supervised training trials found better physical functioning and quality of life.
The largest single trial, OptimEx-Clin (180 people, 67% women), compared 3 months of interval or moderate training with one-off activity advice. Fitness rose a little with both kinds of training, but neither reached the gain the researchers had set as meaningful (2.5 ml/kg/min), and there were no differences at a year. The 2026 analysis used a lower bar for a meaningful gain, but found no clear quality-of-life gain for any type of exercise training. So how big the benefit is remains uncertain.
In trials of 12 weeks or less, people completed 76% to 90% of their sessions, but only 38% at 12 months. Choose something you can keep doing, and build it into your week.
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In 100 older people with obesity and preserved ejection fraction, 20 weeks of exercise and a lower-calorie diet each improved fitness, and together the gains added up. Quality of life didn't change significantly. Our weight loss guide has more.
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Moderate cardio plus light strength work, built up gradually, is the recommended base, as for other types of heart failure. Add harder intervals only once you're used to regular exercise and your team agrees.
The BHF says be careful in the pool, as you can work a lot harder when you're swimming than you realise. European guidance notes concerns about the extra blood returning to the heart in water, though water exercise may be safe for some people. Ask your team first; walking in the shallow end or gentle water exercise is a gentler start than lengths (our suggestion).
In SMARTEX, 261 people with reduced ejection fraction did 12 weeks of supervised hard intervals or moderate training. Intervals were no better for heart size or fitness, half of the interval group trained below their target, and the gains had gone a year later. You don't need intervals to benefit; if you want to try them, do them within rehab or with your team's agreement.
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European sports cardiology guidance advises against high-intensity power and endurance sports with reduced ejection fraction, and says any return to sport should follow a full assessment by your team, once you're stable on treatment.
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Training the breathing muscles with a small hand-held device can improve fitness and breathlessness in heart failure, especially for people who are very deconditioned. It needs the right device and settings, so ask your rehab team rather than starting on your own.
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Slow breathing with no holds suits a cool-down. Leave out breathing patterns with long breath-holds, because the BHF advises against holding your breath when you exercise.
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A build-up of fluid can cause sudden weight gain: as much as 3 kg in 1 or 2 days, the BHF says. The NHS says weigh yourself regularly, and ask for an urgent GP appointment or call NHS 111 if you've suddenly gained weight.
If your doctor or nurse asks you to weigh yourself every day, weigh at the same time each morning, after going to the toilet, in similar clothes, and write it down. Use the weight change your team gives you as the signal to contact them: NICE asks teams to give clear guidance on what to do if things get worse.
Tell your heart failure team if you notice any of these. On those days, don't exercise (our suggestion, following the BHF's advice not to exercise when you're unwell or more breathless than normal).
NICE says not to routinely restrict salt or fluid, but some people are given a fluid limit for a medical reason. If you have one, never change it on your own. When the weather warms up, the BHF says check with your team whether to keep to it, and contact them for sudden weight gain, more swelling or breathlessness, extreme thirst, or feeling dizzy or unwell.
If you take a diuretic such as furosemide, check with your doctor how much you can drink; it's important not to get dehydrated. Peeing less than usual, dark yellow or brown pee, feeling dizzy or light-headed, feeling tired, sunken eyes and confusion are signs of being very dehydrated: call NHS 111.
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On a fluid limit, ask your team how to fit drinks around exercise. In summer, exercise in the cooler part of the day, and stand up slowly after seated or floor exercise (our suggestions).
Never stop or change a heart medicine because you've started exercising. Ask your heart failure nurse, GP or pharmacist.
Beta blockers slow your heartbeat and may make you feel more tired or less energetic. Use the talk test or the Borg scale rather than heart rate. If a beta blocker makes you dizzy, the NHS says not to drive, ride a bike or use machinery until the dizziness stops. Talk to your doctor if you want to change your exercise routine, and don't change your dose yourself.
Ivabradine is a heart-rate-lowering medicine, and digoxin slows your heart rate and makes it beat more strongly. Both mean heart rate targets don't fit: go by how the effort feels. The NHS says don't stop taking digoxin suddenly, as this could make your heart problems worse.
If you want a number, ask your rehab team: they can work out a training heart rate from an exercise test that allows for your medicines. The BHF asks people with a heart condition to check any heart rate target with their team.
If a medicine leaves you dizzy, or too tired to exercise, tell your doctor or heart failure nurse rather than stopping it. Exercise works alongside your medicines, not instead of them.
If you have an ICD or CRT device, exercise is still encouraged: our pacemaker and ICD guide covers the arm limits after it's fitted and what to do after a shock.
Mix these with marching in a warm-up of at least 15 minutes, and hold each stretch for 30 seconds in a cool-down of at least 10. Finish with slow breathing, sitting rather than lying down.
Use these after your rehab assessment, with your team's agreement. The heart failure session has a seated option for every move; the rehab-style session is mostly standing, for better days. Keep push-ups at the wall.
A 40-minute heart failure workout you can do seated or standing: a long, gentle warm-up, cardio mixed with light strength, and a slow cool-down.
40 minBeginner13 movesA bench or box, A wallA 45-minute home session built like a UK cardiac rehab class: a 15-minute warm-up, 20 minutes of cardio mixed with light strength, and a 10-minute cool-down.
45 minBeginner14 movesA wall, A bench or boxA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 10-minute routine for straight after a meal: an easy walk, a few simple standing moves from blood sugar trials, then a short walk to finish.
