ABSTRACT
Heart failure (HF) is a complex clinical syndrome with a multipart pathophysiology
involving a wide variety of cells, tissues, organs, and organ systems. Whereas systolic HF
remains commonly conceptualized in terms of impaired heart pumping function, i.e., a
heart that is unable to pump to meet the body’s needs with normal intracardiac chamber
pressures, this textbook has accentuated the contrasting principle that HF pathophysiology
extends well beyond the heart, including a constellation of peripheral effects that are
integral to HF’s notorious course (Fig. 1). Whereas resting pump function relates poorly to
exercise capacity, a variety of extra-cardiac HF effects have significant bearing on
functional limits. Given that exercise training modifies many tissues and organ systems,
there is compelling rationale for its use to modify the systemic nature of HF. Consistently,
exercise training has been demonstrated to modify many peripheral manifestations of HF
with associated functional improvements. In this chapter, we will, therefore, review salient
aspects of peripheral HF pathophysiology as a perspective from which benefits of exercise
training can be highlighted. We will then review some of the trial data demonstrating
utility of exercise training for systolic HF, and clarify related details regarding training
strategies and safety.
