Benefits and Risks of High-Intensity Interval Training in Patients With Coronary Artery Disease

The PAD-adapted 30-20-10 during Nordic walking: A new exercise training session in patients with symptomatic peripheral artery disease

This study aimed to investigate the feasibility of a peripheral artery disease (PAD)-adapted 30-20-10 Nordic walking session in patients with symptomatic PAD and to compare the cardiovascular response of this new training session to a traditional walking (TW) and 4 × 4 minutes Nordic walking session. This is a prospective observational study. Patients with Fontaine stage II PAD were included. Patients participated in Nordic walking sessions, which were randomly assigned as TW, 4 × 4 minute intervals, and peripheral artery disease adapted 30-20-10 exercise session (PAD-adapted 30-20-10 sessions). PAD-adapted 30-20-10 and 4 × 4 minutes sessions consisted of 4 repetitions of 4 minutes of effort followed by 3 minutes of passive recovery. PAD-adapted 30-20-10 session was characterized by 4 continuous 1-min repetitions at 3 different walking speeds [high (30 seconds), moderate (20 seconds) and low (10 seconds)]. During the 4 × 4 minutes session, patients were asked to cover the maximal distance at a constant speed. During TW session, patients were asked to walk at a speed inducing moderate-to-severe claudication pain. Heart rate, rating of perceived exertion (RPE) and claudication pain intensity using a visual analog scale were assessed. The perceived enjoyment of each session was assessed using a visual analog scale ranging from 0 (not enjoyable) to 10 (very enjoyable). Eleven patients with chronic symptomatic PAD were included (62 ± 13 years; 54% women). The mean heart rate during the time of effort was significantly higher in PAD-adapted 30-20-10 group than in 4 × 4 minutes and TW groups (127 ± 12, 122 ± 12, 114 ± 11 bpm, respectively; P ≤ .001). The mean rating of perceived exertion (16 ± 1, 15 ± 1, 13 ± 1; P ≤ .001) and claudication pain intensity (8 ± 1, 7 ± 1; 7 ± 1 mm; P ≤ .019) were significantly higher during PAD-adapted 30-20-10 sessions than during 4 × 4 minutes and TW sessions. The perceived enjoyment was similar among sessions (8.7 ± 1.6 for TW, 8.6 ± 1.7 for 4 × 4 minutes, and 8.8 ± 1.8 mm for PAD-adapted 30-20-10 sessions; P = .935). The PAD-adapted 30-20-10 session is feasible and induces higher cardiovascular stimulation and claudication pain than 4 × 4 minutes and TW procedures in patients with symptomatic PAD. Despite these different responses, a similar perceived enjoyment among the sessions has been shown. Future investigations are needed to examine the effects of this new training session in these patients.

Cardiomyocyte Adaptation to Exercise: K+ Channels, Contractility and Ischemic Injury

Cardiovascular disease is a leading cause of morbidity and mortality, and exercise-training (TRN) is known to reduce risk factors and protect the heart from ischemia and reperfusion injury. Though the cardioprotective effects of exercise are well-documented, underlying mechanisms are not well understood. This review highlights recent findings and focuses on cardiac factors with emphasis on K+ channel control of the action potential duration (APD), β-adrenergic and adenosine regulation of cardiomyocyte function, and mitochondrial Ca2+ regulation. TRN-induced prolongation and shortening of the APD at low and high activation rates, respectively, is discussed in the context of a reduced response of the sarcolemma delayed rectifier potassium channel (IK) and increased content and activation of the sarcolemma KATP channel. A proposed mechanism underlying the latter is presented, including the phosphatidylinositol-3kinase/protein kinase B pathway. TRN induced increases in cardiomyocyte contractility and the response to adrenergic agonists are discussed. The TRN-induced protection from reperfusion injury is highlighted by the increased content and activation of the sarcolemma KATP channel and the increased phosphorylated glycogen synthase kinase-3β, which aid in preventing mitochondrial Ca2+ overload and mitochondria-triggered apoptosis. Finally, a brief section is presented on the increased incidences of atrial fibrillation associated with age and in life-long exercisers.

Short-duration aerobic high-intensity intervals versus moderate exercise training intensity in patients with peripheral artery disease: study protocol for a randomised controlled trial (the Angiof-HIIT Study)

INTRODUCTION

Supervised exercise training is among the first-line therapies for patients with peripheral artery disease (PAD). Current recommendations for exercise include guidance focusing on claudication pain, programme and session duration, and frequency. However, no guidance is offered regarding exercise training intensity. This study aims to compare the effects of 12-week-long supervised walking exercise training (high-intensity interval training (HIIT) vs moderate-intensity exercise (MOD)) in patients with chronic symptomatic PAD.

METHODS AND ANALYSIS

This study is a monocentric, interventional, non-blinded randomised controlled trial. 60 patients (30 in each group) will be randomly allocated (by using the random permuted blocks) to 12 weeks (three times a week) of HIIT or MOD. For HIIT, exercise sessions will consist of alternating brief high-intensity (≥85% of the peak heart rate (HRpeak)) periods (≤60 s) of work with periods of passive rest. Patients will be asked to complete 1 and then 2 sets of 5-7 (progressing to 10-15×60 s) walking intervals. For the MOD group, exercise training sessions will consist of an alternation of periods of work performed at moderate intensity (≤76% HRpeak) and periods of passive rest. Interventions will be matched by training load. The primary outcome will be the maximal walking distance. Secondary outcomes will include functional performance, functional capacity, heath-related quality of life, self-perceived walking abilities, physical activity and haemodynamic parameters.

ETHICS AND DISSEMINATION

The Angiof-HIIT Study was approved by the Human Research Ethics Committee of the Canton de Vaud (study number: 2022-01752). Written consent is mandatory prior to enrolment and randomisation. The results will be disseminated via national and international scientific meetings, scientific peer-reviewed journals and social media.

TRIAL REGISTRATION NUMBER

NCT05612945.

The relationship between different exercise conditions and pericoronary inflammation as quantified by coronary CTA in coronary artery disease

Objectives

The correlation between exercise type and intensity and coronary artery inflammation in patients with stable coronary artery disease (CAD) is unknown. Therefore, this study assessed the relationship between coronary inflammation quantified by coronary computed tomography angiography (CCTA) and exercise intensity and pattern in patients with CAD.

