In patients with heart failure treated with cardiac resynchronisation therapy (CRT), proper programming of the device can enhance the benefits of stimulation. Nowadays, adjustment of atrio-ventricular delay (AVD) is usually guided by echocardiography and performed only in resting conditions. The issue of optimal CRT programming during exercise, and the decision regarding the use of rate-adaptive pacing and rate-adaptive AVD algorithm during CRT, are largely empirical. We present a case report, and we indicate that programming of rate-adaptive pacing and rate-adaptive AVD algorithm on the basis of extended echocardiographic evaluation can further benefit the individual patient.