Exercise training in the treatment of heart failure: what is achieved and how?

Exercise intolerance is present in most patients with left ventricular dysfunction. Factors affecting the central and peripheral circulation, ventilatory system and skeletal muscles limit the exercise capacity in varying degrees within each patient. Exercise training is now being applied with growing enthusiasm to patients with heart failure. Improvements in the peripheral circulation and skeletal muscle structure and function appear to account for the observed benefit in exercise tolerance after training. Exercise programmes in these patients should be initially conducted with close supervision and tailored to the individual patient.