CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Mark J. Haykowsky, PhD*,
Yuanyuan Liang, PhD,
David Pechter, BA,
Lee W. Jones, PhD,
Finlay A. McAlister, MD, MSc and
Alexander M. Clark, PhD
* 2-50, Corbett Hall, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Edmonton, Alberta T6G-2G4, Canada (Email: mark.haykowsky{at}ualberta.ca).
We thank Dr. Conraads and colleagues for their interest in our meta-analysis. They attribute the lack of positive effects of combined aerobic and strength training reported in our review (1) to greater rates of beta-blocker prescription in the more recent trials of combined training. However, although we agree that beta-blockers have a positive effect on reverse ventricular remodeling, overall prescription rates of beta-blockers were not greater in the trials examining combined training (combined: 31% vs. other trials 44%).
Dr. Conraads and colleagues are correct that the rate–pressure product is lower during leg press exercise versus cycle exercise when performed at the same relative exercise intensity (2). However, the rate–pressure product is not an appropriate measure of left ventricular wall stress (i.e., ventricular pressure multiplied by ventricular radius of curvature divided by ventricular wall thickness), which is an important stimulus for ventricular remodeling (3). We disagree with the implication of Dr. Conraads and colleagues that reverse remodeling is unimportant. An international consensus statement reinforces that slowing or reversing ventricular remodeling is clinically important and essential to prevent the progression of heart failure (4). We also disagree that resistance training should be recommended to heart failure patients based on current evidence. We reiterate that our meta-analysis supported the efficacy of aerobic training on reverse ventricular remodeling and should be the choice of exercise training for clinically stable individuals with heart failure and impaired left ventricular systolic function for whom prevention of heart failure progression is a priority.
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References
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- Haykowsky MJ, Liang Y, Pechter D, Jones LW, McAlister FA, Clark AM. A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: the benefit depends on the type of training performed J Am Coll Cardiol 2007;49:2329-2336.[Abstract/Free Full Text]
- McKelvie RS, McCartney N, Tomlinson C, Bauer R, MacDougall JD. Comparison of hemodynamic responses to cycling and resistance exercise in congestive heart failure secondary to ischemic cardiomyopathy Am J Cardiol 1995;76:977-979.[CrossRef][ISI][Medline]
- Mann DL. Basic mechanisms of left ventricular remodeling: the contribution of wall stress J Card Fail 2004;10:S202-S206.[CrossRef][ISI][Medline]
- Cohn JN, Ferrari R, Sharpe N, International Forum on Cardiac Remodeling Cardiac remodeling—concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling J Am Coll Cardiol 2000;35:569-582.[Abstract/Free Full Text]
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