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Chen X, Zhang T, Hu X, Wen Z, Lu W, Jiang W. High-Intensity Interval Training Programs Versus Moderate-Intensity Continuous Training for Individuals With Heart Failure: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)01047-5. [PMID: 38862032 DOI: 10.1016/j.apmr.2024.05.028] [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: 09/21/2023] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE To explore the effect sizes of different high-intensity interval training (HIIT) protocols on cardiorespiratory parameters when compared with moderate-intensity continuous training (MICT) in different heart failure (HF) subtypes. DATA SOURCES Electronic databases were searched from their inception date until January 23, 2023. STUDY SELECTION Randomized controlled trials (RCTs) were included if they compared HIIT with MICT in patients with HF. The primary outcome was peak oxygen consumption (Vo2peak). Two reviewers independently evaluated 99 initially identified studies, resulting in the selection of 15 RCTs that met the eligibility criteria. DATA EXTRACTION Data were extracted independently by 2 observers using a data extraction form drafted based on the CONSORT statement and the Template for Intervention Description and Replication; the methodological quality of the studies was analyzed individually based on the Tool for the Assessment of Study Quality in Exercise scale. DATA SYNTHESIS Fifteen RCTs with 553 patients with HF were included in the systematic review. The included studies had moderate to good overall methodological quality. The results showed that HIIT was generally more effective than MICT at improving Vo2peak in patients with HF (n=541, 15 RCTs; MD: 1.49 mL/kg/min; I2=66%; P<.001). However, the effect size varied depending on the HF subtype and HIIT protocol used. For patients with HF with reduced ejection fraction (HFrEF), the long-interval (high-intensity interval lasting ≥4 min) and high-volume HIIT (high-intensity efforts in total ≥15 min) showed the largest benefits over the MICT (n=261, 6 RCTs; MD: 2.11 mL/kg/min; P<.001); followed by the short-interval (≤1 min) and high-volume HIIT (≥15 min; n=71, 3 RCTs; MD: 0.91 mL/kg/min; P=.12), and the short-interval and low-volume HIIT showed the least superiority over MICT (n=68, 3 RCTs; MD: 0.54 mL/kg/min; P=.05). For patients with HF with perceived ejection fraction, there was a modest beneficial effect from HIIT over MICT (n=141, 3 RCTs; MD: 0.55 mL/kg/min; P=.32). CONCLUSIONS The long-interval and high-volume HIIT protocol may produce greater benefits than MICT for improving cardiopulmonary fitness in patients with HFrEF. Further research is needed to determine the optimal HIIT protocol for different HF subtypes and to provide definitive recommendations for clinical practice.
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Affiliation(s)
- Xiankun Chen
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou; Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong Province
| | - Tong Zhang
- Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing; Zhen's Miscellaneous Diseases School in Lingnan (Lingnan Zhenshi Miscellaneous Diseases Genre), The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou
| | - Xiaoyue Hu
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou
| | - Zehuai Wen
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou; Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong Province
| | - Weihui Lu
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou; Department of Cardiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
| | - Wei Jiang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou; Department of Cardiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
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Dimopoulos S, Nanas S. The emerging importance of assessing recovery period gas exchange variables during cardiopulmonary exercise testing. Hellenic J Cardiol 2024:S1109-9666(24)00076-9. [PMID: 38583770 DOI: 10.1016/j.hjc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Stavros Dimopoulos
- Cardiac Surgery ICU, Onassis Cardiac Surgery Center, Athens, Greece; Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, National Kapodestrian University of Athens, Athens, Greece.
