High-intensity interval training in cardiac resynchronization therapy: a randomized control trial
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To determine the effects of high-intensity interval training (HIIT) following cardiac resynchronization therapy (CRT) implantation in patients with chronic heart failure (CHF), on noninvasive estimates of systolic ventricular function, exercise performance, severity of symptoms and quality of life.
Cardiopulmonary exercise testing, resting transthoracic echocardiogram and health-related quality of life assessment were obtained before and at 6 months after CRT implantation in 37 patients with moderate-to-severe CHF. Patients were randomized after CRT to either a 24-week HIIT group (90–95% peak heart rate, 2 days per week) or to a usual care group (CON). Mixed design 2 × 2 repeated measures ANOVA were used to test for differences within and in-between groups.
Improvements in health-related quality of life (HIIT = 98.54%, CON = 123.47%), NYHA class (HIIT = 43.44%, CON = 38.30%) HR recovery at minute 1 (HIIT = 32.32%, CON = 42.94%), pulse pressure at peak effort (HIIT = 14.06%, CON = 9.52%, LVEF (HIIT = 42.17%, CON = 51.10%) and LV Mass (HIIT = 13.26%, CON = 11.88%) were similar in both groups (p > 0.05). Significant increases in CPET duration in the HIIT group (25.94%), and increases in peak VO2 (HIIT = 8.64%, CON = 4.85%) and percent-predicted VO2 (HIIT = 10.57%, CON = 4.26%) in both groups, were observed in the intention-to-treat analysis.
Six months of HIIT in patients in CRT did not further improved indices of functional capacity and health-related quality of life, and LV structure and function, compared to CRT alone. However, HIIT led to further improvements in exercise performance. It remains unclear whether HIIT benefits patients in CRT to a similar degree as more conventional forms of exercise training previously shown to maximize benefits in CRT.
Clinical trial registration
http://www.clinicaltrials.gov. Unique identifier: NCT02413151.
KeywordsExercise capacity Chronic heart failure Reduced ejection fraction Exercise training
Chronic heart failure
Cardiopulmonary exercise testing duration
Cardiac resynchronization therapy
High-intensity interval training
- HR recovery 1 min
Heart rate recovery at 1 min after CPET
- HR recovery 3 min
Heart rate recovery at 3 min after CPET
Left ventricular ejection fraction
- LV mass
Left ventricular mass
- LV EDV
Left ventricular end-diastolic volume
- LV ESV
Left ventricular end-systolic volume
New York Heart Association Functional Scale
- Peak PP
Pulse pressure at peak effort during cardiopulmonary exercise testing
- Peak RPP
Rate pressure product at peak effort during cardiopulmonary exercise testing
- Peak HR
Heart rate at peak effort during cardiopulmonary exercise testing
- Peak VO2
Oxygen consumption at peak effort during cardiopulmonary exercise testing
Respiratory exchange ratio
The authors would like to thank Dr. Neil Oldridge’s suggestions on the manuscript. We would also acknowledge the contributions of the cardiopulmonary technicians and the medical interns in cardiology from Hospital Santa-Marta, and Mafalda Carinha from Faculdade de Motricidade Humana, Universidade de Lisboa.
HSC, AA contributed to conception and design, critically revised the manuscript, and gave final approval. VS contributed to acquisition, analysis, critically revised the manuscript and gave final approval. XM contributed to acquisition, analysis, interpretation, drafted the manuscript and gave final approval. RP and BF contributed to interpretation, critically revised manuscript, and gave final approval. PC, MO, MMC contributed to acquisition, critically revised the manuscript, and gave final approval.
This research was supported by National funding from the Portuguese Foundation for Science and Technology (PTDC/DES/120249/2010).
Compliance with ethical standards
Conflict of interest
The authors have no competing interests.
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