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Ejection fraction can improve in some people on proper medical therapy. While exercise doesn't result in the significant improvement in heart function (in most studies) that we'd hope for, it can improve quality of life and functional capacity. I'd talk with the cardiologist about an exercise prescription and whether cardiac rehabilitation could be a possibility.
Heart valve problems. An ejection fraction between 40 and 50 percent may indicate damage to the heart muscle (e.g., from a prior heart attack). Typically, this EF level alone is not low enough to lead to heart failure. But a very low ejection fraction of only 15-25% is indicative of a failing heart or cardiomyopathy.