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Gomes-Neto M, Durães AR, Conceição LSR, Saquetto MB, Alves IG, Smart NA, Carvalho VO. Effects of Different Exercise Interventions on Cardiorespiratory Fitness, as Measured by Peak Oxygen Consumption in Patients with Coronary Heart Disease: An Overview of Systematic Reviews. Sports Med 2024; 54:2395-2409. [PMID: 39037575 DOI: 10.1007/s40279-024-02053-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Exercise is an important component of rehabilitation care for people with coronary heart disease (CHD). OBJECTIVES The aim of this study was to critically analyze and summarize the existing evidence from published systematic reviews (SRs) and meta-analyses of randomized controlled trials (RCTs) that have evaluated the effects of different types of exercise interventions on cardiorespiratory fitness, as measured by peak oxygen consumption in people with CHD. METHODS Electronic databases (Cochrane Library, Medline/PubMed, EMBASE, and PEDro) were searched for SRs of exercise interventions of people with CHD. Two reviewers assessed the quality of SRs using the AMSTAR-2 tool and evaluated the strength of evidence quality with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system for relevant outcome measures. Mean difference (MD) and 95% confidence intervals (CIs) were calculated. RESULTS Thirty-one SRs (with 125 RCTs) met the study criteria, including 33,608 patients. Compared with usual care, continuous aerobic exercise produced an improvement in peak oxygen consumption, MD of 3.8 mL kg-1 min-1 (95% CI: 3.204.4, I2 = 67%); high-intensity interval training, MD 6.1 mL kg-1 min-1 (95% CI: 0.4-11.8, I2 = 97%); resistance training, MD of 2.1 mL kg-1 min-1 (95% CI: 0.98-3.2, I2 = 60%); combined aerobic and resistance training, MD of 3.0 mL kg-1 min-1 (95% CI: 2.5-3.4, I2 = 0%); and water-based exercise, MD of 4.4 mL kg-1 min-1 (95% CI, 2.1-6.7; I2 = 2%). CONCLUSION Exercise interventions improve peak oxygen consumption in people with CHD. However, there was moderate to very-low certainty for the evidence found.
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Affiliation(s)
- Mansueto Gomes-Neto
- Department of Physical Therapy, Federal University of Sergipe (Universidade Federal de Sergipe-UFS), Postgraduate Program in Health Science, Aracaju, SE, Brazil.
- Physical Therapy Department, Federal University of Bahia (UFBA), Salvador, BA, Brazil.
- Physiotherapy Research Group, UFBA, Salvador, BA, Brazil.
- Postgraduate Program in Medicine and Health, UFBA, Salvador, BA, Brazil.
- Physiotherapy Department, Multidisciplinary Institute for Rehabilitation and Health, Federal University of Bahia (UFBA), Rua Padre Feijó, nº 312 (Casas 47 e 49), Bairro Canela, Salvador, BA, 40.110-170, Brazil.
| | | | - Lino Sérgio Rocha Conceição
- Department of Physical Therapy, Federal University of Sergipe (Universidade Federal de Sergipe-UFS), Postgraduate Program in Health Science, Aracaju, SE, Brazil
| | - Michelli Bernardone Saquetto
- Physical Therapy Department, Federal University of Bahia (UFBA), Salvador, BA, Brazil
- Physiotherapy Research Group, UFBA, Salvador, BA, Brazil
- Postgraduate Program in Medicine and Health, UFBA, Salvador, BA, Brazil
| | | | - Neil A Smart
- School of Science and Technology in the Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia
| | - Vitor Oliveira Carvalho
- Department of Physical Therapy, Federal University of Sergipe (Universidade Federal de Sergipe-UFS), Postgraduate Program in Health Science, Aracaju, SE, Brazil
- Physiotherapy Research Group, UFBA, Salvador, BA, Brazil
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Milani JGPO, Milani M, Verboven K, Cipriano G, Hansen D. Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice. Front Cardiovasc Med 2024; 11:1380639. [PMID: 39257844 PMCID: PMC11383788 DOI: 10.3389/fcvm.2024.1380639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 08/01/2024] [Indexed: 09/12/2024] Open
Abstract
Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn't accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg's ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).
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Affiliation(s)
- Juliana Goulart Prata Oliveira Milani
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, Brazil
| | - Mauricio Milani
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, Brazil
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Kenneth Verboven
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Biomedical Research Institute (BIOMED), Hasselt, Belgium
| | - Gerson Cipriano
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, Brazil
- Graduate Program in Human Movement and Rehabilitation of Evangelical (PPGMHR), UniEVANGÉLICA, Anápolis, Brazil
| | - Dominique Hansen
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Biomedical Research Institute (BIOMED), Hasselt, Belgium
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Marinus N, Cornelissen V, Meesen R, Coninx K, Hansen D. Are exercise prescriptions for patients with cardiovascular disease, made by physiotherapists, in agreement with European recommendations? Eur J Cardiovasc Nurs 2024; 23:230-240. [PMID: 37439451 DOI: 10.1093/eurjcn/zvad065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/14/2023]
Abstract
AIMS Physiotherapists often treat patients with (elevated risk for) cardiovascular disease (CVD), and should thus be able to provide evidence-based exercise advice to these patients. This study, therefore, aims to examine whether exercise prescriptions by physiotherapists to patients with CVD are in accordance with European recommendations. METHODS AND RESULTS This prospective observational survey included forty-seven Belgian physiotherapists. The participants agreed to prescribe exercise intensity, frequency, session duration, program duration, and exercise type (endurance or strength training) for the same three patient cases. Exercise prescriptions were compared between physiotherapists and relations with their characteristics were studied. The agreement between physiotherapists' exercise prescriptions and those from European recommendations ('agreement score': based on a maximal score of 60/per case) was assessed. A wide inter-clinician variability was noticed for all exercise modalities, leading to a large variance for total peak-effort training minutes (from 461 up to 9000 over the three cases). The exercise frequency was prescribed fully out of range of the recommendations and the prescription of additional exercise modes was generally flawed. Exercise intensity and program duration were prescribed partially correct. The addition of strength exercises and session duration was prescribed correctly. This led to physiotherapist agreement scores of 25.3 ± 9.6, 23.2 ± 9.9, and 27.1 ± 10.6 (all out of 60), for cases one, two, and three, respectively. A greater agreement score was found in younger colleagues and those holding a Ph.D. CONCLUSION Exercise prescriptions for CVD patients vary widely among physiotherapists and often disagree with European recommendations. REGISTRATION ClinicalTrials.gov NCT05449652.
