Cardiac Rehabilitation in Chronic Heart Failure: Effect of an 8-Week, High-Intensity Interval Training Versus Continuous Training

doi:10.1016/j.apmr.2012.03.007

Archives of Physical Medicine and Rehabilitation

Volume 93, Issue 8, August 2012, Pages 1359-1364

https://doi.org/10.1016/j.apmr.2012.03.007 Get rights and content

Abstract

Freyssin C, Verkindt C, Prieur F, Benaich P, Maunier S, Blanc P. Cardiac rehabilitation in chronic heart failure: effect of an 8-week, high-intensity interval training versus continuous training.

Objective

To compare the effects of an 8-week, high-intensity interval training protocol versus continuous training.

Design

Randomized controlled trial.

Setting

Cardiac rehabilitation center.

Participants

Patients (N=26; mean age ± SD, 54±12y) with chronic heart failure were enrolled in a cardiac rehabilitation program for 8 weeks.

Interventions

Patients were randomly assigned into 2 groups that performed either interval training (IT) or continuous training (CT). IT consisted of 3 sessions of 12 repetitions of 30 seconds of exercise at very high intensity, followed by 60 seconds of complete rest. The CT group performed CT exercises, which consisted of 45 minutes of aerobic exercise.

Main Outcome Measures

Parameters of gas exchanges: peak oxygen consumption (Vo₂peak), first ventilator threshold (VT1), distance at six-minute walk test (6MWT), and level of anxiety and depression were measured.

Results

The IT group increased significantly their Vo₂peak, the duration of the exercise test, the oxygen pulse, oxygen consumption at the VT1, and the distance walked during the 6MWT. The CT group only increased the time at the VT1 and the distance performed at the 6MWT. The improvement in the time at the VT1 was significantly higher for the IT group than for the CT group.

Conclusions

This study shows that IT at very high intensity for patients with heart failure appears to be more effective than CT in improving indices of submaximal exercise capacity.

Section snippets

Participants

Twenty-six patients (mean age ± SD, 54±12y) with chronic heart failure were enrolled in an 8-week tailored multidisciplinary cardiac rehabilitation program at the Sainte Clotilde Cardiovascular Rehabilitation Center (Reunion Island, France). Criteria for inclusion were stable chronic heart failure and a left ventricular ejection fraction less than 40%. Patients have an optimized medical treatment. They received a beta-blocker, diuretic therapy. Patients were randomly assigned to 2 groups: 1

Results

At baseline of cardiac rehabilitation, disease etiology and medications were similar for both groups, and no more therapeutic changes had occurred in the rehabilitation program (see table 1). The pharmacologic treatment was comparable between the groups.

Peak V̇o₂, exercise test duration, oxygen pulse at maximal exercise, and V̇o₂ at the VT1 increased significantly after 8 weeks of IT, while no significant change was observed after CT for these variables (table 2). The time corresponding to the

Discussion

The major finding of the present study was that a short IT program performed at high intensity induced significant improvement in the functional physical capacity in patients with chronic heart failure, while CT had fewer effects on this capacity. Indeed, in CT we observed an increase in the time at the VT1 but no significant change in Vo₂peak, exercise test duration, and V̇o₂ at the VT1, while we found that IT significantly increased Vo₂peak, exercise test duration, time at the VT1, and V̇o₂

Conclusions

The present study demonstrates that a rehabilitation program of 8 weeks with very high-intensity IT in patients with chronic heart failure can result in considerable improvements in physical capacity. These parameters are considered prognostic markers of chronic heart failure. CT programs seem to have lower impact on this capacity. These results can contribute to improve the workout training intervals used for these patients. Moreover, this type of protocol is much more feasible and accessible

Acknowledgments

We thank the team of the Sainte Clotilde Cardiac Rehabilitation Center for their cooperation, A.L. Diquelou and A. Descamps for their help, and S. Jhowry for her translation assistance.