Materials and methods

Patients who underwent CCTA between 2019 and 2023 in the second hospital of Lanzhou University were retrospectively examined. We calculated the pericoronary fat attenuation index (FAI) on the right coronary artery (RCA) as a marker of coronary inflammation. We compared basic information, exercise status, and RCA-FAI values between the two groups, and described the relationship between different exercise durations and RCA-FAI using analysis of variance and restricted cubic splines.

Results

In total, 1222 patients were included: 774 had no CAD and 448 patients had CAD. Sex (P = 0.016; odds ratio [OR]: 0.673), high-density lipoprotein (P = 0.006; OR: 0.601), low-density lipoprotein (P = 0.001; OR. 0.762), hypertension (P = 0.000; OR: 0.762), smoking (P = 0.005; OR: 0.670), and postprandial glucose (P = 0.030; OR: 0.812), household income (P = 0.038; OR:1.117), and body mass index (P = 0.000; OR:1.084) were the risk factors for elevated RCA-FAI values in the patients with coronary artery disease group. And when the exercise modality was running and aerobics, the correlation between RCA-FAI values and exercise time showed a "U"-shaped relationship. Follow-up revealed that short periods of high-intensity exercise resulted in lower RCA-FAI values.

Conclusion

RCA-FAI was significantly associated with coronary artery inflammation. Although appropriate physical activity reduced the risk of pericoronary inflammation and coronary atherosclerosis, overly prolonged exercise could exacerbate the coronary inflammatory response and increase the likelihood of CAD.

The effects of separate and simultaneous upper and lower body cycling on cardiorespiratory responses in young men

BACKGROUND

The aim of the present study was to examine the relative cardiorespiratory and perceptual responses to upper body ergometry, lower body ergometry, and combined upper and lower body ergometry at increasing exercising intensities.

METHODS

Eight healthy males between 19 and 30 years of age completed three exercise sessions over seven days that included graded leg ergometry, arm ergometry, and combined arm and leg ergometry in counterbalanced fashion. During leg-only and arm-only sessions, participants exercised at workloads of 0, 32, 64, and 95 W. The combined session involved simultaneous arm and leg ergometry at 0, 32, 64, and 95 W, thus eliciting double the total power output of arm-only and leg-only sessions.

RESULTS

At all workloads, oxygen consumption and minute ventilation responses were greater during combined arm and leg exercise than during leg-only or arm-only exercise. However, the pattern of changes in heart rate, systolic blood pressure, rate pressure product, and rating of perceived exertion (RPE) were similar in response to arm-only and combined upper and lower body exercise, despite combined exercise involving double the workload. These cardiorespiratory and perceptual responses were significantly lower during leg-only only exercise.

CONCLUSIONS

The results of the study add to limited research comparing physiological and perceptual responses to upper, lower, and combined upper and lower body exercise. The findings highlight heightened cardiorespiratory and perceptual responses to upper body exercise alone or in combination with lower body exercise. Training that combines upper and lower body may create higher power output and elicit greater caloric expenditure while eliciting similar cardiovascular responses as upper body only exercise at moderate and higher intensities.

Acute effects of high intensity interval training versus moderate intensity continuous training on haemostasis in patients with coronary artery disease

Exercise training is associated with an acute net increase in coagulation, which may increase the risk of atherothrombosis in coronary artery disease (CAD) patients. We sought to compare the acute haemostatic effects of a bout of moderate-intensity continuous (MICT) and high-intensity interval training (HIIT) in patients with CAD. Patients after a recent myocardial infarction were randomized into a HIIT or MICT session of exercise training on a stationary bike. Blood was sampled at baseline, after the exercise bout and after a one-hour resting period. We measured overall haemostatic potential (OHP), overall coagulation potential (OCP), fibrinogen, D-dimer and von Willebrand factor (vWF) and calculated overall fibrinolytic potential (OFP). Linear mixed models for repeated measures were constructed to assess the treatment effect. A total of 117 patients were included. OCP, OHP, fibrinogen, D-dimer and vWF significantly increased after exercise and returned to baseline after a one-hour rest, OFP decreased after exercise and returned to baseline levels after a one-hour rest. Linear mixed models showed a significant difference between HIIT and MICT in fibrinogen (p 0.043) and D-dimer (p 0.042). Our study has shown that an exercise bout is associated with a transient procoagulant state in patients with CAD, with similar exercise-induced haemostatic changes for HIIT and MICT.

Elucidating the primary mechanisms of high-intensity interval training for improved cardiac fitness in obesity

Obesity is a global and rising multifactorial pandemic associated with the emergence of several comorbidities that are risk factors for malignant cardiac remodeling and disease. High-intensity interval training (HIIT) has gained considerable attention due to its favorable outcomes of cardiometabolic health in individuals with overweight or obese. The primary aim of this review is to discuss the fundamental processes through which HIIT improves cardiac impairment in individuals with obesity to develop viable treatments for obesity management. In this review, a multiple database search and collection were conducted from the earliest record to January 2013 for studies included the qualitative component of HIIT intervention in humans and animals with overweight/obesity related to cardiac remodeling and fitness. We attempt to integrate the main mechanisms of HIIT in cardiac remolding improvement in obesity into an overall sequential hypothesis. This work focus on the ameliorative effects of HIIT on obesity-induced cardiac remodeling with respect to potential and pleiotropic mechanisms, including adipose distribution, energy metabolism, inflammatory response, insulin resistance, and related risk profiles in obesity. In conclusion, HIIT has been shown to reduce obesity-induced risks of cardiac remodeling, but the long-term effects of HIIT on obesity-induced cardiac injury and disease are presently unknown. Collective understanding highlights numerous specific research that are needed before the safety and effectiveness of HIIT can be confirmed and widely adopted in patient with obesity.

Extraordinary claims in the literature on high-intensity interval training (HIIT): III. Critical analysis of four foundational arguments from an interdisciplinary lens

Kinesiology aspires to be an integrated, interdisciplinary field that studies human movement from multiple perspectives. However, the main societal deliverables of the field, namely exercise prescriptions and physical activity recommendations, still reflect fragmentation, placing more emphasis on physiological outcomes than on behavioral and other considerations. Recently, researchers have called for the introduction of High-Intensity Interval Training (HIIT) to the domain of public health, based on the argument that HIIT can maximize fitness and health benefits for a fraction of the time recommended by the prevailing model of physical activity in public-health guidelines. Here, we show that an unintended side-effect of arguments underpinning the implementation of HIIT in the domain of public health might have been the exacerbation of segmentation. To highlight the value of interdisciplinarity, four foundational claims in support of HIIT are critiqued by tapping into cognate literatures: (1) the primary reason people do not exercise is lack of time, (2) HIIT is relevant to public health, (3) HIIT is being proposed as merely another option, so there is no basis for controversy, and (4) HIIT is safe and well tolerated. These claims are contradicted by credible lines of evidence. To improve the accuracy and effectiveness of its public claims, kinesiology should remain committed to the ideals of integration and interdisciplinarity.

