Cardiac Rehabilitation for Heart Failure With Preserved Ejection Fraction: A Narrative Review of the Benefits and Challenges.

Heart failure with preserved ejection fraction (HFpEF) is an increasingly global health problem with high morbidity and mortality, complicated by heterogeneous pathophysiology and widespread comorbidities. Although pharmacotherapy has some benefits, non-pharmacological approaches, particularly cardiac rehabilitation (CR), play a crucial role in managing cardiovascular disease. This narrative review critically evaluates the therapeutic potential of CR in HFpEF, focusing on its impact on functional capacity, diastolic function, health-related quality of life, and the challenges associated with its implementation. We synthesize current understanding of HFpEF pathophysiology and exercise intolerance, detail the components of modern CR programs, and discuss exercise training modalities, including aerobic, resistance, and varied-intensity protocols. Evidence indicates that CR, particularly supervised exercise training, consistently improves peak oxygen uptake, functional capacity, and quality of life, with a strong safety profile. However, its effects on diastolic function are less consistent. Significant barriers to CR uptake and adherence remain. Future research should prioritize large, well-designed trials to optimize CR protocols, tailor interventions to specific HFpEF phenotypes, and develop practical strategies to overcome implementation barriers. Clinically, broader integration of comprehensive CR into standard HFpEF care is recommended, supported by policy measures to improve access and resource availability for these essential programs.