Experimental studies have demonstrated inconsis- tent results with a high-protein diet in patients with HF. In some models, a high-protein diet (30% of energy intake) compared with a standard diet with 18% of energy intake from protein failed to affect cardiac mass, LV volumes, LVEF, or myocardial mitochondrial oxidative capacity or did not improve survival.330 A few early clinical studies, on the other hand, demonstrated that a high-protein diet can result in moderate weight loss and reduced adiposity in overweight and obese patients with HF, and these changes were associated with improvements in functional status, lipid profiles, glycemic control, and However, these preliminary findings need to be confirmed in studies with more participants and long Exercise Training and Physical Activity as Lifestyle Intervention in HF Exercise and Physical Activity for the Prevention of HF Physical activity and physical fitness have been associ- ated with a lower incidence of HF in several population- based studies and large-scale cohorts.193,311 315 On the other hand, a sedentary lifestyle and physical inactiv- ity have been associated with an increased risk of the development of HF regardless of BMI category, base- line hypertension status, and prevalent coronary heart Although current HF guidelines focus on the role of exercise training (or regular physical activ- ity) in patients with established HF, the beneficial role of physical activity and exercise in cardiovascular health is clear and supported for the prevention of HF193,311 315 (Table 13). Exercise Training and Physical Activity in Patients With Established HF Of the components of lifestyle modification, exercise is the most studied in HF. 