# Exercise Testing and Physical Activity in Dogs: From Health to Heart Disease

## TL;DR

This paper reviews how exercise can be used in diagnosing and managing heart disease in dogs, showing it can improve quality of life and slow disease progression.

## Contribution

The paper compiles veterinary studies to propose structured exercise protocols for dogs with heart failure and highlights the need for standardized methods.

## Key findings

- Exercise training can slow heart disease progression in dogs by modulating sympathetic activity and preserving cardiac function.
- The 6 min walk test and treadmill protocols are useful for assessing functional capacity and monitoring treatment responses.
- Exercise improves functional class and quality of life in dogs with heart failure, despite risks like syncope.

## Abstract

Physical exercise is a well-established supportive therapy in human cardiology, but its use in veterinary cardiology, particularly in dogs with congestive heart failure, remains underexplored. This review compiles existing veterinary studies to provide a basis for the clinical use of exercise in diagnosis, for prognosis, and as a complementary treatment (exercise training). Two main exercise tests have been evaluated: the 6 min walk test, which offers a simple and practical way to assess functional capacity, and treadmill-based protocols, including stepwise or workload tests, which can be paired with biomarkers to monitor therapeutic responses. While exercise training does not reverse myocardial damage, it appears to slow disease progression by modulating sympathetic activity, preserving cardiac function, and improving functional status and quality of life in affected dogs. Improvements in clinical signs and activity tolerance have been reported, which are meaningful outcomes for both clinicians and owners. Although adverse events such as syncope or worsening of clinical signs can occur, especially in advanced cases, the overall risk–benefit profile supports the careful integration of exercise training into case management. This review emphasizes the clinical potential of structured physical activity and underlines the need for further research to standardize protocols and evaluate long-term effects in canine heart failure.

The utility of physical exercise in congestive heart failure is not yet well known in the field of veterinary cardiology, despite many studies already published, unlike in human medicine where the benefits and safety of exercise training have been widely proven and included in recommendations and consensus. Several studies have been conducted since the end of the 20th century, evaluating the usefulness of physical exercise in the diagnosis, prognosis, as well as the treatment of congestive heart failure in dogs. The information from these studies has been compiled in this work to conduct a literature review and propose a work base, information, and protocols to develop knowledge about the effect of exercise training on congestive heart failure for future clinical research in dogs. Two major types of exercise tests have been published: the 6 min walk test, easy to implement and seemingly better at reflecting the daily physical capacities of cardiac dogs, and treadmill tests, such as the ergometric test or incremental tests, which, combined with the measurement of plasma concentration of NT-proBNP (N-terminal pro B-type natriuretic peptide), are promising for prognostic evaluation and monitoring of conventional drug therapy. An exercise training program does not reverse the damage caused by congestive heart failure but can help delay and slow the progression of the disease, essentially having effects on heart rate and sympathetic modulation of cardiac activity and preserving cardiac function. Additionally, an improvement in the functional class of heart failure and quality of life due to physical exercise has been observed, a key point for owners. Even though there are risks associated with this complementary therapy (syncope or risk of exacerbating symptoms of cardiac pathologies), the risk–benefit balance seems to clearly favor the use of exercise when used in a controlled manner in stable patients. Evidence of the utility of physical exercise as a testing method or as a complementary treatment has been gathered in this review. However, to further develop the clinical practice of exercise, additional studies need to be conducted to develop standardized testing methods, clarify the impact of exercise training programs on all classes of heart failure, assess the risks, and analyze the long-term effects on canine species.