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Providing an overview of the clinimetric properties of the steep ramp test (SRT)—a short-term maximal exercise test—to assess cardiorespiratory fitness (CRF), describing its underlying physiological responses, and summarizing its applications in current clinical and research practice.
MEDLINE (through PubMed), CINAHL Complete, Cochrane Library, EMBASE, and PsycINFO were searched for studies published up to July 2023, using keywords for SRT and CRF.
Eligible studies involved the SRT as research subject or measurement instrument and were available as full text articles in English or Dutch.
Two independent assessors performed data extraction. Data addressing clinimetric properties, physiological responses, and applications of the SRT were tabulated.
In total, 370 studies were found, of which 39 were included in this study. In several healthy and patient populations, correlation coefficients between the work rate at peak exercise (WR_peak) attained at the SRT and oxygen uptake at peak exercise during cardiopulmonary exercise testing (CPET) ranged from .771-.958 (criterion validity). Repeated measurements showed intraclass correlation coefficients ranging from .908-.996 for WR_peak attained with the first and second SRT (test-retest reliability). Physiological parameters, like heart rate and minute ventilation at peak exercise, indicated that the SRT puts a lower burden on the cardiopulmonary system compared to CPET. The SRT is mostly used to assess CRF, among others as part of preoperative risk assessment, and to personalize interval training intensity.
The SRT is a practical short-term maximal exercise test that is valid for CRF assessment and to monitor changes in CRF over time in various healthy and patient populations. Its clinimetric properties and potential applications make the SRT of interest for a widespread implementation of CRF assessment in clinical and research practice and for personalizing training intensity and monitoring longitudinal changes in CRF.
Ergophysiological evaluation of heart failure patients with reduced ejection fraction undergoing exercise-based cardiac rehabilitation: A systematic review and meta-analysis
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This systematic review and meta-analysis aims to explore in heart failure (HF) patients with reduced ejection fraction (EF) undergoing exercise-based cardiac rehabilitation the following: 1) the comparison of temporal changes between peak oxygen uptake (VO2peak) and first ventilatory threshold (VO2VT1), 2) the association of VO2peak and VO2VT1 changes with physiological factors, and 3) the differential effects of continuous aerobic exercise (CAE) and interval training (IT) on VO2peak and VO2VT1.
A systematic literature search was conducted in PubMed, CENTRAL, and Scopus. Inclusion criteria were 1) original research articles using exercise-based cardiac rehabilitation, 2) stable HF patients with reduced EF, 3) available values of VO2peak and VO2VT1 (in mL/kg/min) both at baseline and after exercise training with comparison between these time points.
Among the 30 eligible trials, 24 used CAE, 5 IT, and one CAE and IT. Multivariable meta-regression with duration of exercise training and percentage of males as independent variables and the change in VO2peak as a dependent variable showed that the change in VO2peak was negatively associated with duration of exercise training (coefficient=-0.061, p=0.027), implying the possible existence of a waning effect of exercise training on VO2peak in the long term. Multivariable meta-regression demonstrated that both age (coefficient=-0.140, p<0.001) and EF (coefficient=-0.149, p<0.001) could predict the change in VO2VT1, whereas only age (coefficient=-0.095, p=0.022), but not EF (coefficient = 0.082, p = 0.100), could predict the change in VO2peak. The posttraining peak respiratory exchange ratio, as an index of maximum effort during exercise testing, correlated positively with the change in VO2peak (coefficient=-0.021, p=0.044). The exercise-induced changes of VO2peak (p = 0.438) and VO2VT1 (p = 0.474) did not differ between CAE and IT groups.
Improvement of endurance capacity during cardiac rehabilitation may be detected more accurately with the assessment of VO2VT1 rather than VO2peak.
Clinical value and mechanistic analysis of HIIT on modulating risk and symptoms of depression: A systematic review
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The exact causal mechanisms of depression remain unclear due to the complexity of the triggers, which has led to limitations in treating depression using modern drugs. High-intensity interval training (HIIT) is as effective as medication in treating depression without toxic side effects. Typically, HIIT requires less time commitment (i.e., shorter exercise duration) and exhibits pronounced benefits on depressive symptoms than other forms of physical exercise. This review summarizes the risk reduction and clinical effects of HIIT for depression and discusses the underlying mechanisms, providing a theoretical basis for utilizing HIIT in treating depression.
A database search was conducted in PubMed, Embase, Web of Science, and Scopus from inception up to October 2022. The methodological quality of the included literature was evaluated by the physiotherapy evidence database (PEDro) scale criteria. The review focused on evaluating the changes in depression risk or symptoms of HIIT interventions in healthy individuals, patients with depression, and patients with other disorders co-morbid with depression. Consequently, the mechanisms associated with depression related HIIT were summarized.
A total of 586 participants (52 % female; mean age: 43.58±8.93 years) from 22 studies were included. Implementing HIIT using different exercise types alleviates depressive symptoms in individuals with depression and in individuals with depression who have exhibited comorbidities and reduced depression scale scores in subjects immediately after acute exercise. In addition, the long-interval HIIT and short-interval HIIT in the treatment of patients with cardiovascular or psychiatric disorders may reduce depressive symptoms via complex exercise-related changes on several levels, including by effecting the following measures: releasing monoamines, reducing neuronal death, inducing neurogenesis, modulating the functional homeostasis of the HPA axis, and enhancing the level of inflammation in the body.
