Question explored with the scientific record
How does one increase their ejection fraction naturally?
The short version: aerobic exercise can raise a low ejection fraction by a meaningful amount, but the evidence is almost entirely in people with heart failure, and the effect takes months of consistent training.
The evidence for raising ejection fraction naturally comes almost entirely from exercise studies in people with established heart failure. A 2007 meta-analysis found that aerobic training raised ejection fraction by about 2.6 percentage points (95% CI 1.4 to 3.7) in heart failure patients, while combined aerobic and strength training showed no significant effect [1]. A 2016 study of patients with advanced heart failure (baseline EF 24%) found that after 12 months of exercise, EF rose to 38% — a gain of about 14 points [3]. A 2015 study of cardiopulmonary rehabilitation in systolic heart failure patients (baseline EF 33%) reported an increase to 38% after the program [6]. These are real improvements, but they come from supervised, long-term programs, not casual activity.
The evidence is thin for people without heart failure. A 1982 study of 11 men who had a heart attack 6 weeks to 6 months earlier found that 6 months of exercise training improved exercise capacity but did not change resting or exercise ejection fraction [4]. A 2003 study in advanced heart failure found that 4 months of exercise training improved peak oxygen uptake and reduced sympathetic nerve activity but did not change EF at all [2]. A 2025 study of healthy resistance-trained athletes found no difference in ejection fraction compared to untrained men [5]. So the EF improvement seems to depend on how low the starting EF is and how long the training continues.
Weight loss and dietary changes are often recommended alongside exercise, but the evidence here does not directly test whether they raise ejection fraction. The studies on weight loss in this retrieval focus on insulin sensitivity, inflammation, and metabolic markers [7, 8, 9, 10, 11], not on EF. One study of a sodium-restricted DASH diet in heart failure patients with preserved EF actually found a decline in kidney function [12], which is a reminder that dietary interventions can have unintended effects.
The funding picture matters. None of the exercise studies here were funded by a drug manufacturer, which is unusual and actually strengthens the evidence. The 2007 meta-analysis [1], the 2016 long-term training study [3], and the 2015 rehabilitation study [6] all appear to be academic or clinically funded work. That is a genuine positive: the evidence for exercise improving EF is not tainted by the profit motive that corrupts most pharmaceutical research.
The key limitation is that almost all of this evidence comes from people with diagnosed heart failure. If you have a normal or near-normal EF (above 50%), the evidence does not show that exercise will raise it further. If you have a low EF from heart failure, the evidence is reasonably good that sustained aerobic training — at least 3 to 5 sessions per week for 6 to 12 months — can produce a meaningful improvement, often in the range of 5 to 14 percentage points.
My call: for someone with a low ejection fraction from heart failure, sustained aerobic exercise is the most evidence-backed natural intervention, with moderate confidence from multiple studies. For someone with a normal EF, the evidence does not show a benefit. The confidence is moderate overall because the studies are mostly small, the effect varies widely by starting EF and training duration, and the long-term durability of the improvement is not well studied.
Sources used 12
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A Meta-Analysis of the Effect of Exercise Training on Left Ventricular Remodeling in Heart Failure Patients
This meta-analysis investigates the effects of different types of exercise training on left ventricular remodeling in heart failure patients, concluding that aerobic training significantly improves ejection fraction and reduces left ventricular volumes, while combined aerobic an…
DOI: 10.1016/j.jacc.2007.02.055 -
The effects of exercise training on sympathetic neural activation in advanced heart failure
In a randomized controlled trial of adults with advanced heart failure, four months of supervised exercise markedly reduced resting muscle sympathetic nerve activity (MSNA) and improved peripheral and aerobic function without changing left ventricular ejection fraction, suggesti…
DOI: 10.1016/s0735-1097(03)00831-3 -
Long-Term Exercise Training in Patients With Advanced Chronic Heart Failure
This study investigates the long-term effects of exercise training over 12 months on left ventricular performance and exercise capacity in patients with advanced chronic heart failure, demonstrating significant improvements in both metrics.
DOI: 10.1097/hcr.0000000000000165 -
Effects of exercise training on ventricular function in patients with recent myocardial infarction.
A prospective 6-month exercise training trial in 15 patients recently hospitalized for myocardial infarction found that training markedly improved exercise capacity and reduced submaximal heart rate and weight/cholesterol, but left ventricular function at rest and at matched exe…
DOI: 10.1161/01.cir.66.1.100 -
Cardiac structure and systolic function in resistance-trained athletes versus untrained male adults
Male resistance-trained athletes showed greater left ventricular wall thickness and mass than untrained men, differences persisting after body-composition indexing, with no significant differences in ejection fraction or global longitudinal strain, though chamber volumes and dia…
DOI: 10.1007/s00421-025-06060-1 -
Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular‐Arterial Coupling in Patients With Systolic Heart Failure
This study investigates the effects of cardiopulmonary exercise rehabilitation on left ventricular mechanical efficiency and ventricular-arterial coupling in patients with systolic heart failure, finding significant improvements in both metrics post-rehabilitation.
DOI: 10.1161/jaha.115.002084 -
Effect of Progressive Weight Loss on Lactate Metabolism: A Randomized Controlled Trial
This study investigates the relationship between glucose kinetics and plasma lactate concentration in individuals with obesity, demonstrating that progressive weight loss improves insulin sensitivity and reduces lactate levels, suggesting lactate as a potential biomarker for ins…
DOI: 10.1002/oby.22129 -
Enhanced insulin sensitivity in successful, long-term weight loss maintainers compared with matched controls with no weight loss history
This study investigates the impact of long-term weight loss maintenance on insulin sensitivity in women, revealing that successful weight loss maintainers exhibit significantly enhanced insulin sensitivity compared to matched controls with no weight loss history.
DOI: 10.1038/nutd.2017.31 -
Circulating omentin concentration increases after weight loss
The study demonstrates that weight loss-induced improvement in insulin sensitivity in obese humans is accompanied by a significant rise in circulating omentin-1, suggesting omentin-1 responds positively to metabolic improvements from weight reduction.
DOI: 10.1186/1743-7075-7-27 -
Study on the Correlation between Metabolism, Insulin Sensitivity and progressive weight loss change in Type-2 Diabetes
In obese adults with Type 2 diabetes, progressive weight loss leads to improved lipid metabolism, better glycemic control, and enhanced insulin sensitivity, most notably at 15% body weight reduction.
DOI: 10.12669/pjms.36.7.3027 -
Regulation of adiponectin by adipose tissue-derived cytokines: in vivo and in vitro investigations in humans
The study demonstrates that diet-induced weight loss increases adiponectin levels and adiponectin mRNA in subcutaneous adipose tissue in humans, that adiponectin is inversely related to proinflammatory cytokines (notably IL-6), and that IL-6 plus its soluble receptor and TNF-α c…
DOI: 10.1152/ajpendo.00110.2003 -
SODIUM-RESTRICTED DIETARY APPROACHES TO STOP HYPERTENSION DIET INCREASES EARLY MARKERS OF RENAL TUBULAR INJURY IN HYPERTENSIVE HEART FAILURE WITH PRESERVED EJECTION FRACTION
This study investigates the effects of a sodium-restricted Dietary Approaches to Stop Hypertension (DASH/SRD) diet on renal function in patients with hypertensive heart failure with preserved ejection fraction (HFPEF), finding that it leads to increased urinary markers of renal …
DOI: 10.1016/s0735-1097(14)60939-6