| | - Serafim Nanas
- Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, National Kapodestrian University of Athens, Athens, Greece
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Gu S, Du X, Wang D, Yu Y, Guo S. Effects of high intensity interval training versus moderate intensity continuous training on exercise capacity and quality of life in patients with heart failure: A systematic review and meta-analysis. PLoS One 2023; 18:e0290362. [PMID: 37590312 PMCID: PMC10434865 DOI: 10.1371/journal.pone.0290362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION AND AIMS High intensity interval training (HIIT) is considered as an alternative exercise modality to moderate intensity continuous training (MICT) for heart failure (HF) patients. Yet a growing number of trials demonstrated inconsistent findings about the effectiveness of HIIT versus MICT until SMARTEX study and OptimEx-Clin study have made a consistent negative conclusion that HIIT was not superior to MICT. The aim of this study was to conduct a meta-analysis involving a subgroup analysis of total exercise time (TET) and disease categories of HF to investigate if TET could affect the superiority of HIIT when compared with MICT. METHODS AND RESULTS An electronic literature search of Pubmed, Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov was performed for this review. 16 studies of 661 patients were finally pooled into quantitative synthesis. The weighted mean difference (WMD) and standard mean difference (SMD) with 95% confidence interval (CI) were calculated for quantitative synthesis of outcomes. HIIT was superior to MICT in improving peak oxygen consumption (Peak VO2) (WMD: 1.68 ml · kg-1 · min-1 95% CI: 0.81 to 2.55 n = 661). The subgroup analysis of TET showed that HIIT was superior to MICT in improving Peak VO2 in "short time" subgroup (WMD: 1.61 ml · kg-1 · min-1 95% CI: 0.45 to 2.77 n = 166) and in "medium time" subgroup (WMD: 1.74 ml · kg-1 · min-1 95% CI: 0.53 to 2.95 n = 420), and that there was no significant difference between HIIT and MICT in improving Peak VO2 in "long time" subgroup (WMD: 0.62 ml · kg-1 · min-1 95% CI: -1.34 to 2.58 n = 75). CONCLUSIONS The superiority of HIIT to MICT in improving Peak VO2 arose in a short to medium length of TET whereas it was effaced by an increment of TET. This "paradox" of TET on HIIT versus MICT might be due to the increasing poor adherence to target exercise intensity over time. TRIAL REGISTRATION PROSPERO registration number: CRD42022375076.
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Affiliation(s)
- Shengyuan Gu
- Department of Cardiology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Xinchao Du
- Department of Cardiology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Dongwei Wang
- Department of Cardiac Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Yaohua Yu
- Department of Respiratory Medicine and Pulmonary Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Shifang Guo
- Department of Respiratory Medicine and Pulmonary Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
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Li D, Chen P, Zhu J. The Effects of Interval Training and Continuous Training on Cardiopulmonary Fitness and Exercise Tolerance of Patients with Heart Failure-A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6761. [PMID: 34201804 PMCID: PMC8268940 DOI: 10.3390/ijerph18136761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate the effects of interval training (IT) as compared with continuous training (CT) on cardiorespiratory fitness and exercise tolerance of patients with heart failure (HF), with the aim to provide reasonable exercise prescriptions for patients with HF. METHODS Through searching electronic databases, randomized controlled studies were collected. The included studies were evaluated for methodological quality using the Cochrane risk of bias assessment tool, and statistical analyses were carried out using Review Manager 5.3 and Stata MP 15.1 software. RESULTS A total of seventeen randomized controlled trials (i.e., studies) with 617 patients were included. The meta-analysis showed that IT can improve a patient's peak oxygen uptake (VO2peak) (MD = 2.08, 95% CI 1.16 to 2.99, p < 0.00001), left ventricular ejection fraction (LVEF) (MD =1.32, 95% CI 0.60 to 2.03, p = 0.0003), and 6-minute walk distance (6MWD) (MD = 25.67, 95% CI 12.87 to 38.47, p < 0.0001) as compared with CT. However, for respiratory exchange ratio (RER) (MD = 0.00, 95% CI -0.02 to 0.03, p = 0.81), CO2 ventilation equivalent slope (VE/VCO2 slope) (SMD = 0.04, 95% CI -0.23 to 0.31, p = 0.75), and resting heart rate (HRrest) (MD = 0.15, 95% CI -3.00 to 3.29, p = 0.93) there were no statistical significance. CONCLUSIONS The evidence shows that IT is better than CT for improving the cardiorespiratory fitness and exercise tolerance of patients with HF. Moreover, an intensity of 60-80% peak heart rate of IT is the optimal choice for patients. It is hoped that, in the future, more well-designed studies would further expand the meta-analysis results.
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Affiliation(s)
| | | | - Junying Zhu
- Department of Physical Education, Ocean University of China-Laoshan Campus, Qingdao 266100, China; (D.L.); (P.C.)
