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In 42 patients with chronic heart failure we evaluated left ventricular function, exercise capability and autonomic control before and 3 months after a program of cardiovascular rehabilitation. The results were analyzed separately for younger (Group 1, n=18, age 51±6 years) and older patients (Group 2, n=24, age 68±4 years), with comparable clinical characteristics and therapy. Before rehabilitation, compared to younger patients, Group 2 patients showed a lower exercise capability, a comparable left ventricular ejection fraction and similar high sympathetic activity at rest, with no response to regular breathing (= stimulation of cardiopulmonary receptors, i.e. parasympathetic challenge) and active standing (= sympathetic stimulation). After rehabilitation, in both groups a 20% improvement of exercise tolerance and aerobic performance was observed, as well as a slightly increase of left ventricular ejection fraction (about 10%), and a recovery in vagal and sympathetic responsiveness. Thus, in heart failure patients age does not hinder the favorable clinical and autonomic modulation induced by cardiovascular rehabilitation.