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【杂志名称】Annals of Internal Medicine 【杂志级别】SCI, IF=15 【审稿时间要求】15天 【审稿结果】拒稿 【心得】 以前自己审稿最高的是2.9分的SCI杂志，帮老板审稿的一般在5分左右的为多。这个文章相对专业化程度偏低，而杂志可能看重我发表的东西比较杂，所以约我审稿。因为这个杂志是内科学领域应该说是顶尖杂志，我即使审过很多SCI稿件和国家自然科学基金的，起初还是惴惴的不知道接受与否。最终我接受审稿主要还是因为它给合格的审稿人3分的继续教育学分，而且我对稿件所涉及的领域也比较了解。这个文章则只是一个四十几患者的一个pilot study, 没有太重大的发现，所以只能拒稿。 以下是我的审稿意见 To the Editor, The primary finding, distinguishing the present study from previous ones, is that high-intensity aerobic interval training shows some advantages versus moderate-intensity training. Although high intensity aerobic interval training (AIT) improved aerobic fitness and reduced several CVD risk factors more than moderate continuous aerobic exercise (MIT) as revealed by previous studies, similar effects have not been confirmed in lowering blood pressure in hypertensive subjects. Furthermore, the low intensity training seemed more than, or as effective to lower blood pressure as training at higher intensities in previous studies. Additionally, a former meta-analysis indicated that blood pressure reduction was smaller in trials involving exercise in hypertensive subjects with a larger sample size [Whelton SP, et al. Ann Intern Med. 2002;136:493-503.]. Since the sample size in the present study is too small to estimate the issue of safety, it seems risky to conduct such a study, because risk assessment is always important in studies involving exercise in hypertensive subjects. The reduced blood pressure should be weighed fully against the increased risk. In this context, stratified analyses based on the severity of hypertension (Stage 1, 2 and 3) are necessary to lower the potential risks. A stepwise exploration might be needed to maximize the benefits and to minimize the risks in such a study. Low tolerance and high risk in mild hypertension, for instance, may exclude the necessity for similar research in moderate and severe hypertension. Therefore, the interpretation of the results in the current study should be with caution; otherwise, the popularization of high-intensity aerobic interval training in patients with essential hypertension may lead to unexpected outcome. Future studies are needed to confine the high-intensity aerobic interval training to “safe” populations with essential hypertension. Taken together, since the results are preliminary, far from drawing a robust conclusion, I feel this manuscript is not qualified to be published in Annals. To the authors, This study aimed at addressing the optimal training dose, frequency and intensity of exercise in hypertension and found that aerobic interval training could lower blood pressure and improve other cardiovascular risk factors in an intensity-dependent manner. As acknowledged by the authors, the small sample size and short-term follow-up may limit the significance of this study. The results are preliminary, thus far from drawing a robust conclusion. Major concern: 1. As reviewed by Whelton SP, et al, the degree of blood pressure reduction benefiting from exercise did not differ significantly among trials with different forms of intervention [Whelton SP, et al. Ann Intern Med. 2002;136:493-503.]. Since the “treadmill” is a little abstract in terms of exercise, the baseline levels of exercise in each group of patients may be a confounding factor. The higher levels of daily exercise in any form, either before or during the present trial may potentially reduce the significance of such a “treadmill” exercise. 2. As reviewed in Med Sci Sports Exerc. 2004;36(3):533-53 and Hellenic J Cardiol. 2009;50(1):52-9, the low intensity training is more than, or as effective to lower blood pressure as training at higher intensities. The authors attribute this difference to the fact that intensity of exercise in most studies has been in the range of low-to-moderate corresponding to 45-85% of HRmax. However, this explanation seems far-fetched. Although most studies have been in the range of low-to-moderate corresponding to 45-85% of HRmax, the contradictory results require more consideration, since the sample size in the present is quite small. 3. As mentioned in the Methods, measurements of blood pressure and heart rate were done at least one day after an exercise session. The control group received standard recommendation for patients with essential hypertension, including regular light-moderate intensity exercise, but without supervision. This means the controls in this study may probably took regular exercise, let us say, daily. In this case, could the authors guarantee that measurements of blood pressure and heart rate were done at least one day after exercise in the control group? 4. Although the authors excluded patients with severe hypertension from the study, fluctuation of blood pressure in hypertensive patients should be considered. Acute and fierce fluctuation of blood pressure may increase the risk of cardiovascular events, e.g. hypertensive cerebral hemorrhage; thus the fluctuation of blood pressure in this study should be monitored. 5. Although the mechanisms for the blood-pressure lowering effect of exercise are complex and not fully understood, underlying mechanisms should be discussed, e.g. improvement of insulin resistance resulting from exercise as an underlying mechanism. Minor points: 1. Line 1 of the Setting and Participants in the Methods: “88” should be changed to “Eighty-eight” 2. Line 4 of the Blood pressure and heart rate in the Outcomes and Follow-up in the Methods: “this defined nigh time in this study” should be corrected. 3. Line 5 of the Blood pressure and heart rate in the Outcomes and Follow-up in the Methods: “Is” should be corrected to “are”; the first “after” should be deleted. 4. Line 7 of the Blood pressure and heart rate in the Outcomes and Follow-up in the Methods: The full name of ABP (Ambulatory-24-hour blood pressure) should be given, since it was used for the first time in the text. 5. Line 12 of the Patients and exercise training in the Results: The information about the total patient population for analysis is illustrated in Figure 1 but not Figure 2. 6. Ambulatory blood pressure and heart rate: Analysis according to initial randomization in the Results, Figure 2 should be mentioned to illustrate the results of this part. 7. Line 4 and Line 8 of Ambulatory blood pressure and heart rate: Analysis according to initial randomization in the Results: The “mmHg” is dispensable. 8. Line 1 of Ambulatory blood pressure and heart rate: On treatment in the Results: HR is not illustrated in Figure 3. 9. Line 1 of the Discussion: “Exercise-induce” be corrected to “exercised-induced” 10. Line 11 of Echocardiographic findings in the Discussion: “is correlates to” is somewhat grammatically erroneous. 11. Figure 2: The SD values of ABP systolic seem too small (about 3mmgHg), and differ from baseline values as detailed in Table 1. 12. References 3, 13, 20, 23 in the References: The journal names should be in abbreviation form to be in line with the others. 13. Reference 29 in the References: The names of the authors were mistakenly spelled. 14. References 3 and 13 in the References: The names of the authors should be in accordance with the others in format. 15. References 13 in the References: “2009;27:753-62.” should be corrected to “2009;27(4):753-62.” 16. VO2max (in the Abstract) and VO2max (in the Text) should be uniformed, unless the Journal requires so. |
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