10 minBeginner6 movesCardio machine, A bench or boxA 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepA walking plan gives structure towards 150 minutes a week once your team agrees. Build up more slowly than the plan if you need to.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner3 days a weekA 12-week exercise plan for over-65s: strength and balance three times a week, short balance sessions and daily walks, based on falls-prevention trials.
3 training days40 minBeginnerA&E means accident and emergency. GTN is glyceryl trinitrate, the spray or tablets used for angina.
Call 999 (911 in the US) if:
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Don't drive yourself to A&E. Sit and rest on the floor with your knees bent and your back supported. Take a 300 mg aspirin if you have one and aren't allergic to aspirin, and use your GTN if you have angina. If someone stops responding and stops breathing, start CPR (cardiopulmonary resuscitation).
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Call 999 or go to A&E if palpitations don't go away, or come with chest pain, shortness of breath, feeling faint or fainting. With a fast or irregular heartbeat, the NHS also lists sweating, feeling or being sick, dizziness, a severe headache, weakness or numbness on one side, blurred vision, and confusion or difficulty speaking as reasons to call 999. If palpitations have stopped, ask for an urgent GP appointment or call NHS 111.
Call 999 if someone has fainted while exercising, or while lying down. After any other faint, see a GP.
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Stop if you get palpitations (your heart pounding or skipping a beat), extreme shortness of breath or light-headedness, and stop if you run out of energy. The BHF says stop immediately and contact your GP if you feel unwell, very short of breath, or get chest pain, dizziness or palpitations while exercising. Call 999 for the signs above.
Your heart failure nurse or team first, then your GP or rehab team. The BHF Heart Helpline (0808 802 1234, Monday to Friday, 9am to 5pm) answers questions, and the NHS links to the heart failure charity Pumping Marvellous for more information.
That was the old advice. The BHF says keeping active is now known to improve symptoms and quality of life, and in trials, rehab probably cut hospital admissions (15.9% of people against 23.8%).
The BHF says heart failure can't be cured and isn't reversible with exercise. Aerobic training raised ejection fraction by only about 2.6 percentage points on average in older trials. Your medicines carry the evidence for living longer: keep taking them.
With preserved ejection fraction, exercise improved fitness and walking distance in trials without changing heart scan measurements, because it works on the muscles and blood vessels. How big the gains are is less certain.
Light resistance training improved strength, fitness and walking distance without harming heart function in trials. Keep it light, breathe out on the effort, and avoid heavy weights, breath-holding, press-ups and planks.
The BHF says take care in the pool, because you can work much harder when swimming than you realise, and European guidance notes concerns about water exercise. Ask your team first; walking and cycling are easier to pace.
In SMARTEX (261 people), intervals were no better than moderate training, and half the group didn't reach their interval target. With preserved ejection fraction (180 people), neither intervals nor moderate training beat simple advice by the amount the researchers had set as meaningful.
In heart failure, sudden weight gain is often fluid, as much as 3 kg in 1 or 2 days, and needs your team or an urgent GP appointment.
For most people, yes, once your doctor or heart failure team agrees: keeping active improves symptoms and quality of life, and people used to be told to rest. In the largest trial, exercise training was well tolerated and safe. Start with cardiac rehab if you can, and don't exercise on days you feel unwell or more breathless than normal.
Walking or cycling at a moderate effort, where you're breathing harder but can still hold a conversation, plus light strength work with bands or light weights. Seated exercise counts too: a UK home trial let people choose a chair-based programme or walking. The best one is the one you'll do regularly.
Start with 5 to 10-minute sessions, a few times a day if you like, and build up gradually towards 150 minutes a week. Trials built up over 2 to 3 months to at least 3 sessions a week. Your rehab team will set your level.
The British Heart Foundation says avoid lifting heavy weights, holding your breath, and using your whole body as a weight, such as press-ups or planks, and take care in the pool. European guidance advises against high-intensity power and endurance sports with reduced ejection fraction. Check with your team before anything new or harder.
No: heart failure can't be cured and isn't reversible with exercise. In older trials, aerobic training raised ejection fraction by only about 2.6 percentage points on average, and it didn't change it in preserved ejection fraction. Exercise helps your muscles, lungs and blood vessels work better, so everyday life gets easier.
Pooled trials found it improved fitness, walking distance and quality of life. The largest single trial found only small gains over simple activity advice, short of what its researchers counted as meaningful, so how big the benefit is remains uncertain. Moderate cardio plus light strength work is the recommended base, with weight loss if you're overweight.
Light resistance training is safe and improved strength, fitness and walking distance in trials. Use light weights, bands or tins for 8 to 10 slow repetitions, breathing out on the effort, and avoid heavy weights and breath-holding. Check with your team first.
Ask your team first: the British Heart Foundation warns that you can work a lot harder when you're swimming than you realise. European guidance notes concerns about the extra blood returning to the heart in water, though water exercise may be safe for some people. Walking and cycling are easier to pace.
Not that day: sudden weight gain, more swelling or more breathlessness can mean fluid is building up. Contact your heart failure team, or ask for an urgent GP appointment or call NHS 111 if you've suddenly gained weight.
Go by how it feels rather than a number: beta blockers, ivabradine and digoxin slow the heart, so formulas don't fit. Use the talk test or the Borg scale, or a training heart rate your rehab team works out from an exercise test.
You don't need it: in a trial of 261 people, intervals were no better than moderate training. If you want to try them, do them within rehab or with your team's agreement.
NICE says it should be offered to everyone with heart failure, at home, in the community or in hospital. Only about 1 in 6 eligible people in England start it, so ask your GP, cardiologist or heart failure nurse to refer you. The British Heart Foundation's Heart Helpline (0808 802 1234) can help.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
