Exercise intolerance is recognized as a hallmark of HF. It is now understood that exercise intolerance in HF has a multifactorial etiology and that parameters such as intracardiac filling pressures and LVEF might not be reliable predictors of exercise capacity. Changes in the periphery and LV function are both important determinants of exercise capacity. Therefore, it is rational that exercise training could potentially benefit patients with HF.

Recommendation 71: We recommend regular exercise to improve exercise capacity, symptoms and quality of life in all heart failure patients (Strong Recommendation; Moderate Quality of Evidence).

Recommendation 72: We recommend regular exercise in heart failure patients with reduced ejection fraction to decrease hospital admissions (Strong Recommendation; Moderate Quality of Evidence).

Value and Preferences: These recommendations have placed a high value on regular exercise and not emphasized structured exercise training because it is recognized that not all patients will be able to participate in a structured exercise training program because of patient preferences or availability of resources.

• It is important to individualize the exercise training for each patient, with the more deconditioned patients starting at a lower training intensity and with shorter sessions.