Abstract
Background
In a previous meta-analysis including nine trials comparing aerobic interval training with aerobic continuous training in patients with coronary artery disease, we found a significant difference in peak oxygen uptake favoring aerobic interval training.
Objective
The objective of this study was to (1) update the original meta-analysis focussing on peak oxygen uptake and (2) evaluate the effect on secondary outcomes.
Methods
We conducted a systematic review with a meta-analysis by searching PubMed and SPORTDiscus databases up to March 2017. We included randomized trials comparing aerobic interval training and aerobic continuous training in patients with coronary artery disease or chronic heart failure. The primary outcome was change in peak oxygen uptake. Secondary outcomes included cardiorespiratory parameters, cardiovascular risk factors, cardiac and vascular function, and quality of life.
Results
Twenty-four papers were identified (n = 1080; mean age 60.7 ± 10.7 years). Aerobic interval training resulted in a higher increase in peak oxygen uptake compared with aerobic continuous training in all patients (1.40 mL/kg/min; p < 0.001), and in the subgroups of patients with coronary artery disease (1.25 mL/kg/min; p = 0.001) and patients with chronic heart failure with reduced ejection fraction (1.46 mL/kg/min; p = 0.03). Moreover, a larger increase of the first ventilatory threshold and peak heart rate was observed after aerobic interval training in all patients. Other cardiorespiratory parameters, cardiovascular risk factors, and quality of life were equally affected.
Conclusion
This meta-analysis adds further evidence to the clinically significant larger increase in peak oxygen uptake following aerobic interval training vs. aerobic continuous training in patients with coronary artery disease and chronic heart failure. More well-designed randomized controlled trials are needed to establish the safety of aerobic interval training and the sustainability of the training response over longer periods.
Similar content being viewed by others
References
Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095–128.
Wilkins E, Wilson L, Wickramasinghe K, et al. European cardiovascular disease statistics: 2017 edition. Available from: http://www.ehnheart.org/cvd-statistics.html. Accessed 25 May 2017.
Anderson L, Oldridge N, Thompson DR, et al. Exercise-based cardiac rehabilitation for coronary heart disease Cochrane systematic review and meta-analysis. J Am Coll Cardiol. 2016;67(1):1–12.
Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024–35.
Vanhees L, Stevens A, Schepers D, et al. Determinants of the effects of physical training and of the complications requiring resuscitation during exercise in patients with cardiovascular disease. Eur J Cardiovasc Prev Rehabil. 2004;11(4):304–12.
Moholdt T, Madssen E, Rognmo Ø, et al. The higher the better? Interval training intensity in coronary heart disease. J Sci Med Sport. 2014;17(5):506–10.
Mezzani A, Hamm LF, Jones AM, et al. Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation. Eur J Prev Cardiol. 2013;20(3):442–67.
Rognmo Ø, Hetland E, Helgerud J, et al. High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease. Eur J Cardiovasc Prev Rehabil. 2004;11:2016–22.
Wisløff U, Støylen A, Loennechen JP, et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation. 2007;115:3086–94.
Smart NA, Dieberg G, Giallauria F. Intermittent versus continuous exercise training in chronic heart failure: a meta-analysis. Int J Cardiol. 2013;166:352–8.
Haykowsky MJ, Timmons MP, Kruger C, et al. Meta-analysis of aerobic interval training on exercise capacity and systolic function in patients with heart failure and reduced ejection fraction. Am J Cardiol. 2013;111:1466–9.
Xie B, Yan X, Cai X, et al. Effects of high-intensity training on aerobic capacity in cardiac patients: a systematic review with meta-analysis. Biomed Res Int. 2017;2017:5420840.
Liou K, Ho S, Fildes J, et al. High intensity interval versus moderate intensity continuous training in patients with coronary artery disease: a meta-analysis of physiological and clinical parameters. Heart Lung Circ. 2016;25:166–74.
Elliot AD, Rajopadhyaya K, Bentley DJ, et al. Interval training versus continuous exercise in patient with coronary artery disease: a meta-analysis. Heart Lung Circ. 2015;24:149–57.
Pattyn N, Coeckelberghs E, Buys R, et al. Aerobic interval training vs. moderate continuous training in coronary artery disease patients: a systematic review and meta-analysis. Sports Med. 2014;44:687–700.
Cornelis J, Beckers P, Taeymans J, et al. Comparing exercise training modalities in heart failure: a systematic review and meta-analysis. Int J Cardiol. 2016;221:867–76.
Moher D, Liberati A, Tetzlaff J, et al. Preferred Reporting Items for Systematic Reviews and Meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
Smart NA, Waldron M, Ismail H, et al. Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. Int J Evid Based Health. 2015;13(1):9–18.
Follman D, Elliott P, Suh I, et al. Variance imputation for overviews of clinical trials with continuous response. Clin Epidemiol. 1992;45(7):769–73.
Vanhees L, Geladas N, Hansen D, et al. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR. Part II. Eur J Prev Cardiol. 2012;19(5):1005–33.
