Exercise Training and Physical Activity in Patients With Established HF Of the components of lifestyle modification, exercise is the most studied in HF. Exercise training (or regu- lar physical activity) is recommended by guidelines as Bozkurt et al safe and effective for patients with HF who are able to participate to improve functional status.8,29,317 Exercise has been described to exert the following physiological benefits in HF: decreased plasma norepinephrine levels and inflammation; increased heart rate variability, endo- thelial vasodilatation, coronary blood flow reserve, and anaerobic threshold; and changes in skeletal muscle Meta-analyses and a large, randomized, clinical trial have demonstrated the beneficial effects of an exercise program in patients with established The ExTraMATCH (Exercise Training Meta Analysis of Trials in Chronic Heart Failure Patients) meta-analysis of 9 prospective studies (n=801) dem- onstrated a reduction in overall mortality with exercise that translated into a number needed to treat of 17 to As mentioned in the obesity sec- tion, the HF-ACTION trial randomized 2331 outpatients with HF (EF <35%) to an exercise program or usual The exercise regimen consisted of 36 su- pervised sessions over 3 months followed by home- based training. All-cause mortality and hospitalization were not different between the 2 groups. The Cochrane Database recently published a meta-analysis of 19 tri- als (including the above-mentioned HF-ACTION trial; total n=3647) that assessed the effects of exercise training in HFrEF.319 Exercise interventions reduced HF and improved QOL but did not affect all-cause mortality. Interestingly, when HF-ACTION was excluded, mortality was improved with exercise (relative risk, 0.91; 95% CI, 0.39 0.98; Table 14). Types of Exercise Training Recommended in HF Aerobic exercise training regimens in HF have varied among studies from a low level to a more moderate in- tensity. 