Sarcopenia affects about one-quarter of ambulatory heart failure patients and contributes to reduced activity tolerance, impaired cardiac function, and poor prognosis. The 2025 European Society of Cardiology (ESC) Heart Failure Guidelines recommend resistance training to preserve muscle mass and functional capacity in this population.

In a pilot randomized controlled trial, 58 patients with heart failure and sarcopenia were assigned to a 14-week elastic band–based progressive resistance training (EB-PRT) program or usual care. The program incorporated principles of specificity, overload, and progression and was delivered through hybrid in-person, telehealth, and video-based sessions. Outcomes included appendicular skeletal muscle index, grip strength, physical performance, heart failure symptoms, and health-related quality of life measured at baseline, week 14, and week 26.

Compared with usual care, the EB-PRT group achieved significant improvement in heart failure symptoms (MSAS-HF β = –19.55; p = 0.002) and quality of life (MLHFQ β = –6.17; p = 0.031) at 14 weeks. Trends toward enhanced muscle mass and performance were also observed, with medium effect sizes across several measures. These findings suggest that elastic band–based resistance training is feasible and may enhance symptom control and quality of life in patients with heart failure and sarcopenia, supporting the need for larger, mechanistic trials.