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Abstract
PURPOSE OF REVIEW Heart failure (HF) is a structural or functional cardiac abnormality which leads to failure of the heart to deliver oxygen commensurately with the requirements of the tissues and it may progress to a generalized wasting of skeletal muscle, fat tissue, and bone tissue (cardiac cachexia). Clinically, dyspnea, fatigue, and exercise intolerance are some typical signs and symptoms that characterize HF patients. This review focused on the phenotypic characteristics of HF-induced skeletal myopathy as well as the mechanisms of muscle wasting due to HF and highlighted possible therapeutic strategies for skeletal muscle wasting in HF. RECENT FINDINGS The impaired exercise capacity of those patients is not attributed to the reduced blood flow in the exercising muscles, but rather to abnormal metabolic responses, myocyte apoptosis and atrophy of skeletal muscle. Specifically, the development of skeletal muscle wasting in chronic HF is characterized by structural, metabolic, and functional abnormalities in skeletal muscle and may be a result not only of reduced physical activity, but also of metabolic or hormonal derangements that favour catabolism over anabolism. In particular, abnormal energy metabolism, mitochondrial dysfunction, transition of myofibers from type I to type II, muscle atrophy, and reduction in muscular strength are included in skeletal muscle abnormalities which play a central role in the decreased exercise capacity of HF patients. Skeletal muscle alterations and exercise intolerance observed in HF are reversible by exercise training, since it is the only demonstrated intervention able to improve skeletal muscle metabolism, growth factor activity, and functional capacity and to reverse peripheral abnormalities.
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Zhao Z, Wang X, Wang S, Zhou R, Su Q, Liu Y, Cheng T, Li Q, Lin S, Liu H, Mao J. Research based on the core pathogenesis in the treatment according to traditional Chinese medicine syndrome differentiation for heart failure with normal ejection fraction. Medicine (Baltimore) 2020; 99:e21663. [PMID: 32925713 PMCID: PMC7489596 DOI: 10.1097/md.0000000000021663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The incidence of heart failure with normal ejection fraction (HFNEF) is increasing yearly, accounting for approximately half of all heart failure cases. Even after standardized treatment, the patient's prognosis is not good. Therefore, it is necessary to explore new treatment methods for HFNEF. Yangyin Shuxin Decoction, a traditional Chinese medicine prescription from our clinical experience in the treatment of HFNEF, has a potential cardioprotective effect. Preliminary clinical trials have shown that this prescription can improve the quality of life of HFNEF. This prompted us to use more objective indicators to further evaluate whether Yangyin Shuxin Decoction can improve the exercise capacity in HENEF patients. METHODS This is a single-center parallel randomized controlled trial. The 64 patients who met the inclusion criteria were from the Cardiovascular Clinic. They will be randomly assigned to the treatment group (Yangying Shuxin Decoction combined with standard treatment) or the control group (standard treatment) according to the ratio of 1:1. The course of treatment will be 2 weeks. Both groups were interviewed at the following time points: of at enrollment (V1), and week 2 (V2), week 4 (V3), week 8 (V4), and week 12 (V5) after enrollment. The primary indicator is the peak oxygen consumption (Peak VO2) of the cardiopulmonary exercise test (CPET). Secondary indicators include CPET indicators such as anaerobic threshold oxygen consumption, carbon dioxide ventilation equivalent slope, echocardiographic indicators such as the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity(E/e'), left atrial volume index (LAVI), left ventricular mass index (LVMI), the peak velocity of tricuspid regurgitation (TR), B-type natriuretic peptide (BNP), New York Heart Association (NYHA) cardiac function grading, and so on. These indicators will be used to evaluate the effect of Yangyin Shuxin Decoction on exercise capacity in patients with HFNEF. DISCUSSION At present, it is unclear whether the exercise capacity can be maintained after long-term use of Yangyin Shuxin Decoction. In this study, we will evaluate whether Yangyin Shuxin Decoction can improve the exercise capacity and quality of life of patients with HFNEF. This will provide an objective basis for the therapeutic effect of traditional Chinese medicine on HFNEF. TRIAL REGISTRATION This study protocol has been listed in the Chinese Clinical Trial Registry (registration number: ChiCTR-IOR-17014206, http://www.chictr.org.cn/showproj.aspx?proj=24304) on December 28, 2017.
