Exercise training in patients with chronic heart failure
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《英国医生杂志》
EDITOR—The figure shows the forest plots of the hazard ratios and 95% confidence intervals. The forest plots were removed during revision for reasons of space.
Hazard ratios and 95% confidence intervals for individual studies for effect of exercise training on risk of death and on risk of death and admission to hospital (full data available on bmj.com>)
As Metcalfe observes, in one fairly large study the exercise regimen seemed to be achieving a greater beneficial effect.1 In this, the training type (supervised cycling, 60 minutes three days a week) was similar to that in the other studies, at a slight lower intensity (60% of peak VO2), but the factor that we suspect made the difference was the length of the programme which (at 420 days) was almost double the average of the others (213 (SD 135) days). This is in keeping with the non-significant trend observed in our subgroup analysis.
Although pathophysiological grounds exist to suspect that longer periods of training might be more likely to be effective, even meta-analysis of all available data cannot resolve the question clearly. It is possible that in a future study with more events such differences may become detectable.
We thank Metcalfe for suggesting insertion of a covariate identifying the study into the Cox survival regression. The beneficial effect of exercise remains evident, both for mortality (odds ratio 0.67, 95% confidence interval 0.47 to 0.95) and for the combined end point of mortality or admission (0.67, 0.52 to 0.87).
The benefits for health and survival of supervised exercise training (instead of general advice on healthy living) in heart failure are now established beyond reasonable doubt. We predict, however, that implementation will be far slower for this than for treatments such as drugs and implantable devices—both of which have a natural large industry lobby behind them.
Massimo F Piepoli, member, ExTraMATCH collaborative
m.piepoli@imperial.ac.uk
Darrel P Francis, member, ExTraMATCH collaborative
Clinical Cardiology, Royal Brompton Hospital, Imperial College of Science, Technology and Medicine, London SW3 6LY
Data for figures are available on bmj.com>
Competing interests: None declared.
References
Belardinelli, R, Georgiou D, Cianci D, Purcaro A. Randomized, controlled trial of long term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation 1999;99: 1173-82.
Hazard ratios and 95% confidence intervals for individual studies for effect of exercise training on risk of death and on risk of death and admission to hospital (full data available on bmj.com>)
As Metcalfe observes, in one fairly large study the exercise regimen seemed to be achieving a greater beneficial effect.1 In this, the training type (supervised cycling, 60 minutes three days a week) was similar to that in the other studies, at a slight lower intensity (60% of peak VO2), but the factor that we suspect made the difference was the length of the programme which (at 420 days) was almost double the average of the others (213 (SD 135) days). This is in keeping with the non-significant trend observed in our subgroup analysis.
Although pathophysiological grounds exist to suspect that longer periods of training might be more likely to be effective, even meta-analysis of all available data cannot resolve the question clearly. It is possible that in a future study with more events such differences may become detectable.
We thank Metcalfe for suggesting insertion of a covariate identifying the study into the Cox survival regression. The beneficial effect of exercise remains evident, both for mortality (odds ratio 0.67, 95% confidence interval 0.47 to 0.95) and for the combined end point of mortality or admission (0.67, 0.52 to 0.87).
The benefits for health and survival of supervised exercise training (instead of general advice on healthy living) in heart failure are now established beyond reasonable doubt. We predict, however, that implementation will be far slower for this than for treatments such as drugs and implantable devices—both of which have a natural large industry lobby behind them.
Massimo F Piepoli, member, ExTraMATCH collaborative
m.piepoli@imperial.ac.uk
Darrel P Francis, member, ExTraMATCH collaborative
Clinical Cardiology, Royal Brompton Hospital, Imperial College of Science, Technology and Medicine, London SW3 6LY
Data for figures are available on bmj.com>
Competing interests: None declared.
References
Belardinelli, R, Georgiou D, Cianci D, Purcaro A. Randomized, controlled trial of long term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation 1999;99: 1173-82.