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Affiliation(s)
- Nastasia Marinus
- Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium
| | - Véronique Cornelissen
- Research Group of Rehabilitation for Internal Disorders, University of Leuven, 3000 Leuven, Belgium
| | - Raf Meesen
- Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium
| | - Karin Coninx
- Faculty of Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Dominique Hansen
- Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium
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Li Z, Guo K, Yang Y, Shuai Y, Fan R, Li Y, DU J, Niu J, Yang K. Exercise-based cardiac rehabilitation for patients with coronary heart disease: a systematic review and evidence mapping study. Eur J Phys Rehabil Med 2024; 60:361-372. [PMID: 38345568 PMCID: PMC11112512 DOI: 10.23736/s1973-9087.23.08165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/20/2023] [Accepted: 12/12/2023] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Exercise-based cardiac rehabilitation (CR) plays a critical role in coronary heart disease (CHD) management. There is a heritage in the effect of exercise-based CR with different exercise programs or intervention settings. This study developed an evidence matrix that systematically assesses, organizes, and presents the available evidence regarding exercise-based CR in CHD management. EVIDENCE ACQUISITION A comprehensive literature search was conducted across six databases. Two reviewers screened the identified literature, extracted relevant data, and assessed the quality of the studies. An evidence-mapping framework was established to present the findings in a structured manner. Bubble charts were used to represent the included systematic reviews (SRs). The charts incorporated information, exercise prescriptions, outcome indicators, associated P values, research quality, and the number of original studies. A descriptive analysis summarized the types of CR, intervention settings, influential factors, and adverse events. EVIDENCE SYNTHESIS Sixty-two SRs were included in this analysis, focusing on six exercise types in addition to assessing major adverse cardiovascular events (MACE), cost and rehabilitation outcomes. The most commonly studied exercise types were unspecified (28 studies, 45.2%) and aerobic (11 studies, 17.7%) exercises. All-cause mortality was the most frequently reported MACE outcome (22 studies). Rehabilitation outcomes primarily centered around changes in cardiac function (135 outcomes from 39 SRs). Only 8 (12.9%) studies were rated as "high quality." No significant adverse events were observed in the intervention group. Despite some variations among the included studies, most SRs demonstrated the benefits of exercise in improving one or more MACE or rehabilitation outcomes among CHD patients. CONCLUSIONS The proportion of high-quality evidence remains relatively low. Limited evidence is available regarding the effectiveness of specific exercise types and specific populations, necessitating further evaluation.
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Affiliation(s)
- Zijun Li
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ke Guo
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yongqi Yang
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Yuxi Shuai
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Rui Fan
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Yanfei Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
| | - Jiawei DU
- Second Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Junqiang Niu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
- First Hospital of Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China -
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
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Hansen D, Coninx K, Beckers P, Cornelissen V, Kouidi E, Neunhauserer D, Niebauer J, Spruit MA, Takken T, Dendale P. Appropriate exercise prescription in primary and secondary prevention of cardiovascular disease: why this skill remains to be improved among clinicians and healthcare professionals. A call for action from the EXPERT Network†. Eur J Prev Cardiol 2023; 30:1986-1995. [PMID: 37458001 DOI: 10.1093/eurjpc/zwad232] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
In Europe alone, on a yearly basis, millions of people need an appropriate exercise prescription to prevent the occurrence or progression of cardiovascular disease (CVD). A general exercise recommendation can be provided to these individuals (at least 150 min of moderate-intensity endurance exercise, spread over 3-5 days/week, complemented by dynamic moderate-intensity resistance exercise 2 days/week). However, recent evidence shows that this one size does not fit all and that individual adjustments should be made according to the patient's underlying disease(s), risk profile, and individual needs, to maximize the clinical benefits of exercise. In this paper, we (i) argue that this general exercise prescription simply provided to all patients with CVD, or elevated risk for CVD, is insufficient for optimal CVD prevention, and (ii) show that clinicians and healthcare professionals perform heterogeneously when asked to adjust exercise characteristics (e.g. intensity, volume, and type) according to the patient's condition, thereby leading to suboptimal CVD risk factor control. Since exercise training is a class 1A intervention in the primary and secondary prevention of CVD, the awareness of the need to improve exercise prescription has to be raised among clinicians and healthcare professionals if optimized prevention of CVD is ambitioned.
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Affiliation(s)
- Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre), Hasselt University, Hasselt, Belgium
| | - Karin Coninx
- UHasselt, Human-Computer Interaction and eHealth, Faculty of Sciences, Hasselt University, Hasselt, Belgium
| | - Paul Beckers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp Hasselt, Belgium
| | - Véronique Cornelissen
- Research group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daniel Neunhauserer
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Rehab-Center Salzburg, Ludwig Boltzmann Institute for digital Health and Prevention, Salzburg, Austria
| | - Martijn A Spruit
- Department of Research & Education; CIRO+, Centre of Expertise for Chronic Organ Failure, Horn/Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Tim Takken
- Division of Pediatrics, Child Development & Exercise Center, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre), Hasselt University, Hasselt, Belgium
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Graby J, Khavandi A, Gillison F, Smith T, Murphy D, Peacock O, McLeod H, Dastidar A, Antoniades C, Thompson D, Rodrigues JCL. 'Super Rehab': can we achieve coronary artery disease regression? A feasibility study protocol. BMJ Open 2023; 13:e080735. [PMID: 38086597 PMCID: PMC10729239 DOI: 10.1136/bmjopen-2023-080735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Patients diagnosed with coronary artery disease (CAD) are currently treated with medications and lifestyle advice to reduce the likelihood of disease progression and risk of future major adverse cardiovascular events (MACE). Where obstructive disease is diagnosed, revascularisation may be considered to treat refractory symptoms. However, many patients with coexistent cardiovascular risk factors, particularly those with metabolic syndrome (MetS), remain at heightened risk of future MACE despite current management.Cardiac rehabilitation is offered to patients post-revascularisation, however, there is no definitive evidence demonstrating its benefit in a primary prevention setting. We propose that an intensive lifestyle intervention (Super Rehab, SR) incorporating high-intensity exercise, diet and behavioural change techniques may improve symptoms, outcomes, and enable CAD regression.This study aims to examine the feasibility of delivering a multicentre randomised controlled trial (RCT) testing SR for patients with CAD, in a primary prevention setting. METHODS AND ANALYSIS This is a multicentre randomised controlled feasibility study of SR versus usual care in patients with CAD. The study aims to recruit 50 participants aged 18-75 across two centres. Feasibility will be assessed against rates of recruitment, retention and, in the intervention arm, attendance and adherence to SR. Qualitative interviews will explore trial experiences of study participants and practitioners. Variance of change in CAD across both arms of the study (assessed with serial CT coronary angiography) will inform the design and power of a future, multi-centre RCT. ETHICS AND DISSEMINATION Ethics approval was granted by South West-Frenchay Research Ethics Committee (reference: 21/SW/0153, 18 January 2022). Study findings will be disseminated via presentations to relevant stakeholders, national and international conferences and open-access peer-reviewed research publications. TRIAL REGISTRATION NUMBER ISRCTN14603929.
