The authors suggest that the findings provide a basis for a change in the clinical assessment of older patients with heart failure. Although this may be true, what should be done about the presence of a slow gait or weak grip? The authors reference results from the HF-ACTION trial (6) and suggest that exercise training may be an easy fix for these 2 problems. One must remember, though, that the population in HF-ACTION was much younger (median age: 59 years) and that the intervention required 36 supervised exercise sessions transitioned to home exercise. This level of exercise training had no impact on the primary, composite endpoint of mortality and all-cause admission, even in younger patients. Risk adjustment of the primary endpoint, accounting for prognostic factors, led to a modest, statistically significant impact. The secondary, composite endpoint of mortality and heart failure–related hospital admission was modestly changed in the exercise group (after adjustment), even with documented improvement in exercise stamina. Supervised exercise training is expensive and, at least based on the HF-ACTION data, would not significantly affect the need for hospital admission. What about weak grip? Adding resistance training to aerobic activity has been evaluated only in the context of exercise endurance in small cohorts (7). No prospective data exist to predict whether exercises that focus on improving upper extremity strength would change outcomes in heart failure patients. Finally, although it is clear that severe depressive symptoms are associated with poorer outcomes, no consensus exists about the effects of treatment (8).