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Wehmeier UF, Schweitzer A, Jansen A, Probst H, Grüter S, Hähnchen S, Hilberg T. Effects of high-intensity interval training in a three-week cardiovascular rehabilitation: a randomized controlled trial. Clin Rehabil 2020; 34:646-655. [DOI: 10.1177/0269215520912302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: The aim of this study was to assess the benefit of using high-intensity interval training for cardiovascular patients undergoing outpatient rehabilitation in a standard short-term (three-week) program in Germany. Design: This is a randomized controlled trial (RCT). Setting: This study was conducted at Cardiowell (Wuppertal, Germany), an outpatient rehabilitation center. Intervention: Patients underwent the typical three-week German outpatient rehabilitation program using either moderate continuous training (i.e. the standard training program) or high-intensity interval training. Main measures: A total of 50 patients of an outpatient rehabilitation center were randomized into two groups. The control group underwent the standard rehabilitation protocol that applied moderate continuous training, and the intervention group trained according to a high-intensity interval protocol. Patients trained on a bicycle ergometer. Peak power output, oxygen uptake parameters, heart frequencies, and blood pressure were compared at the beginning and at the end of the rehabilitation program. Results: After three weeks, the intervention group had improved to a significantly greater extent in maximal performance parameters than the control group: the peak power output (20.9 (±14.1) W; control 8.8 (±10.4) W), maximum oxygen uptake (0.33 (±0.33) L/min; control 0.05 (±0.29) L/min)), relative maximum oxygen uptake (3.4 (±4.2) mL/kg/min; control 0.9 (±3.1) mL/kg/min), and O2 pulse (1.8 (±2.2) mL/heart beat; control 0.35 (±1.7) mL/heart beat). Conclusion: The implementation of high-intensity interval training during a typical three-week German cardiac rehabilitation has the power to increase the outcome for the patients.
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Affiliation(s)
- Udo F Wehmeier
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | | | - Armin Jansen
- Cardiowell, Center of Rehabilitation, Wuppertal, Germany
| | - Herbert Probst
- Cardiowell, Center of Rehabilitation, Wuppertal, Germany
| | - Stephan Grüter
- Cardiowell, Center of Rehabilitation, Wuppertal, Germany
| | - Silke Hähnchen
- Cardiowell, Center of Rehabilitation, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
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Gerlach S, Mermier C, Kravitz L, Degnan J, Dalleck L, Zuhl M. Comparison of Treadmill and Cycle Ergometer Exercise During Cardiac Rehabilitation: A Meta-analysis. Arch Phys Med Rehabil 2019; 101:690-699. [PMID: 31738893 DOI: 10.1016/j.apmr.2019.10.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/22/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare treadmill versus cycling-based exercise in cardiac rehabilitation (CR) on functional capacity (FC) outcomes. DATA SOURCE Databases were searched for randomized studies using single modality continuous exercise. STUDY SELECTION Studies implemented a continuous cycling or treadmill protocol for patients with either coronary artery disease (CAD) or chronic heart failure (CHF). The effect of single modality exercise on FC (VO2peak) was analyzed. Differences in the effect of CR on FC was assessed between the mode subgroup (cycling vs treadmill) and disease state subgroup (CAD vs CHF) within both the cycling and treadmill groups. DATA EXTRACTION Data were extracted from 23 studies including 600 patients (mean age 60y, 86% men). DATA SYNTHESIS There was a significant difference in effect size between studies that used cycling, Hedges' g=0.85 (95% confidence interval [95% CI], 0.52-1.17; k=13) and studies that used treadmill exercise, Hedges' g=0.46 (95% CI, 0.22-0.70; k=8). Within cycling studies (n=14), FC was higher among CAD patients, Hedges' g=1.03 (95% CI, 0.65-1.42; k=9) compared to those with CHF, Hedges' g=0.40 (95% CI, 0.09-0.71; k=4, P<.001). Conversely, among treadmill studies (n=9), FC was higher among CHF patients, Hedges' g=0.94 (95% CI, 0.23-1.65; k=2) compared to CAD, Hedges' g=0.33 (95% CI, 0.19-0.47; k=5; P<.01). CONCLUSIONS According to identified studies, when cycling was the primary mode of exercise in CR, there was larger change in FC compared to treadmill exercise. In addition, CAD patients experienced greater gains in FC when cycling was the primary mode of exercise in CR, while CHF patients benefited more from treadmill-based exercise programs.