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Affiliation(s)
- John Graby
- Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Health, University of Bath, Bath, UK
| | - Ali Khavandi
- Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | | | - David Murphy
- Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Health, University of Bath, Bath, UK
| | | | | | | | - Charalambos Antoniades
- Acute Multidisciplinary Imaging & Interventional Centre, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Iannetta D, Rouleau CR, Chirico D, Fontana FY, Hauer T, Wilton SB, Aggarwal S, Austford LD, Arena R, Murias JM. An evaluation of the role of the exercise training dose for changes in exercise capacity following a standard cardiac rehabilitation program. Int J Cardiol 2023; 379:104-110. [PMID: 36934989 DOI: 10.1016/j.ijcard.2023.03.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/21/2023] [Accepted: 03/16/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND To retrospectively characterize and compare the dose of exercise training (ET) within a large cohort of patients demonstrating different levels of improvement in exercise capacity following a cardiac rehabilitation (CR) program. METHODS A total of 2310 patients who completed a 12-week, center-based, guidelines-informed CR program between January 2018 and December 2019 were included in the analysis. Peak metabolic equivalents (METpeak) were determined pre- and post-CR during which total duration (ET time) and intensity [percent of heart rate peak (%HRpeak)] of supervised ET were also obtained. Training responsiveness was quantified on the basis of changes in METpeak from pre- to post-CR. A cluster analysis was performed to identity clusters demonstrating discrete levels of responsiveness (i.e., negative, low, moderate, high, and very-high). These were compared for several baseline and ET-derived variables which were also included in a multivariable linear regression model. RESULTS At pre-CR, baseline METpeak was progressively lower with greater training responsiveness (F(4,2305) = 44.2, P < 0.01, η2p = 0.71). Likewise, average training duration (F(4,2305) = 10.7 P < 0.01, η2p = 0.02) and %HRpeak (F(4,2305) = 25.1 P < 0.01, η2p = 0.042) quantified during onsite ET sessions were progressively greater with greater training responsiveness. The multivariable linear regression model confirmed that baseline METpeak, training duration and intensity during ET, BMI, and age (P < 0.001) were significant predictors of METpeak post-CR. CONCLUSIONS Along with baseline METpeak, delta BMI, and age, the dose of ET (i.e., training duration and intensity) predicts METpeak at the conclusion of CR. A re-evaluation of current approaches for exercise intensity prescription is recommended to extend the benefits of completing CR to all patients.
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Affiliation(s)
- Danilo Iannetta
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Codie R Rouleau
- Department of Psychology, University of Calgary, Calgary, Canada; TotalCardiology™ Research Network, Calgary, Canada
| | - Daniele Chirico
- Faculty of Kinesiology, University of Calgary, Calgary, Canada; TotalCardiology™ Research Network, Calgary, Canada
| | - Federico Y Fontana
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Trina Hauer
- TotalCardiology™ Rehabilitation, Calgary, Canada; TotalCardiology™ Research Network, Calgary, Canada
| | - Stephen B Wilton
- TotalCardiology™ Research Network, Calgary, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Sandeep Aggarwal
- TotalCardiology™ Research Network, Calgary, Canada; Department of Cardiac Science, University of Calgary, Calgary, Canada
| | | | - Ross Arena
- TotalCardiology™ Research Network, Calgary, Canada; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Juan M Murias
- Faculty of Kinesiology, University of Calgary, Calgary, Canada.
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Manresa-Rocamora A, Sarabia JM, Guillen-Garcia S, Pérez-Berbel P, Miralles-Vicedo B, Roche E, Vicente-Salar N, Moya-Ramón M. Heart Rate Variability-Guided Training for Improving Mortality Predictors in Patients with Coronary Artery Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10463. [PMID: 36078179 PMCID: PMC9518028 DOI: 10.3390/ijerph191710463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The objective of this research was to investigate whether heart rate variability (HRV)-guided training improves mortality predictors to a greater extent than predefined training in coronary artery disease patients. Twenty-one patients were randomly allocated to the HRV-guided training group (HRV-G) or the predefined training group (PRED-G). They measured their HRV at home daily and trained three times a week for six weeks. Resting heart rate, isolated vagal-related HRV indices (i.e., RMSSD, HF, and SD1), weekly averaged RMSSD, heart rate recovery, and maximum oxygen uptake were assessed before and after the training period. There was a statistically significant difference (p = 0.034) in the change in weekly averaged RMSSD in favor of the HRV-G, while no differences were found in the remaining analyzed variables (p > 0.050). Regardless of the training prescription method, exercise training decreased resting heart rate (p = 0.001; -4.10 [95% CI = -6.37--1.82] beats per minute (bpm)), and increased heart rate recovery at 2 min (p = 0.010; 4.33 [95% CI = 1.15-7.52] bpm) and maximum oxygen uptake (p < 0.001; 3.04 [95% CI = 1.70-4.37] mL·kg-1·min-1). HRV-guided training is superior to predefined training in improving vagal-related HRV when methodological factors are accounted for.
