Reversing heart failure-associated pathophysiology with exercise: what actually improves and by how much?

Until the late 1980s, physical exercise training was a contraindication in patients with heart failure. Extensive research has demonstrated that exercise training reverses heart failure-associated pathology at the clinical and molecular levels. Exercise training has emerged as a class I recommendation in all major national and international guidelines for the treatment of chronic heart failure. Knowledge gained in clinical trials and molecular research builds a strong case for exercise training as a key therapeutic component of an evidence-based treatment of chronic heart failure. It is long overdue to provide patients with an infrastructure that enables them to benefit from this class I intervention.