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Affiliation(s)
- Stephanie Gerlach
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque, NM; Department of Health, Physical Education and Recreation, Missouri Western State University, St. Joseph, MO.
| | - Christine Mermier
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque, NM
| | - Len Kravitz
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque, NM
| | - James Degnan
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM
| | - Lance Dalleck
- Recreation, Exercise and Sport Science Department, Western Colorado University, Gunnison, CO
| | - Micah Zuhl
- Department of Health, Exercise, and Sport Science, University of New Mexico, Albuquerque, NM; School of Health Sciences, Central Michigan University, Mt. Pleasant, MI
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Abstract
We critically appraised all available evidence regarding exercise interventions for improving patient survival and reducing hospital admissions in adults with chronic heart failure (HF). We searched 4 databases up to April 2018 and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation working group approach. We reviewed 7 meta-analyses and the publications of 48 randomized controlled trials (RCTs). In HF with reduced ejection fraction, low-quality evidence suggests that exercise prevents all-cause hospitalizations [Relative risk (RR), 0.77; 95% confidence interval (CI), 0.63 to 0.93; 1328 patients in 15 RCTs] and hospitalizations due to HF (RR, 0.57; 95% CI, 0.37 to 0.88; 1073 patients in 13 RCTs) and improves quality of life (standardized mean difference, -0.37; 95% CI, -0.60 to -0.14; 1270 patients in 25 RCTs) but has no effect on mortality. In HF with preserved ejection fraction, low-quality evidence suggests that exercise improves peak oxygen uptake (mean difference, 2.36; 95% CI, 1.16 to 3.57; 171 patients in 3 RCTs) and quality of life (mean difference, -4.65; 95% CI, -8.46 to -0.83; 203 patients in 4 RCTs). In patients after heart transplantation, low-quality evidence suggests that exercise improves peak oxygen uptake (standardized mean difference, 0.68; 95% CI, 0.43 to 0.93; 284 patients in 9 RCTs) but does not improve quality of life. In order to reduce hospitalization and improve quality of life for adults with HF and reduced ejection fraction, clinicians should recommend exercise interventions. For adults with HF and preserved ejection fraction and in those undergoing heart transplantation, clinicians may recommend exercise interventions in order to improve peak oxygen uptake.
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Panagopoulou N, Karatzanos E, Dimopoulos S, Tasoulis A, Tachliabouris I, Vakrou S, Sideris A, Gratziou C, Nanas S. Exercise training improves characteristics of exercise oscillatory ventilation in chronic heart failure. Eur J Prev Cardiol 2017; 24:825-832. [PMID: 28436722 DOI: 10.1177/2047487317695627] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Exercise oscillatory ventilation in chronic heart failure has been suggested as a factor related to adverse cardiac events, aggravated prognosis and higher mortality. Exercise training is well known to affect exercise capacity and mechanisms of pathophysiology beneficially in chronic heart failure. Little is known, however, about the exercise training effects on characteristics of exercise oscillatory ventilation in chronic heart failure patients. Design and methods Twenty (out of 38) stable chronic heart failure patients exhibited exercise oscillatory ventilation (age 54 ± 11 years, peak oxygen uptake 15.0 ± 5.0 ml/kg per minute). Patients attended 36 sessions of high intensity interval exercise. All patients underwent cardiopulmonary exercise testing before and after the programme. Assessment of exercise oscillatory ventilation was based on the amplitude of cyclic fluctuations in breathing during rest and exercise. All values are mean ± SD. Results Exercise training reduced ( P < 0.05) the percentage of exercise oscillatory ventilation duration (79.0 ± 13.0 to 50.0 ± 25.0%), while average amplitude (5.2 ± 2.0 to 4.9 ± 1.6 L/minute) and length (44.0 ± 10.9 to 41.0 ± 6.7 seconds) did not change ( P > 0.05). Exercise oscillatory ventilation patients also increased exercise capacity ( P < 0.05). Conclusions A rehabilitation programme based on high intensity interval training improved exercise oscillatory ventilation observed in chronic heart failure patients, as well as cardiopulmonary efficiency and functional capacity.
