Precision Rehabilitation for Veterans With (HFpEF)

Inclusion Criteria: * New York Heart Association Class II or III HF symptoms * History of hypertension * EF≥50% * LVH confirmed by echocardiography, Cardiac CT, or Cardiac MR * Diastolic dysfunction which must include ≥2 of the following: 1. Average E/e'\>14 2. Septal e'\<7 cm/s or Lateral e' \<10 cm/s 3. TR velocity\> 2.8 m/s 4. LA computed volume index \>34 mL/M2 5. PCWP or LVEDP\>15 * Ability to participate in an exercise program as determined by a research, cardiology, or primary care provider Exclusion Criteria: * Ejection Fraction \< 50% * Absence of LVH * LV Dilation (LV end diastolic volume indexed to BSA \> 75 ml/m2) * Any Segmental wall motion abnormality * Acute ST segment elevation myocardial infarction (STEMI) * Significant valvular or other non-coronary heart disease * Any non-cardiac disease or condition that could influence myocardial function (e.g., collagen-vascular disease, history of cardiotoxic cancer chemotherapy, amyloid) * Anemia defined as Hgb \< 11.0 g/dl in males, 10 g/dl in females * Current accelerating angina, unstable angina, angina at rest, or NSTEMI within 3 months * Chronic pulmonary disease requiring home oxygen or steroid therapy * Significant non-CV organ disease: Chronic hepatic or renal disease (eGFR \< 25 mL/min/1.73m2) * Inability to provide informed consent * Inability to perform exercise