## 4 Discussion
This finding has important implications for real-world clinical settings, where patient adherence may differ, highlighting the potential for this intervention to provide significant benefits across diverse patient populations. Our study revealed that both HIIT and CE had positive effects on key functional parameters, such as cadence, HRmax, and exercise intensity, during the 6 MWT in patients with HFpEF. The observed improvements in walking distance were particularly associated with increased cadence, which was strongly influenced by both exercise regimens. Notably, while CE generally improved overall walking performance, HIIT was more effective at increasing HRmax, suggesting that the cardiovascular demands of HIIT may better stimulate the heart rate response in these patients [34]. This finding indicates that although both exercise modalities contribute to improved physical function, they may do so through slightly different mechanisms. The association of cadence with exercise intensity further underscores the role of efficient gait patterns in improving cardiovascular fitness, which is crucial for patients with HFpEF, who often experience significant exercise limitations. These results highlight the complementary nature of CE and HIIT, where CE may be more beneficial for improving endurance and overall gait efficiency, whereas HIIT could be particularly effective for improving cardiovascular fitness. This dual approach could provide a comprehensive strategy to address the complex exercise needs of patients with HFpEF. While the results of this study demonstrate the benefits of combined exercise and HIIT to improve functional capacity and cardiovascular health in patients with HFpEF, it is critical to emphasize that these interventions should not be performed without appropriate medical supervision [16]. Patients with HFpEF present with a complex set of comorbidities and physiological challenges that require personalized exercise prescriptions on the basis of a thorough clinical evaluation [35]. Participation in unsupervised or poorly designed exercise programs may pose risks, especially in a population in which exercise tolerance is already compromised [36]. Therefore, healthcare professionals with expertise in the pathophysiology of HFpEF must carefully design and supervise these training programs to ensure patient safety and optimize outcomes [16]. In assessing the overall impact of our study, it is important to recognize both its strengths and limitations. One of the main strengths of this study is its rigorous design, which includes a well-structured comparison between HIIT and CE in patients with HFpEF, providing valuable information on the differential effects of these exercise modalities on functional capacity. Furthermore, the use of objective measures such as cadence, HRmax, and exercise intensity during the 6 MWT adds robustness to the findings, ensuring that the results are clinically relevant. However, the study also has several limitations. In particular, despite the randomization process, some baseline parameters differed between groups. These differences could be due to the relatively small sample size, which may not completely eliminate the variability between groups and could influence the results of the study. In addition, the short duration of the intervention may not fully reflect the long-term effects of the exercise programs. Moreover, the study did not control potential confounding factors, such as variations in medication use or baseline fitness levels, which could further affect the results. Despite these limitations, the results provide a solid basis for future research and suggest important implications for the treatment of HFpEF through tailored exercise interventions.