We recommend that gradual mobilization and/or small muscle group strength/flexibility exercises be considered as soon as possible either alone or in combination for patients with NYHA class IV symptoms or recently decompensated HF. This should be considered only in consultation with an experienced HF team.
(Strong Recommendation, Low-Quality Evidence)

Values and preferences: This recommendation places high value on initiating mobilization and therapy early (even if only limited exercises are prescribed) to prevent further decline of muscle function, improve function during day-to-day activities, and provide a baseline from which to add further exercise modalities.

Practical tip: Selected patients might benefit from limited exercise therapy, such as lower extremity or inspiratory muscle strengthening, directed toward alleviating symptoms of muscle fatigue.