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Affiliation(s)
- Niki Panagopoulou
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Eleftherios Karatzanos
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Stavros Dimopoulos
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Athanasios Tasoulis
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Ioannis Tachliabouris
- 2 Third Cardiology Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Styliani Vakrou
- 2 Third Cardiology Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Antonios Sideris
- 3 Second Department of Cardiology, "Evaggelismos" General Hospital, Athens, Greece
| | - Christina Gratziou
- 4 Pulmonary and Critical Care University Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Serafim Nanas
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
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Koschate J, Drescher U, Brinkmann C, Baum K, Schiffer T, Latsch J, Brixius K, Hoffmann U. Faster heart rate and muscular oxygen uptake kinetics in type 2 diabetes patients following endurance training. Appl Physiol Nutr Metab 2017; 41:1146-1154. [PMID: 27819153 DOI: 10.1139/apnm-2016-0001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cardiorespiratory kinetics were analyzed in type 2 diabetes patients before and after a 12-week endurance exercise-training intervention. It was hypothesized that muscular oxygen uptake and heart rate (HR) kinetics would be faster after the training intervention and that this would be detectable using a standardized work rate protocol with pseudo-random binary sequences. The cardiorespiratory kinetics of 13 male sedentary, middle-aged, overweight type 2 diabetes patients (age, 60 ± 8 years; body mass index, 33 ± 4 kg·m-2) were tested before and after the 12-week exercise intervention. Subjects performed endurance training 3 times a week on nonconsecutive days. Pseudo-random binary sequences exercise protocols in combination with time series analysis were used to estimate kinetics. Greater maxima in cross-correlation functions (CCFmax) represent faster kinetics of the respective parameter. CCFmax of muscular oxygen uptake (pre-training: 0.31 ± 0.03; post-training: 0.37 ± 0.1, P = 0.024) and CCFmax of HR (pre-training: 0.25 ± 0.04; post-training: 0.29 ± 0.06, P = 0.007) as well as peak oxygen uptake (pre-training: 24.4 ± 4.7 mL·kg-1·min-1; post-training: 29.3 ± 6.5 mL·kg-1·min-1, P = 0.004) increased significantly over the course of the exercise intervention. In conclusion, kinetic responses to changing work rates in the moderate-intensity range are similar to metabolic demands occurring in everyday habitual activities. Moderate endurance training accelerated the kinetic responses of HR and muscular oxygen uptake. Furthermore, the applicability of the used method to detect these accelerations was demonstrated.
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Affiliation(s)
- Jessica Koschate
- a Institute of Physiology and Anatomy, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Uwe Drescher
- a Institute of Physiology and Anatomy, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Christian Brinkmann
- b Institute of Cardiovascular Research and Sport Medicine, Department of Molecular and Cellular Sport Medicine, German Sport University Cologne, 50933 Cologne, Germany
| | - Klaus Baum
- a Institute of Physiology and Anatomy, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Thorsten Schiffer
- c Outpatient Clinic for Sports Traumatology and Public Health Consultation, German Sport University Cologne, 50933 Cologne, Germany
| | - Joachim Latsch
- d Institute of Cardiovascular Research and Sport Medicine, Department of Preventive and Rehabilitative Sport Medicine, German Sport University Cologne, 50933 Cologne, Germany
| | - Klara Brixius
- b Institute of Cardiovascular Research and Sport Medicine, Department of Molecular and Cellular Sport Medicine, German Sport University Cologne, 50933 Cologne, Germany
| | - Uwe Hoffmann
- a Institute of Physiology and Anatomy, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
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Spee RF, Niemeijer VM, Wijn PF, Doevendans PA, Kemps HM. Effects of high-intensity interval training on central haemodynamics and skeletal muscle oxygenation during exercise in patients with chronic heart failure. Eur J Prev Cardiol 2016; 23:1943-1952. [DOI: 10.1177/2047487316661615] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Ruud F Spee
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
- ICIN, Netherlands Heart Institute, Utrecht, The Netherlands
| | - Victor M Niemeijer
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Pieter F Wijn
- Department of Clinical Physics and Clinical Informatics, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Pieter A Doevendans
- ICIN, Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands
| | - Hareld M Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
