Exercise training in patients with congestive heart failure. How to achieve benefits safely

Inactivity adds to the decline of patients with congestive heart failure (CHF). However, in prescribing exercise in these patients, three principles must be understood: ejection fraction does not predict functional capacity, exercise can bring marked peripheral improvement without changing ejection fraction or hemodynamics, and benefits accrue slowly. The authors review the mechanisms of exercise intolerance in CHF and the factors to keep in mind when designing an exercise program.