The Effects of Resistance Exercise on the Cardiorespiratory Tissue of Rats with Parkinson's Disease

Parkinson's Disease (PD) affects the cardiorespiratory system, causing an increase in the left ventricular mass in the heart and respiratory muscle weakness in relation to healthy individuals. The objective of this study was to investigate the effects of progressive resistive physical exercise on the vertical ladder on the histomorphometry of cardiac tissue and respiratory muscles in rats with PD. Seventy male Wistar rats, aged 40 days old, were divided into Parkinson's (PD) and Sham (SH) groups; they were also subdivided into groups that performed progressive resistive physical exercise on the vertical ladder Before Surgery (ExBS), After Surgery (ExAS), and Before and After Surgery (ExBAS). The physical training was carried out before and/or after PD induction. Exercise was performed five times a week for 25 min/day for four or eight weeks. PD induction was conducted via electrolytic stimulation of the Substantia nigra of the animals' brains, adopting the following stereotaxic table coordinates: -4.9; lateral medium equal to 1.7, and dorsoventral equal to 8.1. For the morphometric analysis of the heart, the following variables were calculated: relative weight and diameter and thickness of the left ventricle. The diaphragm and the myocardial, intercostal, and abdominal muscles were stained with Hematoxylin and Eosin (HE). The histomorphometric analysis was performed using the ImageJ software to assess the cross-sectional area of muscles and the number of muscle fibers. Progressive resistance exercise promoted the hypertrophy of respiratory muscles and the left ventricle in animals with PD.

Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations

The prescription of exercise for individuals with and without cardiovascular disease (CVD) should be scientifically-based yet adapted to the patient. This scientific statement reviews the clinical and physiologic basis for the prescription of exercise, with specific reference to the volume of physical activity (PA) and level of cardiorespiratory fitness (CRF) that confer significant and optimal cardioprotective benefits. Recommendations are provided regarding the appropriate intensity, frequency, and duration of training; the concept of MET-minutes per week; critical components of the exercise session (warm-up, conditioning phase, cool-down); methodologies for establishing the training intensity, including oxygen uptake reserve (V̇O2R), target heart rate derivation and rating perceived exertion; minimum and goal intensities for exercise training; and, types of training activities, including resistance training, adjunctive lifestyle PA, marathon/triathlon training, and high-intensity interval training. In addition, we discuss the rationale for and value of exercise training programs for patients with peripheral artery disease, diabetes mellitus, and heart failure.

Effect of Exercise on Carotid Artery Intima-Media Thickness in Adults: A Systematic Review and Meta-Analysis

BACKGROUND

Carotid intima-media thickness (cIMT) is a validated surrogate marker of atherosclerosis that is independently associated with the risk for cardiovascular disease. Recent studies on the effect of exercise on cIMT have yielded conflicting results.

METHODS

Studies that were available up until October 30, 2021 from the PubMed, Cochrane Library, Embase, and Web of Science databases were included in the analysis. Subgroup analyses were performed to determine the effects of the type, intensity, and duration of exercise on cIMT.

RESULTS

This review included 26 studies with 1370 participants. Compared with control participants, those who engaged in exercise showed a decline in cIMT (weighted mean difference [WMD] -0.02; 95% confidence interval [CI], -0.03 to -0.01; I2 = 90.1%). Participants who engaged in aerobic (WMD -0.02; 95% CI, -0.04 to -0.01; I2 = 52.7%) or resistance (WMD -0.01; 95% CI, -0.02 to -0.00; I2 = 38.5%) exercise showed lower cIMT compared with control participants. An exercise duration of >6 months was associated with a 0.02 mm reduction in cIMT. In participants with low cIMT at baseline (<0.7 mm), exercise alone was not associated with a change in cIMT (WMD -0.01; 95% CI, -0.03 to 0.00; I2 = 93.9%).

CONCLUSIONS

Exercise was associated with reduced cIMT in adults. Aerobic exercise is associated with a greater decline in cIMT than other forms of exercise. Large, multicenter, randomized controlled trials are required to establish optimal exercise protocols for improving the pathological process of atherosclerosis.

Feasibility and impact of whole-body high-intensity interval training in patients with stable coronary artery disease: a randomised controlled trial

Exercise training reduces cardiovascular mortality and improves quality of life in CAD patients. We investigated the feasibility and impact of 12 weeks of low-volume high-intensity interval training (HIIT) in CAD-patients. Patients with stable CAD were randomized 1:1 to supervised HIIT or standard care. HIIT sessions were completed three times weekly for 12 weeks on a rowing ergometer. Before and after the 12-week intervention, patients completed a physiological evaluation of cardiorespiratory performance and quality of life questionnaires. Mixed model analysis was used to evaluate differences between and within groups. A total of 142 patients (67 ± 9 years, n_HIIT = 64, n_{Standard care} = 78) completed the trial. Training adherence was 97% (range 86-100%). Six patients dropped out because of non-fatal adverse events. Weekly training duration was 54 min with an average power output of 138 W. HIIT increased peak oxygen uptake by 2.5 mL/kg/min (95% CI 2.1-3.0), whereas no change was observed in standard care (0.2 mL/kg/min, 95% CI - 0.2-0.6, P < 0.001). In addition, HIIT improved markers of quality of life, including physical functioning, limitations due to physical illness, general health and vitality (P < 0.05). Twelve weeks of low-volume whole-body HIIT increased cardiorespiratory capacity and improved quality of life in patients with stable CAD compared to standard care. In addition, our study demonstrates that the applied vigorous training regime is feasible for this patient group.Clinical trial registration: www.clinicaltrials.gov . Identification number: NCT04268992.

Which high-intensity interval training program is more effective in patients with coronary artery disease?

