Chronic Heart Failure Rehabilitation: Diaphragm Training Needs More Attention

Bordoni, Bruno; Morabito, Bruno; Myftari, Vincenzo; D’Amato, Andrea; Severino, Paolo

doi:10.3390/jcm14165624

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Chronic Heart Failure Rehabilitation: Diaphragm Training Needs More Attention

by

Bruno Bordoni

¹

,

Bruno Morabito

²

,

Vincenzo Myftari

³,

Andrea D’Amato

^3,*

and

Paolo Severino

^3,*

¹

Department of Cardiopneumology, Fondazione Don Carlo Gnocchi Onlus IRCCS, 20121 Milano, Italy

²

Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy

³

Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale Del Policlinico 155, 00161 Rome, Italy

^*

Authors to whom correspondence should be addressed.

J. Clin. Med. 2025, 14(16), 5624; https://doi.org/10.3390/jcm14165624

Submission received: 11 June 2025 / Revised: 2 August 2025 / Accepted: 4 August 2025 / Published: 8 August 2025

(This article belongs to the Special Issue Clinical Challenges in Heart Failure Management)

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Abstract

Background: Chronic heart failure (HF) is a systemic condition in which the heart is unable to meet the body’s peripheral demands, leading to both acute and chronic functional decline, accompanied by high morbidity and mortality rates. A non-pharmacological, non-surgical standard approach to managing HF is cardiovascular rehabilitation, which is widely endorsed by international cardiology societies. This typically includes aerobic and anaerobic physical activity involving the peripheral skeletal muscles. However, international guidelines often overlook the clinical significance of the diaphragm and the role of inspiratory muscle training (IMT) in rehabilitation. The diaphragm plays a critical role not only in respiratory and cardiac function but also in supporting limb movements and overall physical performance. In patients with HF, diaphragmatic dysfunction contributes significantly to the symptoms they experience. Conclusions: This review highlights the need for a greater emphasis on incorporating IMT into the standard rehabilitation protocols for patients with HF, given its potential to improve both respiratory function and overall physical capacity.

Keywords: heart failure; rehabilitation; physiotherapy; diaphragm; inspiratory muscle training; American Heart Association; American College of Cardiology; Heart Failure Society of America; European Society of Cardiology

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MDPI and ACS Style

Bordoni, B.; Morabito, B.; Myftari, V.; D’Amato, A.; Severino, P. Chronic Heart Failure Rehabilitation: Diaphragm Training Needs More Attention. J. Clin. Med. 2025, 14, 5624. https://doi.org/10.3390/jcm14165624

AMA Style

Bordoni B, Morabito B, Myftari V, D’Amato A, Severino P. Chronic Heart Failure Rehabilitation: Diaphragm Training Needs More Attention. Journal of Clinical Medicine. 2025; 14(16):5624. https://doi.org/10.3390/jcm14165624

Chicago/Turabian Style

Bordoni, Bruno, Bruno Morabito, Vincenzo Myftari, Andrea D’Amato, and Paolo Severino. 2025. "Chronic Heart Failure Rehabilitation: Diaphragm Training Needs More Attention" Journal of Clinical Medicine 14, no. 16: 5624. https://doi.org/10.3390/jcm14165624

APA Style

Bordoni, B., Morabito, B., Myftari, V., D’Amato, A., & Severino, P. (2025). Chronic Heart Failure Rehabilitation: Diaphragm Training Needs More Attention. Journal of Clinical Medicine, 14(16), 5624. https://doi.org/10.3390/jcm14165624

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

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