The regulatory role of exercise in heart failure and myocardial energy metabolism: A review

Yuanhao Li; Dongli Gao; Peixia Li; Xulei Duan; Youli Liu; Chengyan Wu; Libo Wang; Xuehui Wang

doi:10.17305/bb.2025.12072

Authors

Yuanhao Li The First Affiliated Hospital of Xinxiang Medical University, Department of Cardiology, Xinxiang, Henan, China
Dongli Gao The First Affiliated Hospital of Xinxiang Medical University, Department of Cardiology, Xinxiang, Henan, China
Peixia Li The First Affiliated Hospital of Xinxiang Medical University, Department of Cardiology, Xinxiang, Henan, China
Xulei Duan The First Affiliated Hospital of Xinxiang Medical University, Department of Cardiology, Xinxiang, Henan, China
Youli Liu The First Affiliated Hospital of Xinxiang Medical University, Department of Cardiology, Xinxiang, Henan, China
Chengyan Wu The Third Affiliated Hospital of Xinxiang Medical University, Department of Cardiology, Xinxiang, Henan, China
Libo Wang The First Affiliated Hospital of Xinxiang Medical University, Department of Cardiology, Xinxiang, Henan, China
Xuehui Wang The First Affiliated Hospital of Xinxiang Medical University, Department of Cardiology, Xinxiang, Henan, China https://orcid.org/0009-0006-0675-8367

DOI:

https://doi.org/10.17305/bb.2025.12072

Keywords:

Exercise, heart failure, HF, metabolism, mitochondria, cardiac remodeling, cardiac rehabilitation

Abstract

Myocardial energy metabolism is crucial for maintaining optimal heart function. The heart, having limited energy storage capacity, is dependent on a continuous energy supply; any disruptions or alterations in energy metabolism pathways can lead to insufficient myocardial energy, potentially triggering heart failure (HF). Exercise, as a safe and economical non-pharmacological intervention, is widely recognized to enhance cardiovascular health and modify myocardial energy metabolism patterns. However, the specific mechanisms by which exercise regulates myocardial metabolism to prevent and treat HF remain unclear. This review aims to detail the characteristics of myocardial metabolism under normal physiological and HF conditions, to further explore the impact of different exercise modalities on myocardial metabolism, and to summarize the molecular mechanisms by which exercise protects the heart by optimizing myocardial energy metabolism. Ultimately, this article aims to provide an in-depth understanding and evidence for the application of exercise interventions in cardiac rehabilitation.