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Beyond pharmacologic replacement, several non-pharmacological interventions can modulate the GH/IGF-1 axis: a) regular physical activity and cardiac rehabilitation increase physiological GH pulsatility and IGF-1 levels, improving skeletal muscle function and exercise capacity, b) nutritional optimization and correction of cachexia support IGF-1 synthesis and may partially reverse GH resistance, c) treatment of IR and obesity (e.g., with SGLT2 inhibitors and GLP-1 RAs) may indirectly normalize GH/IGF-1 dynamics by improving metabolic status, sleep quality and systemic inflammation, thus creating a more favorable hormonal milieu for the failing heart

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