The aim of the study is to examine high-intensity interval training (HIIT) programs and a moderate-intensity continuous training (MICT) program, which are frequently used in cardiac rehabilitation programs in terms of their effects on the functional capacity and quality of life of patients with coronary artery disease (CAD). The study included 20 patients with CAD (mean age, 60.95 ± 5.08 years) who had undergone revascularization surgery. The participants were randomized into HIIT-short, HIIT-long, and MICT groups. All the groups participated in a 24-session exercise-based cardiac rehabilitation program. The participants' exercise capacity was evaluated using the maximal exercise test and estimated VO2max values, functional capacity using the 6-min walk test (6MWT), and quality of life using the Short Form-36 survey and MacNew Heart Disease Health-related Quality of Life (MacNew) questionnaire. It was determined that the estimated VO2max values statistically significantly improved after treatment (P < 0.05), and both HIIT groups were superior to the MICT group (P < 0.05). Only the HIIT groups achieved the minimal clinically important difference in the 6MWT distance. After treatment, only the MICT group had a statistically significant improvement in quality of life. There was no statistically significant difference between the groups in relation to the improvement in the 6MWT distance and quality of life (P > 0.05). The results of our study showed that both HIIT programs were superior to MICT in improving the maximal exercise capacity of patients with CAD, and the three programs had a similar effect on quality of life.

Fit, Female or Fifty–Is Cardiac Rehabilitation “Fit” for Purpose for All? A Systematic Review and Meta-Analysis With Meta-Regression

Aims

Cardiac rehabilitation (CR) is an evidence-based intervention promoting risk factor modification following coronary artery disease events but the relative benefits for patient subgroups is not clear. This review synthesizes the available evidence on the effectiveness of modern CR programs and determines outcomes for age, sex and prior level of fitness.

Methods

MEDLINE, CINAHL, and EMBASE were examined for RCT and cohort studies involving exercise prescription or phase II or III CR following Myocardial Infarction (MI), Percutaneous Coronary Intervention (PCI) and cardiac surgery from January 2010 to February 2021. Outcomes assessed included peakVO2max, 6-min walk test and Metabolic Equivalent of Task. Meta-regression was used to determine CR impact for change in fitness and age and sex influences.

Results

The mean age of study participants was 59.5 years and 82.7% were male. Females, younger people and those of average or above cardiorespiratory fitness were substantially under-represented in data and attendance, with 13% of study groups with a mean age &lt;55 years. At entry, 73% were below average for fitness vs. age-matched normative values. Fitness improved across all groups following CR with no evidence of sex or age independently affecting outcomes.

Conclusions

Modest improvements in fitness in all groups were shown, but the benefits of CR can be far greater. A modern, innovative approach to CR will likely lead to more substantial benefits. This may require a “Precision Medicine” model which tailors exercise prescription to different populations to ensure all CR participant's needs are met. This will ensure that CR is more flexible and accessible for all.

Analysis of the Effect of External Counterpulsation Combined With High-Intensity Aerobic Exercise on Cardiopulmonary Function and Adverse Cardiovascular Events in Patients With Coronary Heart Disease After PCI

Purpose

To explore the intervention effect of external counterpulsation (ECP) combined with high-intensity aerobic exercise (HIAT) on patients with coronary heart disease (CHD) after PCI.

Methods

124 patients with stable CHD after PCI admitted to our hospital from June 2018 to June 2021 were selected, and all patients were divided into control group and observation group using the random number table method. The control group received conventional treatment, The observation group received ECP combined with HIAT based on the control group. The cardiorespiratory function indexes, exercise endurance indexes, incidence of major cardiovascular adverse events (MACE), Barthel index of the two groups were observed.

Results

After intervention, METs _max, VO_2max, VO_2max/kg, VO_2max/HR, and PP, ED, AT, and Barthel score in both groups were significantly higher than before intervention, and patients in the observation group were significantly higher than those in the control group (P < 0.05). The incidence of MACE in the observation group (3.23%) was lower than in the control group (12.90%) (P < 0.05).

Conclusion

ECP combined with HIAT can improve the cardiopulmonary function of patients with CHD after PCI, and improve exercise endurance, reduce the incidence of MACE, improve patients' ability of daily living.

Cardiac Rehabilitation and Resting Blood Pressure: MONTANA OUTCOMES PROJECT CARDIAC REHABILITATION REGISTRY FINDINGS

PURPOSE

Exercise-based cardiac rehabilitation (CR) is essential for treating cardiovascular disease, and modifying risk factor modification, including hypertension. Because the causes of hypertension and benefits of CR are faceted, we examined the influence of phase II CR on resting blood pressure (BP).

METHODS

Outcomes straddle the release of the updated BP guidelines, and study emphases included CR session number, sex, race/ethnicity, insurance provider, and referring diagnosis.

RESULTS

Patient files of 31 885 individuals uploaded to the Montana Outcomes Project registry indicated that lowered systolic and diastolic BP were further improved after the release of the revised BP guidelines. The CR session number was proportional to improvements in diastolic BP. Blood pressure improved independent of sex, although female patients exhibited lower diastolic BP before and after CR. Race/ethnicity analyses indicated that Asian and White patients experienced drops in systolic and diastolic BP, while diastolic BP was improved in Hispanic patients. Neither American Indian nor Black patients exhibited statistically altered BP. Medicare, Veterans Administration, and privately insured patients had lowered systolic and diastolic BP, while Medicaid patients had lower diastolic BP, and the uninsured had lower systolic BP. Blood pressure outcomes were generally improved independent of the primary referring diagnosis, while those with peripheral artery disease showed no improvements.

CONCLUSIONS

Findings demonstrate that phase II CR is highly effective in the control of BP, although improvements are not equally distributed to all individuals according to differences in sex, race/ethnicity, and access to insurance-funded health care.

Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.

When It HIITs, You Feel No Pain: Psychological and Psychophysiological Effects of Respite-Active Music in High-Intensity Interval Training

The authors investigated the effects of respite-active music (i.e., music used for active recovery in between high-intensity exercise bouts) on psychological and psychophysiological outcomes. Participants (N = 24) made four laboratory visits for a habituation, medium- and fast-tempo music conditions, and a no-music control. A high-intensity interval-training protocol comprising 8 × 60-s exercise bouts at 100% Wmax with 90-s active recovery was administered. Measures were taken at the end of exercise bouts and recovery periods (rating of perceived exertion [RPE], state attention, and core affect) and then upon cessation of the protocol (enjoyment and remembered pleasure). Heart rate was measured throughout. Medium-tempo music enhanced affective valence during exercise and recovery, while both music conditions increased dissociation (only during recovery), enjoyment, and remembered pleasure relative to control. Medium-tempo music lowered RPE relative to control, but the heart rate results were inconclusive. As predicted, medium-tempo music, in particular, had a meaningful effect on a range of psychological outcomes.

