Making non-drug interventions easier to find and use

Patients with heart failure are often anxious about any exertion as it brings on the shortness of breath that characterises their condition. But exercise for heart failure appears to be as good as the medications we use, and may be better for symptoms and quality of life. The 10 year follow up of an Italian randomised trial found that patients allocated to supervised exercise had significantly better quality of life, and around a one-third reduction in hospital readmission and cardiac mortality. A Cochrane review of shorter term studies supports these overall findings. Despite this, exercise for heart failure appears to be underprescribed, but also getting the 'prescription' correct - dose, duration, monitoring - is not straightforward. A non-pharmacopeia might be helpful.