Aims Supervised exercise can benefit selected patients with heart failure, however the effectiveness of home‐based exercise remains uncertain. We aimed to assess the effectiveness of a home‐based exercise programme in addition to specialist heart failure nurse care. Methods and results This was a randomized controlled trial of a home‐based walking and resistance exercise programme plus specialist nurse care (n = 84) compared with specialist nurse care alone (n = 85) in a heart failure population in the West Midlands, UK. Primary outcome: Minnesota Living with Heart Failure Questionnaire (MLwHFQ) at 6 and 12 months. Secondary outcomes: composite of death, hospital admission with heart failure or myocardial infarction; psychological well‐being; generic quality of life (EQ‐5D); exercise capacity. There was no statistically significant difference between groups in the MLwHFQ at 6 month (mean, 95% CI) (−2.53, −7.87 to 2.80) and 12 month (−0.55, −5.87 to 4.76) follow‐up or secondary outcomes with the exception of a higher EQ‐5D score (0.11, 0.04 to 0.18) at 6 months and lower Hospital Anxiety and Depression Scale score (−1.07, −2.00 to −0.14) at 12 months, in favour of the exercise group. At 6 months, the control group showed deterioration in physical activity, exercise capacity, and generic quality of life. Conclusion Home‐based exercise training programmes may not be appropriate for community‐based heart failure patients.

Background: Exercise has been shown to be beneficial for selected patients with heart failure, but questions remain over its effectiveness, cost-effectiveness and uptake in a real world setting. This paper describes the design, rationale and recruitment for a randomised controlled trial that will explore the effectiveness and uptake of a predominantly home-based exercise rehabilitation programme, as well as its cost-effectiveness and patient acceptability.

Background: Diagnosing heart failure and left ventricular systolic dysfunction is difficult on clinical grounds alone. We sought to determine the accuracy of a heart failure register in a single primary care practice, and to examine the usefulness of b-type (or brain) natriuretic peptide (BNP) assay for this purpose.

Challenge to racism must continueEditor-As McKenzie highlights in his editorial, the emphasis to date has been on the role of racism in recruitment and career development. 1 This must continue despite initiatives and legislation such as the recent Race Relations Amendment Act, as racism still exists in the NHS. 2 We need to continue to challenge racism not only from our colleagues but also from our patients-zero tolerance is needed. 3 The importance of racism on health and health care will not diminish owing to increasing migration to the United Kingdom particularly from east European countries. The often hostile reception of the public, media, and some politicians reinforces the negative attitudes that prevail, 4 and these may manifest through acute and chronic stress to the detriment of the individual. Research on evaluating the mechanism for racism and health outcomes is in early infancy; most studies are being conducted in the United States. We agree with McKenzie that further funding is needed in this area.The biological models alluded to seem plausible, but before investigating these further substantial research needs to be done first to define, measure, and validate "racism" as an epidemiological variable. Then we need studies to disentangle the effect of racism on health. Urgency and opportunity exist to initiate a national ethnic cohort study within the planned UK Biobank study (www.ukbiobank.ac.uk) to include examination of the effect of racism on health outcomes.

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