**6.3 Life coordination for HF and living meaningfully**

In the stable period, excessive rest causes a decrease in exercise capacity and exacerbates fatigue and dyspnea during exertion, so moderate exercise increases exercise capacity, and it has been clarified that it leads to improvement of symptoms and improvement of QOL [5]. Appropriate exercise tolerance, evaluation of activities of daily living, and correction of physical activity and living behavior in consideration of physical function and living environment for each heart failure patient are required. **Table 6** shows the viewpoint of assessment of lifestyle and life circumstance.

### **6.4 Evaluation of exercise tolerance**

Specific activity scale (SAS) specifies the metabolic equivalents (METs) for each physical activity, and it is possible to estimate the physical activity level from the


#### **Table 6.**

*Assessment of lifestyle and life circumstance.*


Ask questions about the following items and ask them to answer either "yes" or "no." The amount of exercise (METs) of the item for which the answer "no" appears for the first time is used as an index of the minimum amount of exercise in which symptoms appear

#### **Table 7.**

*SAS, METs, and the NYHA classification.*

questionnaire [18]. METs are often used in clinical practice as a simple indicator of exercise intensity. NYHA classification is classified according to the degree of restriction of daily activities, and this classification is widely used for heart disease, especially in the stable period of HF. Its usefulness is high, and many reports have been made regarding its association with exercise tolerance and prognosis. The NYHA classification is simple and useful, but the content of the activity that is the basis of judgment is not clear, so SAS was developed to supplement it. SAS has tested the reproducibility and validity of the NYHA classification and METs. It is said to be more closely related to exercise tolerance and prognosis than the NYHA classification [19]. Physical activity that triggers the onset of HF symptoms is quantified by METs. **Table 7** shows the correspondence table between SAS, METs and NYHA classification [19].
