Dietary Guidelines in Patients With HF Typical dietary guidelines for the HF population state that sodium restriction or fluid restriction in patients with severe HF with congestion and with hyponatremia is rea- Otherwise, there are no specific recommenda- tions for caloric intake or dietary composition included in the current AHA/ACCF, Heart Failure Society of America, or European Society of Cardiology HF guidelines8,29,317 other than nutritional supplements not being recom- mended as treatment of HF in patients with current or prior symptoms of HFrEF.8 Guideline Recommendations for Exercise With the above background, the Heart Failure Society of America, European Society of Cardiology, ACC, and AHA recommend exercise training or regular physical activity in patients with HF,8,29,249,317,318 but these guidelines have Management of Comorbidities in Chronic Heart Failure CLINICAL STATEMENTS AND GUIDELINES not addressed the beneficial role of exercise in preven- tion of HF, which we tried to address by adding a rec- ommendation stating the beneficial role of exercise or physical activity for patients with stage A or B HF. In the Heart Failure Society of America guidelines, it is recommended that patients with HF undergo exercise testing before enrollment in an exercise training pro- gram to determine suitability for exercise training and to assess for ischemia or arrhythmias. If deemed safe, exercise training should be considered for patients with HF. Initially, exercise should be supervised to educate the patient on heart rate response and level of exercise and to gradually increase exercise duration and intensity. 