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Background Heart failure with reduced ejection fraction (HFrEF) is characterized by diminished cardiac output and limited exercise tolerance.Cardiac rehabilitation (CR) is central to optimising outcomes in HFrEF, but conventional programmes may not fully address individualised lifestyle and psychological needs. Evidence on the feasibility and physiological impact of long-term, high-volume exercise in this population remains scarce, particularly related to preparation for recreational endurance events.Aim To assess how a prolonged, supervised, high-volume aerobic exercise programme, including race-specific preparation, affects haemodynamic and cardiopulmonary function in a male patient with HFrEF.Methods A single-patient, prospective case study was conducted over 15 months involving a 61-year-old man with ischaemic HFrEF (baseline ejection fraction [EF]: 32%).The intervention consisted of a structured hybrid aerobic and resistance exercise programme totalling 328 hours, averaging over 300 minutes/week. Training included moderate-intensity continuous aerobic sessions (cycling and treadmill walking/running) supplemented by supervised resistance exercises for major muscle groups, with additional race-specific preparation involving graded long runs, pacing drills, and interval sessions in the final 6 months. Echocardiography (measuring EF, stroke volume, and cardiac output) and comprehensive cardiopulmonary exercise testing (CPET: VO2max, anaerobic threshold [AT], ventilatory efficiency [VE/VCO2slope], oxygen pulse) were performed at baseline (January 2024) and at 15-month follow-up (April 2025).Physical activity and heart rate were monitored continuously using a Garmin wearable.Results Clinically meaningful improvements were observed following the intervention. All variables demonstrated clinically meaningful improvement after the intervention ( table 1).Abstract P36 Table 1A summary of the baseline and follow up outcomes for the case study patient including percentage changes Parameter Baseline (Jan 2024) Follow up (April 2025) Percentage change Ejection Fraction (EF ) % 32 42 +31% Stroke Volume (SV ) mL 48 60 +25% Cardiac Output (CO ) L/min 3.8 5.1 +34% VO2 max mL/kg/min 14.2 19.1 +35% AT advanced from 54% to 67% of predicted maximum—demonstrating significantly enhanced aerobic capacity and exercise tolerance.These percentage changes are consistent with, or exceed, those reported for established CR interventions in HFrEF populations as described in the literature. No adverse events or exercise-related complications were observed, supporting the safety and feasibility of this high-volume approach.Conclusion This single-patient case study demonstrates that carefully monitored, high-volume aerobic training—including a dedicated ‘recreational race preparation’—can lead to clinically significant improvements in central haemodynamic and aerobic capacity in an individual with HFrEF. Larger studies are warranted to confirm these findings and to explore wider applicability.