High level physical activity in cardiac rehabilitation: Implications for exercise training and leisure-time pursuits

IMPORTANCE

Regular moderate-to-vigorous physical activity and increased levels of cardiorespiratory fitness (CRF) are widely promoted as cardioprotective measures in secondary prevention interventions.

OBSERVATIONS

A low level of CRF increases the risk of cardiovascular disease (CVD) to a greater extent than merely being physically inactive. An exercise capacity <5 metabolic equivalents (METs), generally corresponding to the bottom 20% of the fitness continuum, indicates a higher mortality group. Accordingly, a key objective in early cardiac rehabilitation (CR) is to increase the intensity of training to >3 METs, to empower patients to vacate this "high risk" group. Moreover, a "good" exercise capacity, expressed as peak METs, identifies individuals with a favorable long-term prognosis, regardless of the underlying extent of coronary disease. On the other hand, vigorous-to-high intensity physical activity, particularly when unaccustomed, and some competitive sports are associated with a greater incidence of acute cardiovascular events. Marathon and triathlon training/competition also have limited applicability and value in CR, are associated with acute cardiac events each year, and do not necessarily provide immunity to the development of or the progression of CVD. Furthermore, extreme endurance exercise regimens are associated with an increased incidence of atrial fibrillation and accelerated coronary artery calcification.

CONCLUSIONS AND RELEVANCE

High-intensity training offers a time-saving alternative to moderate intensity continuous training, as well as other potential advantages. Additional long-term studies assessing safety, adherence, and morbidity and mortality are required before high-intensity CR training can be more widely recommended, especially in previously sedentary patients with known or suspected CVD exercising in non-medically supervised settings.

Effect of High-Intensity Interval Training on Physical Health in Coronary Artery Disease Patients: A Meta-Analysis of Randomized Controlled Trials

The effects of exercise-based cardiac rehabilitation (CR) on physical health in coronary artery disease (CAD) patients has long been established, while the optimal exercise mode remains to be determined. This meta-analysis compared the efficacy of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) in CAD patients. Databases were searched up to December 2020. Twenty-five studies with 1272 participants were analyzed. The results showed that both HIIT and MICT induced significant VO_2peak improvement with a 4.52 mL/kg/min (p < 0.01) and 2.36 mL/kg/min (p < 0.01), respectively. Additionally, a larger improvement of VO_2peak (1.92 mL/kg/min, p < 0.01) was observed in HIIT over MICT. HIIT with medium and long intervals, higher work/rest ratio induced larger VO_2peak improvement than the compared subgroup. Interestingly, non-isocaloric exercise protocols induced larger VO_2peak improvement compared with isocaloric protocols. In addition, both HIIT and MICT significantly increased anaerobic threshold and peak power with HIIT superior to MICT. No significant different changes were observed in blood pressure after HIIT or MICT intervention, however when HIIT was compared with MICT, MICT seems superior to HIIT in reducing systolic blood pressure (−3.61 mmHg, p < 0.01) and diastolic blood pressure (−2.37 mmHg, p < 0.01). Although, HIIT and MICT induced significant improvement of most other parameters, like HR_rest, HR_peak, left ventricular ejection fraction (LVEF), quality of life (QoL), no significant differences were noted between groups. This meta-analysis suggested that HIIT is superior to MICT in increasing VO_2peak, anaerobic threshold, peak power in CAD patients. Additionally, the efficacy of HIIT over MICT in improving VO_2peaks was influenced by HIIT intervals, work/rest ratio and total caloric consumption. Both HIIT and MICT did not significantly influence resting BP, however, MICT seemed to be more effective in reducing BP than HIIT. HIIT and MICT equally significantly influenced HR_rest, HR_peak, HRR1min, OUES, LVEF%, QoL.

Cognitive effectiveness of high-intensity interval training for individuals with methamphetamine dependence: a study protocol for randomised controlled trial

INTRODUCTION

Cognitive deficit is a common syndrome of methamphetamine (MA) dependence. It is related to decision-making, control ability, and social functioning. High-intensity interval training (HIIT) is a training technique that requires people to work out at full intensity during a short period. Many studies have already shown the potential effects of HIIT on cognitive functions. The purpose of this trial is to evaluate the cognitive effects of HIIT on individuals with MA dependence.

METHODS AND ANALYSIS

A total of 240 individuals with MA dependence will be randomly assigned to the HIIT group, moderate-intensity continuous training (MICT) group and control (CON) group. HIIT will consist of a 24-min HIIT exercise on a treadmill. MICT will consist of a 1-h body-mind exercise. CON will be their traditional intervention. The experimental period will be 12 months with 3 interventions weekly for the first 6 months and follow-up for the next 6 months. All subjects will be given cognitive tests at baseline, after intervention and at follow-up. Cognitive performances will be compared by a mixed-model analysis for repeated measures.

DISCUSSION

HIIT training may reduce illicit drug cravings amongst individuals with MA dependence; hence, HIIT may have a good effect on the cognitive functions, such as memory and executive function, of individuals with MA dependence.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000032492 . Registered on April 30, 2020 ( http://www.chictr.org.cn/edit.aspx?pid=52127&htm=4 ).

Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity

Exercise based cardiac rehabilitation (CR) is recognized internationally as a class 1 clinical practice recommendation for patients with select cardiovascular diseases and heart failure with reduced ejection fraction. Over the past decade, several meta-analyses have generated debate regarding the effectiveness of exercise-based CR for reducing all-cause and cardiovascular mortality. A common theme highlighted in these meta-analyses is the heterogeneity and/or lack of detail regarding exercise prescription methodology within CR programs. Currently there is no international consensus on exercise prescription for CR, and exercise intensity recommendations vary considerably between countries from light-moderate intensity to moderate intensity to moderate-vigorous intensity. As cardiorespiratory fitness [peak oxygen uptake (VO₂peak)] is a strong predictor of mortality in patients with coronary heart disease and heart failure, exercise prescription that optimizes improvement in cardiorespiratory fitness and exercise capacity is a critical consideration for the efficacy of CR programming. This review will examine the evidence for prescribing higher-intensity aerobic exercise in CR, including the role of high-intensity interval training. This discussion will highlight the beneficial physiological adaptations to pulmonary, cardiac, vascular, and skeletal muscle systems associated with moderate-vigorous exercise training in patients with coronary heart disease and heart failure. Moreover, this review will propose how varying interval exercise protocols (such as short-duration or long-duration interval training) and exercise progression models may influence central and peripheral physiological adaptations. Importantly, a key focus of this review is to provide clinically-relevant recommendations and strategies to optimize prescription of exercise intensity while maximizing safety in patients attending CR programs.