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Reboredo MM, Neder JA, Pinheiro BV, Henrique DM, Lovisi JC, Paula RB. Intra-dialytic training accelerates oxygen uptake kinetics in hemodialysis patients. Eur J Prev Cardiol 2014; 22:912-9. [PMID: 25038079 DOI: 10.1177/2047487314543079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/18/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND End-stage renal disease is associated with several hemodynamic and peripheral muscle abnormalities that could slow the rate of change in oxygen uptake ([Formula: see text]O2) at the onset and at the end of exercise. This study was performed to determine whether an intra-dialytic aerobic training program would speed [Formula: see text]O2 kinetics at the transition to and from moderate and high-intensity exercise. DESIGN This study was a randomized controlled trial. METHODS Twenty-four patients with end-stage renal disease (14 females; 47.0 ± 11.9 years) were randomly assigned to either 12-week cycle ergometer-based training at moderate exertion or a similar control period. At initial and final evaluations, patients underwent 6 min moderate and high-intensity tests to exercise intolerance (Tlim). RESULTS Training improved Tlim by ∼90% (median (inter-quartile range) = 232 (59) s to 445 (451) s, p < 0.05); in contrast, Tlim decreased by ∼30% in controls (291 (134) s to 202 (131) s). [Formula: see text]O2 kinetics at the onset of moderate-intensity exercise were significantly accelerated with training leading to lower oxygen (O2) deficit (mean ± standard deviation (SD) = 3.2 ± 1.3 l vs 2.3 ± 1.2 l). Similar positive effects were found at the high-intensity test either at the onset of, or recovery from, exercise (p < 0.05). "Excess" [Formula: see text]O2 at the high-intensity test was also lessened with training. Changes in Tlim correlated with faster [Formula: see text]O2 kinetics and lower "excess" [Formula: see text]O2 (Spearman's ρ = -0.56 and -0.75, respectively; p < 0.01). CONCLUSIONS A symptom-targeted intra-dialytic training program improved sub-maximal aerobic metabolism and endurance exercise capacity. [Formula: see text]O2 kinetics are valuable in providing relatively effort-independent information on the efficacy of exercise interventions in this patient population.
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Affiliation(s)
- Maycon M Reboredo
- Division of Pulmonology, Federal University of Juiz de Fora, Brazil NIEPEN, Federal University of Juiz de Fora, Brazil
| | - J Alberto Neder
- Division of Respiratory and Critical Care Medicine, Queen's University, Canada
| | - Bruno V Pinheiro
- Division of Pulmonology, Federal University of Juiz de Fora, Brazil
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Limitations to high intensity exercise prescription in chronic heart failure patients. Eur J Cardiovasc Nurs 2010; 10:167-73. [PMID: 20643582 DOI: 10.1016/j.ejcnurse.2010.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 06/02/2010] [Accepted: 06/03/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Interval training is recommended for chronic heart failure patients (CHF), but specific guidelines on setting appropriate workloads have not been fully established. The aim of this study was to compare a traditional method of interval training prescription with a protocol specifically designed for CHF. METHODS Ten CHF and 7 healthy controls performed 2 maximal incremental cycle tests to determine interval training workload; a standard test (10Wmin(-)(1)) and a steep test (25W.10(-)(s)). Peak work rate and oxygen uptake (VO(2 peak)) were determined. Training workloads were defined as 100% standard test and 50% steep test peak work rate. RESULTS Training workload determined from the standard test was higher than from the steep test in healthy controls (151 ± 17W vs 118 ± 13W; P<0.01), whereas in CHF there was no significant difference between methods (88 ± 10W vs 96 ± 9W; P>0.05). Steep test VO(2peak) reached 91 ± 5% of standard test VO(2 peak) in controls, and 99 ± 4% in CHF, with no significant differences between tests in either group. CONCLUSION Prescribing interval training from a standard test results in higher workloads than from a steep test in healthy individuals, but in CHF both methods prescribe similar workloads. However it should not be assumed that the two tests can be used interchangeably for CHF. This small-sized study raises issues about interval training prescription that may be hypothesis-generating for future larger-scale studies.
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Effects of a 3-month rehabilitation program on muscle oxygenation in congestive heart failure patients as assessed by NIRS. INTERNATIONAL JOURNAL OF INDUSTRIAL ERGONOMICS 2010. [DOI: 10.1016/j.ergon.2009.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Exercise training increases oxygen uptake efficiency slope in chronic heart failure. ACTA ACUST UNITED AC 2008; 15:140-4. [DOI: 10.1097/hjr.0b013e3282ef19986] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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