Exercise training is a recommended treatment for chronic
heart failure. So far, randomized clinical trials showed that exercise training can improve peak oxygen consumption and reduce neurohormonal and
adrenergic activation, nevertheless, the effect on
left ventricular remodeling is still controversial. The present study reviewed the randomized clinical trials that investigated the effects of exercise training on
left ventricular remodeling. After a first study that showed a worsening of left ventricular function, the following studies showed a neutral effect, and finally, the ELVD-CHF study showed both a reduction in left ventricular dilation and an improvement of ejection fraction. These different results could be explained by the pharmacological treatment before exercise training: in the first study patients did not assume
ACE-inhibitors, in the following studies most patients assumed
ACE-inhibitors and, finally, in ELVD-CHF, patients assumed
ACE-inhibitors and about one fifth of them were on beta-blockers too. In conclusion, exercise training may improve peak oxygen consumption and reduce neurohormonal and
adrenergic activation in patients with chronic
heart failure. Further studies are necessary to assess if exercise training, associated with
ACE-inhibitors and beta-blockers, can reverse or prevent
left ventricular remodeling.