Effects of Aging on Hemodynamic Kinetics in Different Intensities of Dynamic Exercise

Healthy aging hemodynamics is known to exhibit a time-dependent loss of function. We aimed at verifying whether older men would have a slowed cardiac output and stroke volume dynamics in response to the onset ("on") and on recovery ("off") of exercise in comparison to young men. Twenty healthy active men (10 young and 10 older) were recruited. Participants performed an incremental cardiopulmonary exercise testing on a cycle ergometer, and on another day, 3 constant workload tests in different intensities. Compared to younger, older men exhibited a slower cardiac output and stroke volume dynamics in both on and off transients for all exercise intensities (all P < 0.05). During higher intensities, both younger and older men had slower hemodynamic kinetics compared to lower intensities (all P < 0.05). There was strong negative relationship between the time constant of cardiac output on-kinetics during high-intensity with maximal exercise performance in both groups (r = -0.88, P < 0.01). We interpret these findings to mean that healthy older men have slowed hemodynamic kinetics compared to younger, but this difference becomes less evident in higher intensities of exercise.

Exercise Preconditioning as a Cardioprotective Phenotype

Cardiovascular disease (CVD) is potentiated by risk factors including physical inactivity and remains a leading cause of morbidity and mortality. Although regular physical activity does not reverse atherosclerotic coronary disease, precursory exercise improves clinical outcomes in those experiencing life-threatening CVD events. Exercise preconditioning describes the cardioprotective phenotype whereby even a few exercise bouts confer short-term multifaceted protection against acute myocardial infarction. First described decades ago in animal investigations, cardioprotective mechanisms responsible for exercise preconditioning have been identified through reductionist preclinical studies, including the upregulation of endogenous antioxidant enzymes, improved calcium handling, and enhanced bioenergetic regulation during a supply-demand mismatch. Until recently, translation of this research was only inferred from clinically-directed animal models of exercise involving ischemia-reperfusion injury, and reinforced by the gene products of exercise preconditioning that are common to mammalian species. However, recent clinical investigations confirm that exercise preconditions the human heart. This discovery means that simply the initiation of a remedial exercise regimen in those with abnormal CVD risk factor profiles will provide immediate cardioprotective benefits and improved clinical outcomes following acute cardiac events. In conclusion, the prophylactic biochemical adaptations to aerobic exercise are complemented by the long-term adaptive benefits of vascular and architectural remodeling in those who adopt a physically active lifestyle.

Effects of high-intensity interval training in patients with coronary artery disease after percutaneous coronary intervention: A systematic review and meta-analysis

AIM

To evaluate whether high-intensity interval training (HIIT) was superior to low-intensity training or usual care among patients after percutaneous coronary intervention. The hypothesis was that HIIT would help patients after percutaneous coronary intervention (PCI) improve cardiopulmonary function, lipid profiles and in-stent restenosis.

DESIGN

A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA)2009 Checklist.

METHODS

Randomized controlled trials (RCTs) focusing on HIIT programme in patients after PCI were searched in Cochrane Library, Web of Science Core Collection, EMbase, PubMed, China National Knowledge Infrastructure (CNKI) and SinoMed from the inception to 24 March 2020. Standard Mean difference (SMD) and 95% confidence intervals (CI) were performed to summarize the effect sizes.

RESULTS

Six RCTs (247 patients) met the criteria. HIIT programme had a statistically significant effect on raising left ventricular ejection function (LVEF) (SMD = 0.38, 95%CI [0.03, 0.73], I2  = 3%), VO2peak (SMD = 0.94, 95%CI [0.61, 1.28], I2  = 0%), as well as improving the serum level of high-density lipoprotein (SMD = 0.55, 95%CI [0.06, 1.03], I2  = 0%) and late luminal loss (SMD = -0.65, 95%CI [-1.07, -0.23], I2  = 0%). But HIIT had no prominent effect on improving heart rate (SMD = -0.04, 95%CI [-0.29, 0.21], I2  = 0%). Summarily, HIIT programme appears to be favourable for CAD patients after PCI by improving cardiopulmonary function, such as LVEF and VO2peak , as well as reducing late luminal loss in per stented arteries. Nevertheless, HIIT has no advantage for adjusting heart rate. More researches with rigorous methods are warranted to explore the controversy about lipid profiles.

Safety and improvement in exercise tolerance with interval training vs moderate-intensity continuous training in heart disease patient of very high cardiovascular risk

Objetivo:

Evaluar la seguridad y el efecto del entrenamiento por intervalos de moderada y alta intensidad (EIMI, EIAI) y compararlo con el entrenamiento de intensidad moderada continua (EIMC) en pacientes de riesgo cardiovascular (RCV) muy alto.

Método:

Estudio cuasi experimental de 81 pacientes que ingresaron al programas de rehabilitación cardíaca y prevención secundaria (PRHCPS); en la estratificación de riesgo, todos los pacientes presentaron ≥ 2 factores de RCV alto. Entrenamiento concurrente: aeróbico supervisado: 2 semanas de entrenamiento de base de EIMC; luego el grupo EIMC con la misma prescripción, EIMI a 3 intervalos de 3’ al 70 a 80% de FCR con pausas activas de 3’ al 60 a 70% de FCR; EIAI, 3 intervalos de 3’ a 80 a 90% de FCR con pausas activas de 3’ al 70 a 80% de FCR, entrenamiento de fuerza con tres sesiones semanales de ejercicios isotónicos y una de calistenia e intervención multidisciplinaria.

