Aerobic exercise training was associated with a significant improvement in QOL across all BMI catego- ries, with a slightly greater degree of improvement in QOL with exercise in the more obese patients (BMI 35 Thus, exercise therapy may be a strategy to improve the QOL of obese patients with HF. Because adherence to exercise programs has been shown to be difficult in patients with HF and home-based exercise programs may be more practical and less expensive to implement, adherence to the programs may need to be monitored with heartrate monitors, exercise diaries, Obesity is even more prevalent in patients with HFpEF. Although no study has specifically examined exercise training and QOL in obese patients with HFpEF, >50% of patients enrolled in studies of exercise training in HFpEF are obese (mean BMI >30 kg/m2 A meta-analysis of 228 individuals with HFpEF enrolled in studies that examined exercise training demonstrated a significantly greater improvement in exercise capacity and QOL in patients in the exercise training arm compared with the control arms with no serious adverse events related to Taken together, the above data suggest that exercise therapy may be safe in obese patients with HFrEF and HFpEF and may be associated with improvement in both QOL and exercise capacity. Sleep Apnea, Obesity, and HF OSA, obesity, and HF have a complex interaction.259 In the Sleep Heart Health Study, OSA was detected in 37% of patients with HF, with a higher prevalence of OSA in men than in women.260 In men, the main risk factor for OSA was obesity, whereas in women, it was older age. 