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URL: http://www.clinicaltrials.gov. Unique identifier: NCT03058120.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to the novel coronavirus disease 2019 (COVID-19) pandemic was first reported in Wuhan, Hubei Province, China. 1 The first cases emerged in late December 2019 rapidly spreading throughout China and beyond, leading to increasing rates of morbidity and mortality worldwide. 2 SARS-CoV-2 is the seventh member of the coronaviruses family that is known to infect humans. 1 As of May 24, 2020, the number of cases exceeds 5 million worldwide accounting for over 337,000 deaths. 3 The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) reported in April 2020 that approximately 92% of hospitalized patients with COVID-19 had at least one co-morbid condition. The most common associated conditions with COVID-19 among hospitalized patients are hypertension, obesity, and underlying cardiovascular disease. 4 Chronic immunosuppression accounts for approximately 10% of the patients hospitalized. Given the state

Exercise cardiac rehabilitation (CR) represents an evidence-based therapy for patients with heart failure with reduced ejection fraction (HFrEF) and this article provides a concise review of the relevant exercise testing and CR literature, including aspects unique to their care. Clinical Considerations: A hallmark feature of HFrEF is exercise intolerance (eg, early-onset fatigue). Drug therapies for HFrEF target neurohormonal pathways to blunt negative remodeling of the cardiac architecture and restore favorable loading conditions. Guideline drug therapy includes β-adrenergic blocking agents; blockade of the renin-angiotensin system; aldosterone antagonism; sodium-glucose cotransport inhibition; and diuretics, as needed. Exercise Testing and Training: Various assessments are used to quantify exercise capacity in patients with HFrEF, including peak oxygen uptake measured during an exercise test and 6-min walk distance. The mechanisms responsible for the exercise intolerance include abnormalities in (a) central transport (chronotropic response, stroke volume) and (b) the diffusion/ utilization of oxygen in skeletal muscles. Cardiac rehabilitation improves exercise capacity, intermediate physiologic measures (eg, endothelial function and sympathetic nervous system activity), health-related quality of life (HRQoL), and likely clinical outcomes. The prescription of exercise in patients with HFrEF is generally similar to that for other patients with cardiovascular disease; however, patients having undergone an advanced surgical therapy do present with features that require attention. Summary: Few patients with HFrEF enroll in CR and as such, many miss the derived benefits, including improved exercise capacity, a likely reduction in risk for subsequent clinical events (eg, rehospitalization), improved HRQoL, and adoption of disease management strategies.