Resultados:

81 pacientes asignados en tres grupos: 61 a EIMC, 13 a EIMI y 7 a EIAI, sin diferencias significativas en las variables epidemiológicas. Hubo ganancias porcentuales en MET-carga de 45%, 60% y 86% (p = 0.17) y carga-vatios de 51, 44 y 48 en EIMC, EIMI, EIAI, respectivamente (p = 0.54). A pesar de no existir diferencias estocásticamente significativas intergrupales, sí se registró una ganancia mayor en MET-carga en el grupo de EIAI. No se observó desenlace adverso en ningún tipo de entrenamiento.

Conclusiones:

En cardiópatas de riesgo cardiovascular muy alto, el entrenamiento interválico EIMI/EIAI supervisado es seguro, con tendencia a mayor ganancia en tolerancia al esfuerzo (MET-carga) con el EIAI en comparación con el EIMC.

Clinical evaluation of high intensity interval training exercise in coronary heart disease patients after percutaneous coronary intervention: A protocol for systematic review and meta-analysis

BACKGROUND:

Although the effect of high intensity interval training (HIIT) was gradually explicit, little is explored about the role and the validity of HIIT on patients following percutaneous coronary intervention (PCI). As far as we know, no evidence has been established to assess HIIT program for coronary heart disease (CHD) patients attending cardiac rehabilitation after PCI. Therefore, this systematic review and meta-analysis will be conducted to assess the efficacy and safety of HIIT program for CHD patients attending cardiac rehabilitation after PCI.

METHODS:

Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library will be searched in March 2021 by 2 independent reviewers. Study included in this systematic review and meta-analysis has to meet all of the following inclusion criteria in the PICOS order: 1. Participants: CHD patients after PCI; 2. Intervention: patients received HIIT; 3. Comparator: patients received other treatment; 4. Outcomes: cardiopulmonary function, lipid profiles and in- stent restenosis; 5. Study design: cohort trials. Data extraction will be performed independently, and any conflict will be resolved before final analysis. Review Manager software (v 5.3; Cochrane Collaboration) is used for the meta-analysis.

RESULTS:

The results of this research will be delivered in a peer-reviewed journal.

CONCLUSION:

This study expects to provide credible and scientific clinical evidence for the efficacy and safety of HIIT program for CHD patients attending cardiac rehabilitation after PCI.

OSF REGISTRATION NUMBER:

10.17605/OSF.IO/AUMR6.

Brief Vigorous Stair Climbing Effectively Improves Cardiorespiratory Fitness in Patients With Coronary Artery Disease: A Randomized Trial

Background: Cardiac rehabilitation exercise reduces the risk of secondary cardiovascular disease. Interval training is a time-efficient alternative to traditional cardiac rehabilitation exercise and stair climbing is an accessible means. We aimed to assess the effectiveness of a high-intensity interval stair climbing intervention on improving cardiorespiratory fitness (V˙O2peak) compared to standard cardiac rehabilitation care.

Methods: Twenty participants with coronary artery disease (61 ± 7 years, 18 males, two females) were randomly assigned to either traditional moderate-intensity exercise (TRAD) or high-intensity interval stair climbing (STAIR). V˙O2peak was assessed at baseline, following 4 weeks of six supervised exercise sessions and after 8 weeks of ~24 unsupervised exercise sessions. TRAD involved a minimum of 30 min at 60–80%HR_peak, and STAIR consisted of three bouts of six flights of 12 stairs at a self-selected vigorous intensity (~90 s/bout) separated by recovery periods of walking (~90 s). This study was registered as a clinical trial at clinicaltrials.gov (NCT03235674).

Results: Two participants could not complete the trial due to the time commitment of the testing visits, leaving n = 9 in each group who completed the interventions without any adverse events. V˙O2peak increased after supervised and unsupervised training in comparison to baseline for both TRAD [baseline: 22.9 ± 2.5, 4 weeks (supervised): 25.3 ± 4.4, and 12 weeks (unsupervised): 26.5 ± 4.8 mL/kg/min] and STAIR [baseline: 21.4 ± 4.5, 4 weeks (supervised): 23.4 ± 5.6, and 12 weeks (unsupervised): 25 ± 6.2 mL/kg/min; p (time) = 0.03]. During the first 4 weeks of training (supervised) the STAIR vs. TRAD group had a higher %HR_peak (101 ± 1 vs. 89 ± 1%; p ≤ 0.001), across a shorter total exercise time (7.1 ± 0.1 vs. 36.7 ± 1.1 min; p = 0.009). During the subsequent 8 weeks of unsupervised training, %HR_peak was not different (87 ± 8 vs. 96 ± 8%; p = 0.055, mean ± SD) between groups, however, the STAIR group continued to exercise for less time per session (10.0 ± 3.2 vs. 24.2 ± 17.0 min; p = 0.036).

Conclusions: Both brief, vigorous stair climbing, and traditional moderate-intensity exercise are effective in increasing V˙O2peak, in cardiac rehabilitation exercise programmes.

Adherence to High-Intensity Interval Training in Cardiac Rehabilitation: A REVIEW AND RECOMMENDATIONS

PURPOSE

High-intensity interval training (HIIT) is gaining popularity as a training approach for patients attending cardiac rehabilitation (CR). While the literature has focused on the efficacy of HIIT for improving cardiorespiratory fitness (CRF), particularly when compared with moderate intensity exercise, less emphasis has been placed on adherence to HIIT. The aim of this review was to summarize the current literature regarding adherence to HIIT in CR patients with coronary artery disease.

REVIEW METHODS

A review identified 36 studies investigating HIIT in CR patients with coronary artery disease. Methods and data were extracted for exercise or training adherence (to attendance, intensity, and duration), feasibility of protocols, and CRF. The review summarizes reporting of adherence; adherence to HIIT and comparator/s; the influence of adherence on changes in CRF; and feasibility of HIIT.

SUMMARY

Adherence to the attendance of HIIT sessions was high and comparable with moderate-intensity exercise. However, adherence to the intensity and duration of HIIT was variable and underreported, which has implications for determining the treatment effect of the exercise interventions being compared. Furthermore, additional research is needed to investigate the utility of home-based HIIT and long-term adherence to HIIT following supervised programs. This review provides recommendations for researchers in the measurement and reporting of adherence to HIIT and other exercise interventions to facilitate a sufficient and consistent approach for future studies. This article also highlights strategies for clinicians to improve adherence, feasibility, and enjoyment of HIIT for their patients.

Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure

Cardiac rehabilitation is a package of lifestyle secondary prevention strategies designed for patients with coronary heart disease and chronic heart failure. A community-based cardiac rehabilitation programme provides patients with a structured exercise training intervention alongside educational support and psychological counselling. This review provides an update regarding the clinical benefits of community-based cardiac rehabilitation from a psycho-physiological perspective, and also focuses on the latest epidemiological evidence regarding potential survival benefits. Behaviour change is key to long-term adoption of a healthy and active lifestyle following a cardiac event. In order for lifestyle interventions such as structured exercise interventions to be adopted by patients, practitioners need to ensure that behaviour change programmes are mapped against patient's priorities and values, and adapted to their level of readiness and intention to engage with the target behaviour. We review the evidence regarding behaviour change strategies for cardiac patients and provide practitioners with the latest guidance. The 'dose' of exercise training delivered to patients attending exercise-based cardiac rehabilitation is an important consideration because an improvement in peak oxygen uptake requires an adequate physiological stimulus to invoke positive physiological adaptation. We conclude by critically reviewing the latest evidence regarding exercise dose for cardiac patients including the role of traditional and more contemporary training interventions including high intensity interval training.

The feasibility of implementing high-intensity interval training in cardiac rehabilitation settings: a retrospective analysis

Background

Cardiovascular disease is the leading cause of death worldwide. Notwithstanding the well-known benefits of cardiac rehabilitation (CR), adherence to CR remains low, particularly in women. High-intensity interval training (HIIT) has received specific attention as an emerging exercise-training paradigm that addresses frequently cited barriers to CR (i.e. lack of motivation/enjoyment and time, perceiving exercise regime as tiring/boring) and improves cardiovascular risk factors. Previous studies have examined the safety of HIIT in CR; there is little evidence on the feasibility of HIIT in CR. The aims of this study were to evaluate the feasibility of HIIT within a CR setting and examine the sex differences regarding the feasibility of such programming.

Methods

Patients attended an on-site HIIT CR program (10-min warm-up, 25 min of interspersed high-intensity [HI - 4 min at 85–95% HRpeak] and lower intensity [LO - 3 min at 60–70% HRpeak] intervals, 10-min cool-down) twice weekly for 10 weeks. Heart rate (HR) and the Borg rating of perceived exertion (RPE) scale (6–20 points) were recorded at each session. Feasibility was assessed by: [1] attendance and compliance: the number of sessions attended and the compliance to the prescribed HI and LO HR ranges; [2] the patient experience: patients’ perceived effort, program difficulty, if the program was challenging and satisfying; and, [3] safety. Descriptive statistics were used to report the means and their variations. Mann-Whitney U tests and Chi-square analyses were performed to examine sex-differences.

Results

A total of 151 patients (33% women, 57.5 ± 9.1 years) attended the HIIT program and completed 16 ± 5 classes with a low attrition rate (11.3%). Most patients met or exceeded the prescribed target HR for the HI (80%) and LO (84%) intervals, respectively. Patients reported a “somewhat hard” RPE for HI (14 ± 2 points) and “very light” for LO (10 ± 2 points) intervals. All patients were satisfied with the program and found it challenging. Most patients found HIIT to be difficult (7 ± 2 points, scale range 0–10 points), yet safe (97%). Three vasovagal episodes occurred and more women dropped-out of the program than men (p < 0.01).

Conclusions

HIIT is a feasible, safe and well-received exercise paradigm in a CR setting.

Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective-An Update: A Scientific Statement From the American Heart Association

Epidemiological and biological plausibility studies support a cause-and-effect relationship between increased levels of physical activity or cardiorespiratory fitness and reduced coronary heart disease events. These data, plus the well-documented anti-aging effects of exercise, have likely contributed to the escalating numbers of adults who have embraced the notion that "more exercise is better." As a result, worldwide participation in endurance training, competitive long distance endurance events, and high-intensity interval training has increased markedly since the previous American Heart Association statement on exercise risk. On the other hand, vigorous physical activity, particularly when performed by unfit individuals, can acutely increase the risk of sudden cardiac death and acute myocardial infarction in susceptible people. Recent studies have also shown that large exercise volumes and vigorous intensities are both associated with potential cardiac maladaptations, including accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, and atrial fibrillation. The relationship between these maladaptive responses and physical activity often forms a U- or reverse J-shaped dose-response curve. This scientific statement discusses the cardiovascular and health implications for moderate to vigorous physical activity, as well as high-volume, high-intensity exercise regimens, based on current understanding of the associated risks and benefits. The goal is to provide healthcare professionals with updated information to advise patients on appropriate preparticipation screening and the benefits and risks of physical activity or physical exertion in varied environments and during competitive events.

Integration of metabolomics and proteomics to reveal the metabolic characteristics of high-intensity interval training

Metabolomics and proteomics were integrated to research the molecular characterization of high-intensity interval training, revealing changes in biological pathways.

Exercise Parameters and Outcome Measures Used in Cardiac Rehabilitation Programs Following Median Sternotomy in the Elderly: A Systematic Review and Meta-Analysis

OBJECTIVE

The aim of this systematic review was to identify exercise parameters and outcome measures used in cardiac rehabilitation programs following median sternotomy, in the elderly cardiac population.

DATA SOURCES

Five (5) electronic databases were searched for relevant studies published in English after 1997.

STUDY SELECTION

The screening process was completed by two independent researchers, with a third independent reviewer for overall agreement. Studies were selected if they included only cardiac patients aged ≥65 years who had undergone valve surgery and/or coronary artery bypass grafting via median sternotomy, and who had undertaken a postoperative cardiac rehabilitation exercise intervention assessing physical function and/or cognitive recovery as outcomes.

DATA EXTRACTION

Two researchers independently completed the data extraction and quality assessment. Quality was assessed using a modified Downs and Black tool.

DATA SYNTHESIS

In total, 11 articles were included for appraisal with respect to the quality of the study. Only two randomised controlled trials were suitable for meta-analysis. A higher volume of exercise was shown to have a positive effect on functional recovery, assessed using the 6-minute walk test (6MWT) (mean difference=26.97m; 95% confidence interval [CI], 6.96-46.97; p=0.008; I²=0%). No significant improvement was shown between additional exercise compared to standard care in improving VO_2peak, maximal power output or quality of life. No studies evaluated the effect of exercise on cognitive recovery.

CONCLUSIONS

Exercise significantly improves functional recovery in the post-surgical elderly cardiac population, however uncertainty still exists with regard to which modes of exercise and their specific parameters are most effective in improving cognitive recovery.