Ask a PT Rsponse: "I am assuming that his 40% function of left ventricle is his ejection fraction.  Normal EF is 50-70%.  When we risk stratify 40-50% is moderate risk and less than 40% is high risk.  You would want to make sure the patient does not Valsalva or strain when lifting weights.  When training aerobically, the patient's systolic blood pressure should increase from rest.  If it is dropping that is a sign that the pump (heart) can't keep up with the exercise load.  The therapist should watch for signs of heart failure (increased pedal edema, increase shortness of breath, weight gain of more than 3 lb in 2 days or 5 lbs in one week, inability to lie flat due to SOB, and crackles on auscultation)."