Exercise training represents an efficient therapy in stable, chronic heart failure (CHF). The impact of cardiac rehabilitation programmes on autonomic nervous system (ANS) equilibrium is now well established. Furthermore, biventricular pacing (BiP) is emerging as an important long-term therapy for symptomatic CHF patients. Such resynchronisation therapy may achieve several of the treatment goals in CHF including slowing of disease progression and survival. Analysis of heart rate variability (HRV) has become an important method for assessing cardiac autonomic regulation and has been shown to predict clinical outcome in CHF (arrhythmic as well as non-arrhythmic mortality). Cardiac resynchronisation therapy improves autonomic function by increasing HRV as well as exercise training do. The interpretation is a shift of cardiac autonomic balance toward a more favorable profile that is less dependent on sympathetic activation. The effect is sustained in advanced CHF. Lack of HRV improvement four weeks after BiP could identify patients at higher risk for major cardiovascular events. Lack of baroreflex response improvement after cardiac rehabilitation could also identify subjects at high risk for arrhythmic event. Cardiac resynchronisation therapy is also associated with long-term improvement in cardiac sympathetic nerve activity as reflected by improvements in cardiac 123I-MIBG uptake. Two months BiP, as well as 8 weeks of exercise training, decreases muscle sympathetic nerve activity (MSNA) in patients with severe CHF. Such reversible sympathoinhibition is a marker of the clinical response to cardiac resynchronisation therapy. In conclusion: exercise training, biventricular pacing have significant favourable effects on ANS equilibrium in CHF. Modifications of autonomic balance following BiP or exercise training could be related to a possible decrease in mortality in CHF patients.