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Wang F, Bai Y, Hua B, Zhou W, Wang X. Effect of different intensity exercises on cardiopulmonary function and quality of life of patients with chronic heart failure : A systematic review and meta-analysis. Herz 2024; 49:134-146. [PMID: 37552242 DOI: 10.1007/s00059-023-05202-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation has positive benefits for patients with chronic heart failure (CHF), but the choice of exercise intensity has been controversial. The aim of this systematic review and meta-analysis was to investigate the effects of different exercise intensities on cardiopulmonary function and quality of life (QoL) of patients with CHF. METHODS Randomized controlled trials (RCTs) of different exercise intensities applied to patients with CHF were searched in PubMed, Web of Science, the Cochrane Library, and Embase databases from inception to December 2021. Study selection and data extraction were performed simultaneously by two independent reviewers, using the Physiotherapy Evidence Database Scale (PEDro) for quality assessment of the included literature. The weighted mean differences (WMD) or standardized mean difference (SMD) were calculated by employing a fixed or random effects model. Other statistical analyses included subgroup analysis and sensitivity analysis. Quality of evidence was evaluated by the Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) method. RESULTS Eight RCTs were included. Analyses reported no significant improvement in left ventricular ejection fractions (LVEF; WMD = 0.47, 95% CI [-4.10, 5.03], p = 0.841), peak oxygen uptake (peak VO2) (SMD = 0.38, 95% CI [-0.03, 0.80], p = 0.069) and 6‑min walking distance (6MWD) (WMD = 14.10, 95% CI [-9.51, 37.72], p = 0.242). Exercise interventions of varying intensity produced small-to-moderate beneficial effects on QoL (WMD = -4.99, 95% CI [-8.29, -1.68], p = 0.003), which appeared to be attenuated at long-term follow-up (WMD = 2.12, 95% CI [-2.91, 7.16], p = 0.409). CONCLUSION High-intensity exercise does not have a significant advantage over moderate-intensity exercise in improving cardiopulmonary function and aerobic capacity in patients with CHF. Beneficial changes in QoL from high-intensity exercise also appeared to decrease during long-term follow-up, indicating a cumulative effect of the efficacy of high-intensity exercise.
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Affiliation(s)
- Fengying Wang
- Cancer Institute, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Bai
- Department of Cardiology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bin Hua
- Department of Cardiology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenqin Zhou
- Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoyan Wang
- Department of Anus and Intestine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Gonçalves C, Bravo J, Pais J, Abreu A, Raimundo A. Improving Health Outcomes in Coronary Artery Disease Patients with Short-Term Protocols of High-Intensity Interval Training and Moderate-Intensity Continuous Training: A Community-Based Randomized Controlled Trial. Cardiovasc Ther 2023; 2023:6297302. [PMID: 38146531 PMCID: PMC10749735 DOI: 10.1155/2023/6297302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/26/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
Studies have shown that the higher the aerobic capacity, the lower the risk of cardiovascular mortality and morbidity. In the case of cardiac patients, high-intensity interval training (HIIT) seems to be more effective than moderate-intensity continuous training (MICT) in improving aerobic capacity. The aim of this study was to investigate the effects of two community-based exercise programs using two short-term protocols (HIIT and MICT) on physical fitness and physical activity (PA) levels in coronary artery disease (CAD) patients. Methods. In this randomized controlled trial, body composition, aerobic capacity, muscle strength, and daily PA levels were assessed before and after 6 weeks of intervention in 69 patients diagnosed with CAD. All patients were randomly (1 : 1 : 1) assigned to two exercise groups (HIIT or MICT) or a control group (no exercise). Both training programs consisted of 6 weeks of supervised treadmill exercise, three sessions per week. MICT targeted ≈70-75% of peak heart rate (HR), while HIIT aimed for ≈85-95% of peak HR. The control group only followed the medical recommendations. Results. Community-based exercise programs showed more positive effects on physical fitness variables and physical activity levels compared to control. HIIT could significantly improve waist circumference, body fat mass, VO2peak, sedentary behavior, and moderate-to-vigorous PA compared to MICT. Moreover, the control group showed poorer results. Conclusion. HIIT can improve health outcomes more positively than MICT and control. These findings indicate that HIIT may be an alternative and effective training method in community-based exercise programs for CAD patients. This trial is registered with NCT03538119.
