BOOST: Blended Onsite and Offsite Structured Exercise Training and Coaching

Prior treatment

• Significant change in cardiac medication or heart failure (HF) symptoms within 3 weeks prior to enrollment
• Hospitalization or urgent care visit for HF within 4 weeks prior to enrollment
• Acute coronary syndrome, stroke, transient ischemic attack; cardiac, carotid or other major Cardiac Vascular (CV) surgery; percutaneous coronary intervention (PCI) or carotid angioplasty, within 30 days prior to enrolment
• Patients with a history of heart transplant or Left Ventricular Assist Device (LVAD), currently on the transplant list
• Already engaging in regular moderate to vigorous exercise conditioning defined as \>30 minutes per day, ≥twice per week consistently during the previous 6 weeks

Other illness

• Uncontrolled hypertension
• Recent or debilitating stroke
• Severe pulmonary disease including chronic obstructive pulmonary disease (COPD)
• Significant, unrepaired cardiac valvular disease
• A non-cardiac medical condition with an estimated life expectancy of \< 12 months
• Known pericardial constriction, genetic hypertrophic cardiomyopathy, or infiltrative cardiomyopathy including amyloid heart disease (amyloidosis)
• Any condition that in the judgement of the investigator precludes participation in study or study procedures such as significant dementia, mobility impairment, uncontrolled psychiatric disease, etc.

Lab values

• Hemoglobin (Hgb) \< 9.5 g/dL males and \< 9 g/dL females within 30 days prior to enrollment

Other

• Life-threatening or uncontrolled dysrhythmia, including symptomatic or sustained ventricular tachycardia and atrial fibrillation or flutter
• A treadmill exercise test revealing: ischemia; chest pain or leg claudication; exercise Systolic Blood Pressure \> 240 mmHg, Diastolic Blood Pressure \> 110 mmHg; unstable hemodynamics or rhythm; or unwilling or unable to complete adequate exercise test
• Inability to meet the expectations of the intervention (i.e., excessive distance from facility, work conflict with intervention)

• Diagnosis of heart failure with signs and symptoms of heart failure and at least one of the following: Evidence of increased LV filling pressures at rest, exercise, or other provocations / Prior HF hospitalization / Elevated heart Failure with Preserved Ejection Fraction (H2FPEF) score or elevated Heart Failure Association-Pre-test, Echocardiography \& natriuretic peptide, Functional testing, Final etiology (HFA-PEFF) score
• Left ventricular ejection fraction ≥ 50%
• New York Heart Association (NYHA) functional class II-IV
• Age ≥ 55 years old