The National Institute for Clinical Excellence (NICE) has recommended that exercise training be offered to patients with chronic heart failure (CHF). This recommendation is supported by research-based evidence from a variety of studies over the past 10 years. Initially, the studies were concerned primarily with the safety and effectiveness of exercise in these high-risk patients, but more recent studies have begun to investigate the most appropriate methods of exercise for this patient population. This article presents a systematic review of the literature relating to exercise training and CHE. It then attempts to identify, in light of the evidence, the most effective programme of exercise, including type, duration and degree of exercise. Finally, it discusses practical application and implementation of the research findings into everyday health care, including issues such as staff development and training, assessment, exercise and prescription for individual patients, and evaluation of the service.