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Affiliation(s)
- Catarina Gonçalves
- Department of Sports and Health, School of Science and Technology, University of Évora, 7000-727 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Portugal
| | - Jorge Bravo
- Department of Sports and Health, School of Science and Technology, University of Évora, 7000-727 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Portugal
| | - João Pais
- Department of Cardiology, Espírito Santo Hospital of Évora, 7000-811 Évora, Portugal
| | - Ana Abreu
- Department of Cardiology, Santa Maria Hospital, 1649-028 Lisbon, Portugal
| | - Armando Raimundo
- Department of Sports and Health, School of Science and Technology, University of Évora, 7000-727 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Portugal
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Currie KD, Dizonno V, Oh PI, Goodman JM. Acute physiological responses to high-intensity interval exercise in patients with coronary artery disease. Eur J Appl Physiol 2023; 123:737-747. [PMID: 36445494 DOI: 10.1007/s00421-022-05102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Time spent closer to maximal effort during exercise is a potent stimulus for cardiorespiratory adaptations. The primary purpose was to determine which high-intensity interval exercise (HIIE) protocol provided the greatest physiological stimulus by comparing time spent ≥ 90% peak oxygen consumption (V̇O2peak) and heart rate reserve (HRR) in patients with coronary artery disease (CAD) in response to 3 HIIE protocols and the exercise standard of care, moderate-intensity continuous exercise (MICE). A secondary purpose was to assess protocol preference. METHODS Fifteen patients with CAD (6 females, 67 ± 6 years) underwent measurements of V̇O2 and heart rate during MICE and three HIIE protocols all performed on a treadmill. The HIIE protocols included one with long intervals (4 × 4-min), short intervals (10 × 1-min), and an adapted version of the 4 × 4 [Toronto Rehabilitation Institute Protocol, (TRIP)]. Time spent ≥ 90% V̇O2peak and HRR were compared. RESULTS Time spent ≥ 90% V̇O2peak was higher during 4 × 4 (6.3 ± 8.4 min) vs. MICE (1.7 ± 3.9 min; P = 0.001), while time spent ≥ 90% HRR was higher during 4 × 4 (6.0 ± 5.3 min) vs. MICE (0.1 ± 0.2 min; P < 0.001) and 10 × 1 (0.7 ± 0.8 min; P = 0.016). TRIP had similar responses as 10 × 1 and MICE. The 10 × 1 was the most preferred protocol and the 4 × 4 was the least preferred protocol. CONCLUSION Longer intervals (4 × 4) provided the greatest physiological stimulus compared to the exercise standard of care and shorter intervals. However, this protocol was least preferred which may impact exercise adherence. Although the physiological stimulus is important to maximize training adaptations, exercise preferences and attitudes should be considered.
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Affiliation(s)
- Katharine D Currie
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA.
| | - Vanessa Dizonno
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Paul I Oh
- University Health Network, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Jack M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto Rehabilitation Institute, Toronto, ON, Canada
- Division of Cardiology, Mt. Sinai Hospital, Toronto, ON, Canada
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Zheng L, Pan D, Gu Y, Wang R, Wu Y, Xue M. Effects of high-intensity and moderate-intensity exercise training on cardiopulmonary function in patients with coronary artery disease: A meta-analysis. Front Cardiovasc Med 2022; 9:961414. [PMID: 36204588 PMCID: PMC9530785 DOI: 10.3389/fcvm.2022.961414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The study aims to evaluate the effects of high-intensity and moderate-intensity exercise training on cardiopulmonary function and exercise endurance in patients with coronary artery diseases (CAD). Methods We performed a systematic search of the English and Chinese databases from their inception to March 2022. Randomized controlled trials (RCTs) were included to compare high-intensity and moderate-intensity exercise training on cardiopulmonary function in patients with CAD. The primary outcomes included peak oxygen uptake (peak VO2) and anaerobic threshold (AT). The secondary outcomes included left ventricular ejection fraction (LVEF), exercises duration (ED), respiratory exchange ratio (RER), resting heart rate (RHR), peak heart rate (PHR) and oxygen pulse (O2 pulse). The continuous variables were expressed as mean differences (MD) along with their corresponding standard deviations (SD), and the I2 test was applied in the assessment of heterogeneity. Results After systematically literature search, 19 studies were finally selected for our meta-analysis (n = 1,036), with 511 patients in the experimental group (high-intensity exercise) and 525 patients in the control group (moderate-intensity exercise). The results showed that high-intensity exercise significantly increased patients' Peak VO2 [MD = 2.67, 95% CI (2.24, 3.09), P < 0.00001], LVEF [MD = 3.60, 95% CI (2.17, 5.03), P < 0.00001], ED [MD = 37.51, 95% CI (34.02, 41.00), P < 0.00001], PHR [MD = 6.86, 95% CI (4.49, 9.24), P < 0.00001], and O2 pulse [MD = 0.97, 95% CI (0.34, 1.60), P = 0.003] compared with moderate-intensity exercise. However, there were no significant differences in AT [MD = 0.49, 95% CI (−0.12, 1.10), P = 0.11], RER [MD = 0.00, 95% CI (−0.01, 0.02), P = 0.56], and RHR [MD = 1.10, 95% CI (−0.43, 2.63), P = 0.16]. Conclusion Our results show that high-intensity exercise training has more significant positive effects compared with moderate-intensity exercise training in improving peak VO2, LVEF, ED, PHR and O2 pulse in patients with CAD, while no significant differences were observed in AT, RER and RHR. To sum up, high-intensity exercise training is better than moderate-intensity exercise training in improving cardiopulmonary function and exercise endurance in patients with CAD. Systematic review registration PROSPERO (CRD42022328475), https://www.crd.york.ac.uk/PROSPERO/.
