Patients with HFpEF, in addition to cardiac abnormalities, display changes in skeletal muscle metabolism and in fat distribution and character. The importance of these changes is demonstrated in that stable, non-decompensated patients seem to benefit from exercise; specifically increased VO2 max and exercise tolerance. However, this benefit appears to be derived from changes in muscle and vasculature as opposed to directly on the heart, which displays minimal change in output following exercise training.[38]