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Affiliation(s)
- Agustín Manresa-Rocamora
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
| | - José Manuel Sarabia
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
| | | | - Patricio Pérez-Berbel
- Department of Cardiology, Hospital Clínico Universitario San Juan, 03550 San Juan de Alicante, Spain
- Department of Cardiology, Hospital Universitario del Vinalopó, 03293 Elche, Spain
| | | | - Enrique Roche
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
- Department of Applied Biology-Nutrition, Institute of Bioengineering, Miguel Hernández University of Elche, 03202 Elche, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Néstor Vicente-Salar
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
- Department of Applied Biology-Nutrition, Institute of Bioengineering, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Manuel Moya-Ramón
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, 03202 Elche, Spain
- Institute for Health and Biomedical Research of Alicante (ISABIAL), 03010 Alicante, Spain
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9
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Exercise Training and Interventions for Coronary Artery Disease. J Cardiovasc Dev Dis 2022; 9:jcdd9050131. [PMID: 35621842 PMCID: PMC9146277 DOI: 10.3390/jcdd9050131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/18/2022] [Accepted: 04/24/2022] [Indexed: 12/22/2022] Open
Abstract
Coronary artery disease (CAD) may be considered a main cause of mortality and the prevalence of CAD is increasing nowadays, leading to high health costs in many countries. Despite the fact of the regression of the atherosclerotic plaque, the decrease in blood viscosity and the growth of collateral vessels have been proposed as improvements that CAD patients may obtain under exercise performance. Thus, the present narrative review aimed to carry out a brief specific analysis of the results achieved when performing endurance, strength or inspiratory muscle training. Exercise attenuates certain pathophysiological processes of this disease, such as endothelial dysfunction or the vulnerability of atherosclerotic plaques, and produces improvements in functional capacity and muscle strength, among others. Within the different exercise modalities, the most important parameter to be considered seems to be the total caloric expenditure, and not so much the modality itself. As such, in cardiac rehabilitation, when prescribing exercise, we should possibly focus on the modality that obtains more adherence in patients. To conclude, it must be highlighted that total caloric expenditure is not being taken into account when comparing interventions and this relevant information should be considered in future studies.
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Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, Laukkanen JA, Pedretti R, Simonenko M, Wilhelm M, Davos CH, Doehner W, Iliou MC, Kränkel N, Völler H, Piepoli M. 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. Eur J Prev Cardiol 2022; 29:230-245. [PMID: 34077542 DOI: 10.1093/eurjpc/zwab007] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Hasselt, Belgium
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Académico de Medicina de Lisboa (CAML), Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Veronique Cornelissen
- Research Unit of Cardiovascular Exercise Physiology, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
| | - Andreas Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Sesto San Giovanni, Milano, Italy
| | - Roberto Pedretti
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Maria Simonenko
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Constantinos H Davos
- BCRT-Berlin Institute of Health Center for Regenerative Therapies, Department of Cardiology (Virchow Klinikum), Charité - Universitätsmedizin Berlin, Partner Site Berlin, Germany
| | - Wolfram Doehner
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Paris, France
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
| | - Marie-Christine Iliou
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Cardiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Nicolle Kränkel
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
- Klinik am See, Rehabilitation Centers for Internal Medicine, Berlin, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Potsdam, Germany
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
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11
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Lima KR, Schmidt HL, Daré LR, Soares CB, Lopes LF, Carpes FP, Mello-Carpes PB. Concurrent exercise does not prevent recognition memory deficits induced by beta-amyloid in rats. Physiol Behav 2021; 243:113631. [PMID: 34715093 DOI: 10.1016/j.physbeh.2021.113631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/07/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
Alzheimer's disease affects thousands of people worldwide. Alternatives aiming to prevent the disease or reduce its symptoms include different physical exercise configurations. Here we investigate the potential of concurrent exercise to prevent recognition memory deficits in an Alzheimer's disease-like model induced by the hippocampal beta-amyloid (Aβ) injection in Wistar rats. We demonstrate that the concurrent exercise, which included running and strength exercises performed in the same exercise session, is ineffective in preventing recognition memory deficits in the Aβ rats. Besides, higher levels of reactive oxygen species were found in the concurrent exercise group's hippocampus. The running exercise administrated alone prevented recognition memory impairments.
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Affiliation(s)
- Karine Ramires Lima
- Physiology Research Group, Stress, Memory and Behavior Lab, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Helen Lidiane Schmidt
- Physiology Research Group, Stress, Memory and Behavior Lab, Federal University of Pampa, Uruguaiana, RS, Brazil; Applied Neuromechanics Group, Laboratory of Neuromechanics, Universidade Federal do Pampa, Uruguaiana, RS, Brazil
| | - Leticia Rossi Daré
- Physiology Research Group, Stress, Memory and Behavior Lab, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Caroline Bitencourt Soares
- Physiology Research Group, Stress, Memory and Behavior Lab, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Luiza Freitas Lopes
- Physiology Research Group, Stress, Memory and Behavior Lab, Federal University of Pampa, Uruguaiana, RS, Brazil
| | - Felipe P Carpes
- Applied Neuromechanics Group, Laboratory of Neuromechanics, Universidade Federal do Pampa, Uruguaiana, RS, Brazil
| | - Pâmela Billig Mello-Carpes
- Physiology Research Group, Stress, Memory and Behavior Lab, Federal University of Pampa, Uruguaiana, RS, Brazil.
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12
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Ghayour Najafabadi M, Sobhrakhshan Khah A, Parent-Nichols J. The Effects Of Exercise Training On Physical, Physiological And Psychological Risk Factors Of Patients With Cardiovascular Disease. RUSSIAN OPEN MEDICAL JOURNAL 2021. [DOI: 10.15275/rusomj.2021.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background — Exercise training is an important component of wellness for individuals diagnosed with cardiovascular disease (CVD). Exercise may have an effect on cardiovascular risk factors such as hypertension, lipid levels, and other associated physical, psychological, and physiological risk factors. Exercise intensity may further impact those risk factors. Aim — This narrative review of the literature aims to identify the effect of regular physical exercise on modifying risk factors for CVD and increased morbidity and mortality related to CVD. Methods — Published English-language papers from 2011 to 2020, available in Scopus, PubMed, Cochrane, Google Scholar, and Thompson were included in this review. Keywords for this search were exercise training, cardiovascular disease, hypertension, physical function, physiological, and psychological risk factors. Conclusions — Exercise training may be a cost-effective intervention that improves the physical, physiological, and psychological risk factors and the motor function of patients with cardiovascular disease.