HIIT is a relatively safe and effective antidepressant, which may involve multiple neurobiological mechanisms (release of monoamines, reducing neuronal death, inducing neurogenesis, modulating the functional homeostasis of the HPA axis, and enhancing the level of inflammation in the body), thereby reducing the risk or symptoms of depression in participants.
Effect of high-intensity interval training compared to moderate-intensity continuous training on body composition and insulin sensitivity in overweight and obese adults: A systematic review and meta-analysis
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To compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on adults with overweight and obesity. Outcomes, including changes in insulin sensitivity, weight, body mass index (BMI), waist circumference, and body fat, were analyzed.
A systematic literature review was conducted. This review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42021281899. Clinical trials involving individuals who are overweight and obese and comparing HIIT with MICT effects on insulin sensitivity, weight, BMI, body fat percentage, and waist circumference were included. PubMed, Web of Science, Embase, and Scopus databases were searched using controlled vocabulary and free-text terms related to HIIT, obesity, and overweight. The search included studies published until September 2022. The Rob2 tool was used to assess the risk of bias. The results were presented through meta-analyses that provided summary estimators and confidence intervals. Subgroup analyses were conducted to assess the effect of the risk of bias on the outcomes. This research did not receive any specific funding.
Of the 2534 articles, 30 met the eligibility criteria. The intervention duration ranged from 4 to 16 weeks. The observed effects for each outcome were as follows: insulin sensitivity (p = 0.02), weight (p = 0.58), BMI (p = 0.53), waist circumference (p = 0.87), body fat percentage (p = 0.07), body fat mass in kilograms (p = 0.39). The level of evidence obtained was moderate except for waist circumference, which was rated as low. Limitations included heterogeneity in training protocols, measurements, and study duration. Additionally, a risk of bias was identified in these studies.
HIIT and MICT did not significantly differ in their effects on weight, BMI, waist circumference, or body fat mass in adults with overweight and obesity. However, a moderate beneficial effect of HIIT was observed on insulin sensitivity. Therefore, further evidence is required to confirm these findings.
Organization of Rehabilitation Services in Randomized Controlled Trials: Which Factors Influence Functional Outcome? A Systematic Review
2022, Archives of Rehabilitation Research and Clinical Translation
To identify factors related to the organization of rehabilitation services that may influence patients’ functional outcome and make recommendations for categories to be used in the reporting of rehabilitation interventions.
A systematic review based on a search in MEDLINE indexed journals (MEDLINE [OVID], Cumulative Index of Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials) until June 2019.
In total 8587 candidate randomized controlled trials reporting on organizational factors of multidisciplinary rehabilitation interventions and their associations with functional outcome. An additional 1534 trials were identified from June 2019 to March 2021. Data Extraction: Quality evaluation was conducted by 2 independent researchers. The organizational factors were classified according to the International Classification for Service Organization in Health-related Rehabilitation 2.0.
In total 80 articles fulfilled the inclusion criteria. There was a great heterogeneity in the terminology and reporting of service organization across all studies. Aspects of Settings including the Mode of Service Delivery was the most explicitly analyzed organizational category (44 studies). The importance of the integration of rehabilitation in the inpatient services was supported. Furthermore, several studies documented a lack of difference in outcome between outpatient vs inpatient service delivery. Patient Centeredness, Integration of Care, and Time and Intensity factors were also analyzed, but heterogeneity of interventions in these studies prohibited aggregation of results.
Settings and in particular the way the services were delivered to the users influenced functional outcome. Hence, it should be compulsory to include a standardized reporting of aspects of service delivery in clinical trials. We would also advise further standardization in the description of organizational factors in rehabilitation interventions to build knowledge of effective service organization.
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: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

: In-press corrected proof published online on May 8, 2012, at www.archives-pmr.org.

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Featured articleOriginal articleCardiac Rehabilitation in Chronic Heart Failure: Effect of an 8-Week, High-Intensity Interval Training Versus Continuous Training

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Participants

Results

Discussion

Conclusions

Acknowledgments

Arch Cardiovasc Dis

Ann Cardiol Angeiol (Paris)

J Am Coll Cardiol

Am J Cardiol

Ann Cardiol Angeiol (Paris)

Am J Cardiol

Am J Cardiol

Am Heart J

Arch Phys Med Rehabil

Arch Phys Med Rehabil

J Am Coll Cardiol

Ann Phys Rehabil Med

Chest

Controlled trial of physical training in chronic heart failureExercise performance, hemodynamics, ventilation, and autonomic function

Circulation

Safety and effects of physical training in chronic heart failureResults of the Chronic Heart Failure and Graded Exercise study (CHANGE)

Eur Heart J

Combined endurance/resistance training reduces NT-proBNP levels in patients with chronic heart failure

Eur Heart J

Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: a randomized trial

JAMA

Featured article
Original article
Cardiac Rehabilitation in Chronic Heart Failure: Effect of an 8-Week, High-Intensity Interval Training Versus Continuous Training