PRIME HFrEF: Novel Exercise for Older Patients With Heart Failure With Reduced Ejection Fraction

Inclusion Criteria: * Subjects must be able to communicate meaningfully with the investigator and must be legally competent to provide written informed consent. * Subjects may be of either sex with age \> 65 years. * Subjects must be diagnosed with HFrEF as per established echocardiographic criteria (New York Heart Association Class II-III) with an ejection fraction \<45%. * Cardiologist approve after thorough chart review and physical examination * Hemoglobin of at least 10.0 g/dL Exclusion Criteria: * Progressive worsening of exercise tolerance or dyspnea at rest or on exertion over previous 3-5 days * Significant ischemia at low exercise intensities (\<2 METS or \~50 W) * Uncontrolled diabetes (HbA1c \>10%) * Acute systemic illness of fever * Recent embolism (in the 6 weeks) * Deep Vein Thrombophlebitis * Active pericarditis or myocarditis * Severe aortic stenosis (aortic valve area \<1.0 cm2) * Regurgitant valvular heart disease requiring surgery * Myocardial infarction within previous 3 weeks * New onset atrial fibrillation (in the last 4 weeks) * Resting Heart Rate \>120bpm