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13
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Soares CB, Daré LR, Lima KR, Lopes LF, Santos AGD, Schimidt HL, Carpes FP, Lloret A, Viña J, Mello-Carpes PB. Multicomponent Training Prevents Memory Deficit Related to Amyloid-β Protein-Induced Neurotoxicity. J Alzheimers Dis 2021; 83:143-154. [PMID: 34275902 DOI: 10.3233/jad-210424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is characterized by the accumulation of the amyloid-β peptide in the brain, leading to early oxidative stress and neurotoxicity. It has been suggested that physical exercise could be beneficial in preventing AD, but studies with multicomponent training are scanty. OBJECTIVE Verify the effects of multicomponent exercise training to prevent deficits in recognition memory related to Aβ neurotoxicity. METHODS We subjected Wistar rats to multicomponent training (including aerobic and anaerobic physical exercise and cognitive exercise) and then infused amyloid-β peptide into their hippocampus. RESULTS We show that long-term multicomponent training prevents the amyloid-β-associated neurotoxicity in the hippocampus. It reduces hippocampal lipid peroxidation, restores antioxidant capacity, and increases glutathione levels, finally preventing recognition memory deficits. CONCLUSION Multicomponent training avoids memory deficits related to amyloid-β neurotoxicity on an animal model.
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Affiliation(s)
| | - Leticia Rossi Daré
- Federal University of Pampa, campus Uruguaiana, Uruguaiana, RS, Brazil.,Federal University of Triangulo Mineiro, Uberaba, MG, Brazil
| | | | | | | | | | | | | | - Jose Viña
- University of Valencia, Valencia, Spain
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14
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Price KJ, Gordon BA, Bird SR, Benson AC. Evaluating Exercise Progression in an Australian Cardiac Rehabilitation Program: Should Cardiac Intervention, Age, or Physical Capacity Be Considered? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115826. [PMID: 34071598 PMCID: PMC8197818 DOI: 10.3390/ijerph18115826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/30/2022]
Abstract
Progression of prescribed exercise is important to facilitate attainment of optimal physical capacity during cardiac rehabilitation. However, it is not clear how often exercise is progressed or to what extent. This study evaluated whether exercise progression during clinical cardiac rehabilitation was different between cardiovascular treatment, age, or initial physical capacity. The prescribed exercise of sixty patients who completed 12 sessions of outpatient cardiac rehabilitation at a major Australian metropolitan hospital was evaluated. The prescribed aerobic exercise dose was progressed using intensity rather than duration, while repetitions and weight lifted were utilised to progress resistance training dose. Cardiovascular treatment or age did not influence exercise progression, while initial physical capacity and strength did. Aerobic exercise intensity relative to initial physical capacity was progressed from the first session to the last session for those with high (from mean (95%CI) 44.6% (42.2-47.0) to 68.3% (63.5-73.1); p < 0.001) and moderate physical capacity at admission (from 53.0% (50.7-55.3) to 76.3% (71.2-81.4); p < 0.001), but not in those with low physical capacity (from 67.3% (63.7-70.9) to 85.0% (73.7-96.2); p = 0.336). The initial prescription for those with low physical capacity was proportionately higher than for those with high capacity (p < 0.001). Exercise testing should be recommended in guidelines to facilitate appropriate exercise prescription and progression.
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Affiliation(s)
- Kym Joanne Price
- Discipline of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3083, Australia;
- Correspondence:
| | - Brett Ashley Gordon
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, VIC 3550, Australia;
| | - Stephen Richard Bird
- Discipline of Exercise Sciences, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3083, Australia;
| | - Amanda Clare Benson
- Department of Health and Biostatistics, Sport Innovation Research Group, Swinburne University of Technology, Melbourne, VIC 3122, Australia;
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15
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Are the Current Cardiac Rehabilitation Programs Optimized to Improve Cardiorespiratory Fitness in Patients? A Meta-Analysis. J Aging Phys Act 2020; 29:327-342. [PMID: 32796140 DOI: 10.1123/japa.2019-0363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022]
Abstract
Previous meta-analyses have shown that high-intensity interval training (HIIT) is more suitable than moderate continuous training (MCT) for improving peak oxygen uptake (VO2peak) in patients with coronary artery disease. However, none of these meta-analyses have tried to explain the heterogeneity of the empirical studies in optimizing cardiac rehabilitation programs. Therefore, our aims were (a) to estimate the effect of MCT and HIIT on VO2peak, and (b) to find the potential moderator variables. A search was conducted in PubMed, Scopus, and ScienceDirect. Out of the 3,110 references retrieved, 29 studies fulfilled the selection criteria to be included in our meta-analysis. The mean difference was used as the effect size index. Our results showed significant enhancements in VO2peak after cardiac rehabilitation based on MCT and HIIT (mean difference = 3.23; 95% confidence interval [2.81, 3.65] ml·kg-1·min-1 and mean difference = 4.61; 95% confidence interval [4.02, 5.19] ml·kg-1·min-1, respectively), with greater increases after HIIT (p < .001). Heterogeneity analyses reached statistical significance with moderate heterogeneity for MCT (p < .001; I2 = 67.0%), whereas no heterogeneity was found for the effect of HIIT (p = .220; I2 = 22.0%). Subgroup analyses showed significant between-group heterogeneity of the MCT-induced effect based on the training mode (p < .001; I2 = 90.4%), the risk of a new event (p = .010; I2 = 77.4%), the type of cardiovascular event (p = .009; I2 = 84.8%), the wait time to start cardiac rehabilitation (p = .010; I2 = 76.6%), and participant allocation (p = .002; I2 = 89.9%). Meta-regressions revealed that the percentages of patients undergoing a revascularization procedure (B = -0.022; p = .041) and cardiorespiratory fitness at baseline (B = -0.103; p = .025) were inversely related to the MCT-induced effect on the VO2peak.
