Nazir A. Isolated knee extension resistance training and functional outcomes in patients with heart failure: A narrative review. World J Cardiol 2026; 18(6): 119751 [DOI: 10.4330/wjc.119751]
Corresponding Author of This Article
Arnengsih Nazir, MD, PhD, Academic Fellow, Assistant Professor, Department of Cardiovascular, Dr. Hasan Sadikin General Hospital, No. 38 Jalan Pasteur, Bandung 40161, West Java, Indonesia. arnengsih@unpad.ac.id
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Cardiac & Cardiovascular Systems
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review-article
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Nazir A. Isolated knee extension resistance training and functional outcomes in patients with heart failure: A narrative review. World J Cardiol 2026; 18(6): 119751 [DOI: 10.4330/wjc.119751]
World J Cardiol. Jun 26, 2026; 18(6): 119751 Published online Jun 26, 2026. doi: 10.4330/wjc.119751
Isolated knee extension resistance training and functional outcomes in patients with heart failure: A narrative review
Arnengsih Nazir
Arnengsih Nazir, Department of Cardiovascular, Dr. Hasan Sadikin General Hospital, Bandung 40161, West Java, Indonesia
Arnengsih Nazir, Department of Physical and Rehabilitation Medicine, Faculty of Medicine Universitas Padjadjaran, Bandung 40161, West Java, Indonesia
Author contributions: Nazir A contributed to all manuscript processes.
AI contribution statement: Grammarly was used for grammar polishing of both the manuscript and the answering reviewers’ comments. In addition, ChatGPT was used to support translation from Indonesian to English, literature searching, paraphrasing, and table editing. The main sections of the manuscript (abstract, introduction, methods, results, discussion, and conclusion) were not generated by AI. AI tools were not used for data analysis nor for writing the scientific content of the manuscript. AI tools were not involved in the study design or in the interpretation of the results. All figures in the manuscript are the original work of the authors and were not generated by AI. Two tables included in the manuscript are also original, with AI assistance limited to editing only. The authors take full responsibility for the content and accuracy of the manuscript.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Corresponding author: Arnengsih Nazir, MD, PhD, Academic Fellow, Assistant Professor, Department of Cardiovascular, Dr. Hasan Sadikin General Hospital, No. 38 Jalan Pasteur, Bandung 40161, West Java, Indonesia. arnengsih@unpad.ac.id
Received: February 5, 2026 Revised: February 19, 2026 Accepted: May 12, 2026 Published online: June 26, 2026 Processing time: 134 Days and 4.2 Hours
Abstract
Heart failure is a major global health problem resulting in reduced exercise tolerance, functional capacity, and health-related quality of life (HRQoL). In addition to central cardiac dysfunction, peripheral skeletal muscle abnormalities, particularly involving the knee extensors, substantially contribute to physical limitation. This narrative review synthesizes current evidence regarding the effects of isolated knee extension resistance training (KERT) on muscle strength, exercise tolerance, and HRQoL in patients with chronic heart failure. A comprehensive but non-systematic search of PubMed, Scopus, and Google Scholar was conducted to identify English-language clinical studies evaluating isolated or predominantly knee extensor-based resistance training with relevant functional outcomes. Evidence indicates that isolated KERT is a safe and clinically meaningful intervention that consistently improves muscle strength and submaximal functional capacity, primarily through peripheral adaptations such as enhanced metabolic efficiency and reduced symptom burden during daily activities. However, substantial heterogeneity in training protocols may partly explain variability in reported outcomes. Changes in peak oxygen uptake are inconsistent, reflecting the specificity of local muscular adaptations. Improvements in HRQoL, particularly in physical functioning domains, are frequently reported. Overall, isolated KERT represents a valuable complementary component of cardiac rehabilitation programs, although further research is needed to optimize protocols and determine long-term effects.
Core Tip: In heart failure, exercise intolerance is caused not only by cardiac dysfunction but also by skeletal muscle dysfunction characterized by atrophy, decreased strength, and impaired muscle metabolism. This condition directly contributes to low peripheral muscle fitness, decreased exercise tolerance, and impaired quality of life. Knee extensor resistance training is an important intervention because it specifically targets the key muscle group involved in daily functional activities. Knee extensor resistance training has been shown to increase muscle strength and endurance, improve oxygen utilization efficiency during activity, and reduce fatigue, thus positively impacting functional activities and quality of life in heart failure patients.
