Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. C URRENT O PINION Improving functional capacity in heart failure: the need for a multifaceted approach Ross Arena a , Lawrence P. Cahalin b , Audrey Borghi-Silva c , and Shane A. Phillips a Purpose of review Functional capacity is a broad term that describes a person’s ability to perform the daily activities that require physical exertion. Patients diagnosed with heart failure, regardless of cause, demonstrate a compromised functional capacity. The ability to perform aerobic activities is a central, but not complete, determinant of functional capacity. Muscular strength and endurance are other important elements of functional capacity. It is well established that patients with heart failure demonstrate attenuated muscular strength and endurance as a consequence of their disease process. Typically, a heart failure patient’s ability to perform daily activities that are either aerobic or resistive in nature is compromised and contributes to the decline in functional capacity. Recent findings There is an abundance of literature demonstrating that exercise training improves aerobic capacity and muscular strength and endurance in those with heart failure. These training benefits translate to an improvement in functional capacity and an enhanced ability to perform activities of daily living. There are several approaches to exercise training in the heart failure population, each of which has implications for the degree to which functional capacity can be improved. Summary This review summarizes the current body of literature related to exercise training as a means of optimizing functional capacity in patients with heart failure. Keywords aerobic capacity, exercise training, heart failure, muscle endurance, muscle strength, rehabilitation INTRODUCTION Functional capacity is a broad term that describes a person’s ability to perform activities that require physical exertion. The integrity of the cardiovascular, respiratory and skeletal muscle systems is the primary determinant of functional capacity. If one or more of these systems are compromised, functional capacity suffers. Decreased functional capacity translates to a diminished ability to perform activities of daily living and occupational tasks. Patients diagnosed with heart failure, essentially from all causes, demonstrate a compromised functional capacity [1–3]. We now appreciate that pathophysiologic alterations in the three systems that influence functional capacity are adversely affected in patients with heart failure [4–8]. The decrement in functional capacity observed in the heart failure population is frequently severe and reflects a combination of disease severity and an oftentimes sedentary lifestyle. Clinically, dimin- ished functional capacity and diminished aerobic capacity are commonly viewed as synonymous terms. Although the ability to perform aerobic activi- ties is a central determinant of functional capacity, muscular strength and endurance are equally import- ant and somewhat separate determinants of func- tional capacity. It is clear that patients with heart failure experience significantly compromised levels a Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, b Department of Physical Therapy, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA and c Cardiopulmonary Physiotherapy Laboratory, Federal University of Sa ˜o Carlos, Sa ˜ o Paulo, Brazil Correspondence to Ross Arena, PhD, PT, FAHA, Professor, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, 1919 W. Taylor Street (MC 898), Chicago, IL 60612, USA. Tel: +1 312 355 3338; fax: +1 312 996 4583; e-mail: raarena @uic.edu Curr Opin Cardiol 2014, 29:000–000 DOI:10.1097/HCO.0000000000000092 0268-4705 ß 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins www.co-cardiology.com REVIEW