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16
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Cuyul-Vásquez I, Leiva-Sepúlveda A, Catalán-Medalla O, Berríos-Contreras L. [Blood flow restriction training for people with cardiovascular disease: An exploratory review]. Rehabilitacion (Madr) 2020; 54:116-127. [PMID: 32370826 DOI: 10.1016/j.rh.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 11/10/2019] [Accepted: 01/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To analyse the evidence on the effects of blood flow restriction training in people with cardiovascular disease. MATERIALS AND METHODS We searched MEDLINE, EMBASE, SPORTDiscus, CINAHL, LILACS, SCOPUS and Wiley databases. Experimental and non-experimental studies investigating the effects of blood flow restriction in participants with cardiovascular disease were included. RESULTS Six clinical trials and three non-experimental studies met the inclusion criteria. The experimental studies were conducted in participants with hypertension and ischaemic heart disease. Non-experimental studies described hemodynamic adaptations and potential adverse effects of therapy. The risk of bias of the included clinical trials was moderate to high. Exercise-induced hemodynamic stress increased significantly during training with blood flow restriction compared with traditional training. The small number of available studies have focused mostly on acute effects, but chronic effects are unknown. CONCLUSION There is currently no evidence to recommend the use of blood flow restriction in people with cardiovascular disease.
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Affiliation(s)
- I Cuyul-Vásquez
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile.
| | - A Leiva-Sepúlveda
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - O Catalán-Medalla
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - L Berríos-Contreras
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
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17
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Kim KH, Jang YC, Song MK, Park HK, Choi IS, Han JY. Changes in Aerobic Capacity Over Time in Elderly Patients With Acute Myocardial Infarction During Cardiac Rehabilitation. Ann Rehabil Med 2020; 44:77-84. [PMID: 32130841 PMCID: PMC7056327 DOI: 10.5535/arm.2020.44.1.77] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/25/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To test the hypothesis that a longer duration of phase II cardiac rehabilitation is required to recover the exercise capacity of elderly patients compared to younger patients. METHODS We retrospectively reviewed and analyzed the medical records of patients who were referred to our cardiac rehabilitation (CR) center and underwent percutaneous coronary intervention for acute myocardial infarction (AMI). A total of 70 patients were enrolled who underwent an exercise tolerance test (ETT) 3 weeks after the occurrence of an AMI (T0), 6 weeks after the first ETT (T1), and 12 weeks after the first ETT (T2). Patients older than 65 years were assigned to the elderly group (n=24) and those aged 65 years and younger to the younger group (n=46). Both groups performed center-based or home-based CR for 12 weeks (3 times per week and 1 session per day). Exercise intensity for each individual was based on the target heart rate calculated by the Karvonen formula. The change in maximal metabolic equivalents (METmax) of the two groups was measured at each assessment point (T0, T1, and T2) to investigate the recovery of exercise capacity. RESULTS The younger group showed improvement in METmax between T0 and T1. However, METmax of the elderly group showed no significant improvement between T0 and T1. The exercise capacity, measured with METmax, of all groups showed improvement between T0 and T2. CONCLUSION Elderly patients with AMI need a longer duration of CR (>6 weeks) than younger patients with AMI.
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Affiliation(s)
- Ki-Hong Kim
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Yun-Chol Jang
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Hyeng-Kyu Park
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - In-Sung Choi
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jae-Young Han
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
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18
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Prescott E, Eser P, Mikkelsen N, Holdgaard A, Marcin T, Wilhelm M, Gil CP, González-Juanatey JR, Moatemri F, Iliou MC, Schneider S, Schromm E, Zeymer U, Meindersma EP, Crocamo A, Ardissino D, Kolkman EK, Prins LF, van der Velde AE, Van’t Hof AWJ, de Kluiver EP. Cardiac rehabilitation of elderly patients in eight rehabilitation units in western Europe: Outcome data from the EU-CaRE multi-centre observational study. Eur J Prev Cardiol 2020; 27:1716-1729. [DOI: 10.1177/2047487320903869] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aims The European Cardiac Rehabilitation in the Elderly (EU-CaRE) HORIZON 2020 project compares the sustainable effects of cardiac rehabilitation (CR) in elderly patients. Methods and results A total of 1633 patients with coronary artery disease (CAD) or heart valve replacement (HVR), with or without revascularization, aged 65 or above, who participated in CR were included. Peak oxygen uptake (VO2peak), smoking, body mass index, diet, physical activity, serum lipids, psychological distress and medication were assessed before and after CR (T0 and T1) and after 12 months (T2). Patients undergoing coronary artery bypass surgery or surgical HVR had lower VO2peak at T0 and a greater increase to T1 and T2 (2.8 and 4.4 ml/kg/min, respectively) than CAD patients undergoing percutaneous or no revascularization (1.6 and 1.4 ml/kg/min, respectively). After multivariable adjustment, earlier CR uptake was associated with greater improvements in VO2peak. The proportion of CAD patients with three or more uncontrolled risk factors declined from 58.4% at T0 to 40.1% at T2 ( p < 0.0001). Psychological distress scores all improved and adherence to medication was overall good at all sites. There were significant differences in risk factor burden across sites, but no CR program was superior to others. Conclusions The outcomes of VO2peak in CR programs across Europe seemed mainly determined by timing of uptake and were maintained or even further improved at 1-year follow-up. Despite significant improvements, 40.1% of CAD patients still had three or more risk factors not at target after 1 year. Differences across sites could not be ascribed to characteristics of the CR programs offered.
