The cardiovascular system provides the link between pulmonary ventilation and oxygen usage at the cellular level. During exercise, efficient delivery of oxygen to working skeletal and cardiac muscles is vital for maintenance of ATP production by aerobic mechanisms. The equine cardiovascular response to increased demand for oxygen delivery during exercise contributes largely to the over 35-fold increases in oxygen uptake that occur during submaximal exercise. Cardiac output during exercise increases greatly owing to the relatively high heart rates that are achieved during exercise. Heart rate increases proportionately with workload until heart rates close to maximal are attained. It is remarkable that exercise heart rates six to seven times resting values are not associated with a fall in stroke volume, which is maintained by splenic contraction, increased venous return, and increased myocardial contractibility. Despite the great changes in cardiac output, increases in blood pressure during exercise are maintained within relatively smaller limits, as both pulmonary and systemic vascular resistance to blood flow is reduced. Redistribution of blood flow to the working muscles during exercise also contributes greatly to the efficient delivery of oxygen to sites of greatest need. Higher work rates and oxygen uptake at submaximal heart rates after training imply an adaptation due to training that enables more efficient oxygen delivery to working muscle. Such an adaptation could be in either blood flow or arteriovenous oxygen content difference. Cardiac output during submaximal exercise does not increase after training, but studies using high-speed treadmills and measurement of cardiac output at maximal heart rates may reveal improvements in maximal oxygen uptake due to increased stroke volumes, as occurs in humans. Improvements in hemoglobin concentrations in blood during exercise after training are recognized, but at maximal exercise, hypoxemia may reduce arterial oxygen content. More effective redistribution of cardiac output to muscles by increased capillarization and more efficient oxygen diffusion to cells may also be an important means of increasing oxygen uptake after training.