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This study recruited 2322 subjects with systolic heart failure and depression from the USA, Canada and France and randomised them to an exercise programme or guideline-based care. At a median follow-up of 30 months, two-thirds of both groups were dead – these people really did have failing hearts. Survivors from the exercise group had slightly lower depression scores. The authors admit that this may be of little importance in the greater scheme of things. I would suggest that this study is one more illustration of the fact that people with heart failure and depression are in the final trajectory of their lives, and badly need the supportive and palliative care that so few of them can currently access.