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Affiliation(s)
- Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Prisca Eser
- Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nicolai Mikkelsen
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Annette Holdgaard
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Thimo Marcin
- Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Matthias Wilhelm
- Preventive Cardiology and Sports Medicine, University Clinic for Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Carlos Peña Gil
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela, SERGAS IDIS CIBERCV, Santiago de Compostela, Spain
| | - José R González-Juanatey
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela, SERGAS IDIS CIBERCV, Santiago de Compostela, Spain
| | - Feriel Moatemri
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Marie Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France
| | - Steffen Schneider
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Eike Schromm
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Uwe Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Esther P Meindersma
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Antonio Crocamo
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Diego Ardissino
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | | | | | - Arnoud WJ Van’t Hof
- Isala Heart Centre, Zwolle, Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
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19
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Gevaert AB, Adams V, Bahls M, Bowen TS, Cornelissen V, Dörr M, Hansen D, Kemps HM, Leeson P, Van Craenenbroeck EM, Kränkel N. Towards a personalised approach in exercise-based cardiovascular rehabilitation: How can translational research help? A 'call to action' from the Section on Secondary Prevention and Cardiac Rehabilitation of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2019; 27:1369-1385. [PMID: 31581819 DOI: 10.1177/2047487319877716] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The benefit of regular physical activity and exercise training for the prevention of cardiovascular and metabolic diseases is undisputed. Many molecular mechanisms mediating exercise effects have been deciphered. Personalised exercise prescription can help patients in achieving their individual greatest benefit from an exercise-based cardiovascular rehabilitation programme. Yet, we still struggle to provide truly personalised exercise prescriptions to our patients. In this position paper, we address novel basic and translational research concepts that can help us understand the principles underlying the inter-individual differences in the response to exercise, and identify early on who would most likely benefit from which exercise intervention. This includes hereditary, non-hereditary and sex-specific concepts. Recent insights have helped us to take on a more holistic view, integrating exercise-mediated molecular mechanisms with those influenced by metabolism and immunity. Unfortunately, while the outline is recognisable, many details are still lacking to turn the understanding of a concept into a roadmap ready to be used in clinical routine. This position paper therefore also investigates perspectives on how the advent of 'big data' and the use of animal models could help unravel inter-individual responses to exercise parameters and thus influence hypothesis-building for translational research in exercise-based cardiovascular rehabilitation.
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Affiliation(s)
- Andreas B Gevaert
- GENCOR Department, University of Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Belgium.,Heart Centre Hasselt, Jessa Hospital, Belgium
| | - Volker Adams
- Department of Molecular and Experimental Cardiology, TU Dresden, Germany
| | - Martin Bahls
- Department of Internal Medicine B, University of Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - T Scott Bowen
- School of Biomedical Sciences, University of Leeds, UK
| | | | - Marcus Dörr
- Department of Internal Medicine B, University of Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Belgium.,Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Hareld Mc Kemps
- Fitheid, Leefstijl, Ontwikkeling en Wetenschap (FLOW), Máxima Medical Centre, The Netherlands
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, UK
| | - Emeline M Van Craenenbroeck
- GENCOR Department, University of Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Nicolle Kränkel
- Department of Cardiology, Charité Universitätsmedizin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany
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20
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Oldridge N, Pakosh M, Grace SL. A systematic review of recent cardiac rehabilitation meta-analyses in patients with coronary heart disease or heart failure. Future Cardiol 2019; 15:227-249. [PMID: 31161796 DOI: 10.2217/fca-2018-0085] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim: The aim of the project was to conduct a systematic review of meta-analyses of supervised, home-based or telemedicine-based exercise cardiac rehabilitation (CR) published between July 2011 and April 2018. Materials & methods: Evidence on mortality, hospitalization, peak VO2, exercise capacity, muscle strength and health-related quality of life in patients with coronary heart disease or heart failure referred to CR was obtained by searching six electronic databases. Results: Of the 127 point estimates identified in the 30 CR meta-analyses identified (mortality, n = 12; hospitalization, n = 11; VO2, n = 40; exercise capacity, n = 20; strength, n = 18; health-related quality of life, n = 26), 60% were statistically significant and 35% clinically important. Conclusion: The statistical data are sufficiently robust to promote strategies to improve referral to and participation in CR although evidence for clinical importance needs to be further investigated.
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Affiliation(s)
- Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Maureen Pakosh
- University Health Network, Toronto Rehabilitation - Rumsey Cardiac Centre Library, Toronto, ON, Canada
| | - Sherry L Grace
- School of Kinesiology & Health Science, York University, & University Health Network Toronto, ON, Canada
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Etiwy M, Akhrass Z, Gillinov L, Alashi A, Wang R, Blackburn G, Gillinov SM, Phelan D, Gillinov AM, Houghtaling PL, Javadikasgari H, Desai MY. Accuracy of wearable heart rate monitors in cardiac rehabilitation. Cardiovasc Diagn Ther 2019; 9:262-271. [PMID: 31275816 DOI: 10.21037/cdt.2019.04.08] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background To assess the accuracy of four wearable heart rate (HR) monitors in patients with established cardiovascular disease enrolled in phase II or III cardiac rehabilitation (CR). Methods Eighty adult patients enrolled in phase II or III CR were monitored during a CR session that included exercise on a treadmill and/or stationary cycle. Participants underwent HR monitoring with standard ECG limb leads, an electrocardiographic (ECG) chest strap monitor (Polar H7), and two randomly assigned wrist-worn HR monitors (Apple Watch, Fitbit Blaze, Garmin Forerunner 235, TomTom Spark Cardio), one on each wrist. HR was recorded at rest and at 3, 5, and 7 minutes of steady-state exercise on the treadmill and stationary cycle. Results Across all exercise conditions, the chest strap monitor (Polar H7) had the best agreement with ECG (rc=0.99) followed by the Apple Watch (rc=0.80), Fitbit Blaze (rc=0.78), TomTom Spark (rc=0.76) and Garmin Forerunner (rc=0.52). There was variability in accuracy under different exercise conditions. On the treadmill, only the Fitbit Blaze performed well (rc=0.76), while on the stationary cycle, Apple Watch (rc=0.89) and TomTom Spark (rc=0.85) were most accurate. Conclusions In cardiac patients, the accuracy of wearable, optically based HR monitors varies, and none of those tested was as accurate as an electrode-containing chest monitor. This observation has implications for in-home CR, as electrode-containing chest monitors should be used when accurate HR measurement is imperative.
