Exercise training in heart failure patients. Does reversing the peripheral abnormalities protect the heart?

E xercise and activity intolerance are the most frequent and debilitating symptoms in patients with mild and moderate congestive heart failure (CHF). Paradoxically, the severity of these symptoms correlates poorly with indexes of cardiac function such as the ejection fraction and hemodynamic measurements.1,2 This discordance has focused attention on pathophysiological changes in the periphery to explain the mechanism of impaired exercise capacity. However, the heart and the periphery are inextricably linked, both in normal physiology and in CHF. The article by Coats and coworkers3 in this issue of Circulation illustrates this linkage and its potentially profound clinical implications.