Nechwatal RM, Duck C, Gruber G. Physical training as interval or continuous training in chronic heart failure for improving functional capacity, hemodynamics and quality of life: a controlled study. Z Kardiol. 2002;91(4):328–37.
Gremeaux M, Hannequin A, Laurent Y, et al. Usefulness of the 6-minute walk test and the 200-metre fast walk test to individualize high intensity interval and continuous exercise training in coronary artery disease patients after acute coronary syndrome: a pilot controlled clinical study. Clin Rehabil. 2011;25(9):844–55.
Kavanagh T, Shephard RJ. Conditioning of postcoronary patients: comparison of continuous and interval training. Arch Phys Med Rehabil. 1975;56(2):72–6.
Gaeini AA, Fallah AA, Kazemi F. Effects of aerobic continuous and interval training on rate-pressure product in patients after CABG surgery. J Sports Med Phys Fitness. 2015;55(1–2):76–83.
Möbius-Winckler S, Uhlemann M, Adams V, et al. Coronary collateral growth induced by physical exercise: results of the impact of intensive exercise training on coronary collateral circulation in patients with stable coronary artery disease (EXCITE) trial. Circulation. 2016;133(15):1438–48.
Tschentscher M, Eichinger J, Egger A, et al. High-intensity interval training is not superior to other forms of endurance training during cardiac rehabilitation. Eur J Prev Cardiol. 2016;23(1):14–20.
Prado DML, Rocco EA, Silva AG, et al. Effects of continuous vs interval exercise training on oxygen uptake efficiency slope in patients with coronary artery disease. Braz J Med Biol Res. 2016;49(2):e4890.
Yaylalı YT, Fındıkoğlu G, Yurtdaş M, et al. The effects of baseline heart rate recovery normality and exercise training protocol on heart rate recovery in patients with heart failure. Anatol J Cardiol. 2015;15(9):727–34.
Iellamo F, Manzi V, Caminiti G, et al. Dose-response relationship of baroreflex sensitivity and heart rate variability to individually-tailored exercise in patients with heart failure. Int J Cardiol. 2013;166:334–9.
Iellamo F, Manzi V, Caminiti G, et al. Validation of rate of perceived exertion-based exercise training in patients with heart failure: Insights from autonomic nervous system adaptations. Int J Cardiol. 2014;176(2):394–8.
Currie KD, Rosen LM, Millar PJ, et al. Heart rate recovery and heart rate variability are unchanged in patients with coronary artery disease following 12 weeks of high-intensity interval and moderate-intensity endurance exercise training. Appl Physiol Nutr Metab. 2013;38(6):644–50.
Amundsen BH, Rognmo Ø, Hatlen-Rebhan G, et al. High-intensity aerobic exercise improves diastolic function in coronary artery disease. Scand Cardiovasc J. 2008;42(2):110–7.
Roditis P, Dimopoulos S, Sakellariou D, et al. The effects of exercise training on the kinetics of oxygen uptake in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2007;14(2):304–11.
Warburton DE, McKenzie DC, Haykowsky MJ, et al. Effectiveness of high-intensity interval training for the rehabilitation of patients with coronary artery disease. Am J Cardiol. 2005;95:1080–4.
Dimopoulos S, Anastasiou-Nana M, Sakellariou D, et al. Effects of exercise rehabilitation program on heart rate recovery in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2006;13:67–73.
Moholdt TT, Amundsen BH, Rustad LA, et al. Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: a randomized study of cardiovascular effects and quality of life. Am Heart J. 2009;158:1031–7.
Freyssin C, Verkindt C, Prieur F, et al. Cardiac rehabilitation in chronic heart failure: effects of an 8-week, high-intensity training versus continuous training. Arch Phys Med Rehabil. 2012;93:1359–64.
Rocco EA, Prado DM, Silva AG, et al. Effects of continuous and interval exercise training on PETCO2 response during graded exercise test in patients with coronary artery disease. Clinics. 2012;67:623–8.
Smart NA, Steele M. A comparison of 16 weeks of continuous vs intermittent exercise training in chronic heart failure patients. Congest Heart Fail. 2012;18:205–11.
Currie KD, Dubberley JB, McKelvie RS, et al. Low-volume, high-intensity interval training in patients with CAD. Med Sci Sports Exerc. 2013;45:1436–42.
Fu TC, Wang CH, Lin PS, et al. Aerobic interval training improves oxygen uptake efficiency by enhancing cerebral and muscular hemodynamics in patients with heart failure. Int J Cardiol. 2013;167:41–50.
Iellamo F, Manzi V, Caminiti G, et al. Matched dose interval and continuous exercise training induce similar cardiorespiratory and metabolic adaptations in patients with heart failure. Int J Cardiol. 2013;167:2561–5.
Iellamo F, Caminiti G, Sposato B, et al. Effect of high-intensity interval training versus moderate continuous training on 24-h blood pressure profile and insulin resistance in patients with chronic heart failure. Intern Emerg Med. 2014;9(5):547–52.
