Regarding “Paradise Lost? New National Heart Foundation of Australia Guidelines on
Heart Failure Fail to Recognise the Intensity of Exercise Evidence”, [
[1]
] we thank the authors for their feedback. We reaffirm that the highest GRADE [
[2]
], level and strength, of evidence for exercise training in patients with heart failure
in the new national guidelines is “up to moderate intensity” [
[3]
]. The largest randomised trial of high intensity interval training in 261 patients
with left ventricular ejection fraction less than or equal to 35% and New York Heart
Association class II–III was not superior to moderate continuous training in altering
left ventricular remodelling or aerobic capacity [
[4]
]. Other trial evidence supporting vigorous and high intensity exercise in patients
with heart failure is beset by study design, size and power, surrogate endpoints,
together with confounding from multimodality exercise. The inferior quality of this
other evidence is alluded to in the Editorial [
[1]
].To read this article in full you will need to make a payment
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References
- Paradise Lost? New National Heart Foundation of Australia Guidelines on Heart Failure Fail to Recognise the Intensity of Exercise Evidence.Heart Lung Circ. 2019; 28: 827-828
- GRADE handbook.2013 (Updated October Available at: http://gdt.guidelinedevelopment.org/app/handbook/handbook.html (Accessed 21/02/18))
- National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018.Heart Lung Circ. 2018; 27: 1123-1208
- High intensity interval training in heart failure patients with reduced ejection fraction.Circulation. 2017; 135: 839-849
- The disease-specific benefits and risks of physical activity and exercise.Public Health Rep. 1985; 100: 180-188
Article info
Publication history
Published online: July 05, 2019
Received:
June 14,
2019
Identification
Copyright
© 2019 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