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Affiliation(s)
- Muhammad Etiwy
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zade Akhrass
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lauren Gillinov
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alaa Alashi
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert Wang
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gordon Blackburn
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Dermot Phelan
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - A Marc Gillinov
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Kabboul NN, Tomlinson G, Francis TA, Grace SL, Chaves G, Rac V, Daou-Kabboul T, Bielecki JM, Alter DA, Krahn M. Comparative Effectiveness of the Core Components of Cardiac Rehabilitation on Mortality and Morbidity: A Systematic Review and Network Meta-Analysis. J Clin Med 2018; 7:E514. [PMID: 30518047 PMCID: PMC6306907 DOI: 10.3390/jcm7120514] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/26/2018] [Accepted: 11/30/2018] [Indexed: 01/12/2023] Open
Abstract
A systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating the core components of cardiac rehabilitation (CR), nutritional counseling (NC), risk factor modification (RFM), psychosocial management (PM), patient education (PE), and exercise training (ET)) was undertaken. Published RCTs were identified from database inception dates to April 2017, and risk of bias assessed using Cochrane's tool. Endpoints included mortality (all-cause and cardiovascular (CV)) and morbidity (fatal and non-fatal myocardial infarction (MI), coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI), and hospitalization (all-cause and CV)). Meta-regression models decomposed treatment effects into the main effects of core components, and two-way or all-way interactions between them. Ultimately, 148 RCTs (50,965 participants) were included. Main effects models were best fitting for mortality (e.g., for all-cause, specifically PM (hazard ratio HR = 0.68, 95% credible interval CrI = 0.54⁻0.85) and ET (HR = 0.75, 95% CrI = 0.60⁻0.92) components effective), MI (e.g., for all-cause, specifically PM (hazard ratio HR = 0.76, 95% credible interval CrI = 0.57⁻0.99), ET (HR = 0.75, 95% CrI = 0.56⁻0.99) and PE (HR = 0.68, 95% CrI = 0.47⁻0.99) components effective) and hospitalization (e.g., all-cause, PM (HR = 0.76, 95% CrI = 0.58⁻0.96) effective). For revascularization (including CABG and PCI individually), the full interaction model was best-fitting. Given that each component, individual or in combination, was associated with mortality and/or morbidity, recommendations for comprehensive CR are warranted.
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Affiliation(s)
- Nader N Kabboul
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
| | - George Tomlinson
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Department of Medicine, University Health Network, 27 King's College Circle, Toronto, ON M5S 1A1, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3M6, Canada.
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
| | - Troy A Francis
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
| | - Sherry L Grace
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
- Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Ave, Toronto, ON M5G 2A2, Canada.
- School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, ON M3J 1P3, Canada.
| | - Gabriela Chaves
- Department of Physical Therapy, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627-Pampulha, Belo Horizonte, MG 31270-901, Brazil.
| | - Valeria Rac
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
| | - Tamara Daou-Kabboul
- Human Nutrition, Bridgeport University, 126 Park Ave, Bridgeport, CT 06604, USA.
| | - Joanna M Bielecki
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
| | - David A Alter
- Department of Medicine, University Health Network, 27 King's College Circle, Toronto, ON M5S 1A1, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3M6, Canada.
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
- Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Ave, Toronto, ON M5G 2A2, Canada.
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.
- Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
- Department of Medicine, University Health Network, 27 King's College Circle, Toronto, ON M5S 1A1, Canada.
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3M6, Canada.
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada.
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23
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Gomes Neto M, Durães AR, Conceição LSR, Saquetto MB, Ellingsen Ø, Carvalho VO. High intensity interval training versus moderate intensity continuous training on exercise capacity and quality of life in patients with heart failure with reduced ejection fraction: A systematic review and meta-analysis. Int J Cardiol 2018; 261:134-141. [PMID: 29572084 DOI: 10.1016/j.ijcard.2018.02.076] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/02/2018] [Accepted: 02/20/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of high intensity interval training (HIIT) versus moderate intensity continuous training (MICT) in heart failure patients with reduced ejection fraction (HFrEF). BACKGROUND Despite the well-known positive effects of exercise in heart failure patients, the best mode of exercise is still under discussion. METHODS We searched Pubmed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to October 2017) for randomized controlled trials that evaluated the effects of HIIT versus MICT in HFrEF patients. Weighted mean differences (WMD) with 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the I2 test. RESULTS 13 studies met the study criteria, including 411 patients. Compared to MICT, HIIT resulted in improvement in Peak VO2 WMD (1.35 mL·kg-1·min-1 95% CI: 0.03 to 2.64 N = 411). HIIT resulted in no difference in VE/VCO2 slope WMD (-1.21 95% CI: -3.0 to 0.58 N = 135), and quality of life measured by Minnesota Living with Heart Failure questionnaire WMD (1.19 95% CI: -5.81 to 8.19 N = 79). Sub-group analyses comparing studies with and without isocaloric exercise training protocol also showed a nonsignificant difference in peak VO2 for participants in the HIIT group compared with MICT group. CONCLUSIONS HIIT improves peak VO2 and should be considered as a component of care of HFrEF patients. However, its superiority versus MICT disappears when isocaloric protocols are compared. An important caveat is uncertainty and variation of actual training intensities compared to program targets.
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Affiliation(s)
- Mansueto Gomes Neto
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Bahia, Brazil; Programa de Pós-Graduação em Medicina e Saúde - UFBA, Salvador, BA, Brazil; Physiotherapy Research Group, UFBA, Brazil; The GREAT Group (GRupo de Estudos em ATividade física), Brazil.
| | | | - Lino Sergio Rocha Conceição
- The GREAT Group (GRupo de Estudos em ATividade física), Brazil; Physical Therapy Department, Federal University of Sergipe - UFS, Aracaju, SE, Brazil
| | - Micheli Bernardone Saquetto
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Bahia, Brazil; Programa de Pós-Graduação em Medicina e Saúde - UFBA, Salvador, BA, Brazil; Physiotherapy Research Group, UFBA, Brazil
| | - Øyvind Ellingsen
- K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vitor Oliveira Carvalho
- Physiotherapy Research Group, UFBA, Brazil; The GREAT Group (GRupo de Estudos em ATividade física), Brazil; Physical Therapy Department, Federal University of Sergipe - UFS, Aracaju, SE, Brazil
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24
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Karami M, Khazaei S. Comment on "The influence of training characteristics on the effect of exercise training in patients with coronary artery disease: Systematic review and meta-regression analysis". Int J Cardiol 2017; 249:81. [PMID: 29121764 DOI: 10.1016/j.ijcard.2017.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 08/18/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Manoochehr Karami
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Salman Khazaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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