Keteyian SJ, Hibner BA, Bronsteen K, et al. Greater improvements in cardiorespiratory fitness using higher-intensity interval training in the standard cardiac rehabilitation setting. J Cardiopulm Rehabil Prev. 2014;34:98–105.
Koufaki PK, Mercer TH, George KP, et al. Low-volume high-intensity interval training vs continuous aerobic cycling in patients with chronic heart failure: a pragmatic randomised clinical trial of feasibility and effectiveness. J Rehabil Med. 2014;46:348–56.
Madssen E, Moholdt T, Videm V, et al. Coronary atheroma regression and plaque characteristics assessed by grayscale and radiofrequency intravascular ultrasound after aerobic exercise. Am J Cardiol. 2014;114:1504–11.
Aksoy S, Findikoglu G, Ardic F, et al. Effect of 10-week supervised moderate-intensity vs. continuous aerobic exercise programs on vascular adhesion molecules in patients with heart failure. Am J Phys Med Rehabil. 2015;94:898–911.
Angadi SS, Mookadam F, Lee CD, et al. High-intensity interval training vs. moderate-intensity continuous exercise training in heart failure with preserved ejection fraction: a pilot study. J App Physiol. 2015;119:753–8.
Benda NM, Seeger JP, Stevens GG, et al. Effects of high-intensity training versus continuous training on physical fitness, cardiovascular function and quality of life in heart failure patients. PloS One. 2015;10:e0141256.
Cardozo GG, Oliveira RB, Farinatti PT. Effects of high intensity interval versus moderate continuous training on markers of ventilatory and cardiac efficiency in coronary heart disease patients. Sci World J. 2015;2015:192472.
Conraads VM, Pattyn N, De Maeyer C, et al. Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the SAINTEX-CAD study. Int J Cardiol. 2015;179:203–10.
Kim C, Choi HE, Lim MH. Effect of high interval training in acute myocardial infarction patients with drug-eluting stent. Am J Phys Med Rehabil. 2015;94:879–86.
Jaureguizar KV, Vicente-Campos D, Bautista LR, et al. Effect of high-intensity interval versus continuous exercise training on functional capacity and quality of life in patients with coronary artery disease: a randomized controlled trial. J Cardiopulm Rehabil Prev. 2016;36:96–105.
Ulbrich AZ, Angarten VG, Netto AS, et al. Comparative effects of high intensity interval training versus moderate intensity continuous training on quality of life in patients with hearts failure: study protocol for a randomized controlled trial. Clin Trials Regul Sci Cardiol. 2016;13:21–8.
Ellingsen Ø, Halle M, Conraads V, et al. High-intensity interval training in patients with heart failure with reduced ejection fraction. Circulation. 2017;135:839–49.
Fletcher GF, Balady GJ, Amsterdam EA, et al. Exercise standard for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation. 2001;104(14):1694–740.
Fletcher GF, Ades PA, Kligfield P, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128:873–934.
Gibbons RJ, Balady GJ, Beasley JW, et al. ACC/AHA guidelines for exercise testing: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Exercise Testing). Circulation. 1997;96:345–54.
Pattyn N, Vanhees L, Cornelissen VA, et al. The long-term effects of a randomized trial comparing aerobic interval versus continuous training in coronary artery disease patients: 1-year data from the SAINTEX-CAD study. Eur J Prev Cardiol. 2016;23(11):1154–64.
Ramos JS, Dalleck LC, Tjonna AE, et al. The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review and meta-analysis. Sports Med. 2015;45:679–92.
Inaba Y, Chen JA, Bergmann SR. Prediction of future cardiovascular outcomes by flow-mediated vasodilatation of brachial artery: a meta-analysis. Int J Cardiovasc Imaging. 2010;26(6):631–40.
Ras RT, Streppel MT, Draijer R, et al. Flow-mediated dilation and cardiovascular risk prediction: a systematic review with meta-analysis. Int J Cardiol. 2013;168(1):344–51.
Thompson PD, Franklin BA, Balady GJ, et al. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation. 2007;115(17):2358–68.
Williams PT, Thompson PD. Increased cardiovascular disease mortality associated with excessive exercise in heart attack survivors. Mayo Clin Proc. 2014;89(9):1187–94.
Mittleman MA, Maclure M, Tofler GH, et al. Triggering of acute myocardial infarction by heavy physical exertion: protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med. 1993;329(23):1677–83.
Rognmo O, Moholdt T, Bakken H, et al. Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation. 2012;126(12):1436–40.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No sources of funding were used to assist in the preparation of this article.
Conflict of interest
Nele Pattyn, Randy Beulque, and Véronique Cornelissen have no conflicts of interest directly relevant to the content of this review.
Authors’ responsibilities
All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Pattyn, N., Beulque, R. & Cornelissen, V. Aerobic Interval vs. Continuous Training in Patients with Coronary Artery Disease or Heart Failure: An Updated Systematic Review and Meta-Analysis with a Focus on Secondary Outcomes. Sports Med 48, 1189–1205 (2018). https://doi.org/10.1007/s40279-018-0885-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40279-018-0885-5