Paradise Lost? New National Heart Foundation of Australia Guidelines on Heart Failure Fail to Recognise the Intensity of Exercise Evidence

Abstract

<p>Thirteen (13) years after they were last revised, management guidelines, including exercise training recommendations, for heart failure patients have been updated by the National Heart Foundation [1]. One might ask if an opportunity to interpret and incorporate some of the latest evidence has been missed? Now, as before, the Foundation's experts propose exercise of "up to moderate intensity" for heart patients. Unequivocal evidence exists that limiting intensity to moderate, deprives some patients of the optimum exercise regime as vigorous and high intensity delivers greater gains in fitness, one of the strongest indicators of future heart failure health [2], [3], in those patients who are stable enough to tolerate it. Obviously, the most challenging patients are the frailest and not everyone will be able to perform exercise above moderate intensity, so it's not a question of one size fits all, but current guidelines will certainly limit the health benefits obtained from exercise in some heart failure patients. Perhaps the writing group could have considered some of the other available exercise epidemiology evidence with respect to heart failure patients, as outlined below.</p>