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Affiliation(s)
- Liying Zheng
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Deng Pan
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Yimeng Gu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Rumeng Wang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanyan Wu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Mei Xue
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Mei Xue
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Yue T, Wang Y, Liu H, Kong Z, Qi F. Effects of High-Intensity Interval vs. Moderate-Intensity Continuous Training on Cardiac Rehabilitation in Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:845225. [PMID: 35282360 PMCID: PMC8904881 DOI: 10.3389/fcvm.2022.845225] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/28/2022] [Indexed: 12/25/2022] Open
Abstract
Background Studies have shown that high-intensity interval training (HIIT) is superior to moderate-intensity continuous training (MICT) for increasing peak oxygen uptake (VO2peak) and reducing cardiovascular disease (CVD) and mortality. To our knowledge, previously published systematic reviews have neither compared different HIIT models with MICT nor investigated intervention frequencies of HIIT vs. MICT for purposes of improving cardiorespiratory fitness in patients with CVD. Objective The purpose of this meta-analysis was to compare the effects of different training models, intervention frequencies and weeks of HIIT vs. MICT on changes in cardiorespiratory fitness during cardiac rehabilitation (CR). Methods A systematic search was carried out for research articles on randomized controlled trials (RCTs) indexed in the PubMed, Cochrane Library, Web of Science, Embase and Scopus databases for the period up to December 2021. We searched for RCTs that compared the effect of HIIT vs. MICT on cardiorespiratory fitness in patients with CVD. Results Twenty-two studies with 949 participants (HIIT: 476, MICT: 473) met the inclusion criteria. Sensitivity analysis revealed that HIIT increased VO2peak more than MICT (MD = 1.35). In the training models and durations, there was a greater increase in VO2peak with medium-interval HIIT (MD = 4.02) and more than 12 weeks duration (MD = 2.35) than with MICT. There were significant improvements in VO2peak with a HIIT frequency of 3 times/week (MD = 1.28). Overall, one minor cardiovascular and four non-cardiovascular adverse events were reported in the HIIT group, while six non-cardiovascular adverse events were reported in the MICT group. Conclusion HIIT is safe and appears to be more effective than MICT for improving cardiorespiratory fitness in patients with CVD. Medium-interval HIIT 3 times/week for more than 12 weeks resulted in the largest improvement in cardiorespiratory fitness during CR. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021245810, identifier: CRD42021245810.
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Affiliation(s)
- Tian Yue
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Yan Wang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Hui Liu
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Zhaowei Kong
- Faculty of Education, University of Macau, Macau, China
| | - Fengxue Qi
- Sports, Exercise and Brain Sciences Laboratory, Beijing Sport University, Beijing, China
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Effect of High-Intensity Interval Training on Physical Health in Coronary Artery Disease Patients: A Meta-Analysis of Randomized Controlled Trials. J Cardiovasc Dev Dis 2021; 8:jcdd8110158. [PMID: 34821711 PMCID: PMC8622669 DOI: 10.3390/jcdd8110158] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 01/02/2023] Open
Abstract
The effects of exercise-based cardiac rehabilitation (CR) on physical health in coronary artery disease (CAD) patients has long been established, while the optimal exercise mode remains to be determined. This meta-analysis compared the efficacy of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) in CAD patients. Databases were searched up to December 2020. Twenty-five studies with 1272 participants were analyzed. The results showed that both HIIT and MICT induced significant VO2peak improvement with a 4.52 mL/kg/min (p < 0.01) and 2.36 mL/kg/min (p < 0.01), respectively. Additionally, a larger improvement of VO2peak (1.92 mL/kg/min, p < 0.01) was observed in HIIT over MICT. HIIT with medium and long intervals, higher work/rest ratio induced larger VO2peak improvement than the compared subgroup. Interestingly, non-isocaloric exercise protocols induced larger VO2peak improvement compared with isocaloric protocols. In addition, both HIIT and MICT significantly increased anaerobic threshold and peak power with HIIT superior to MICT. No significant different changes were observed in blood pressure after HIIT or MICT intervention, however when HIIT was compared with MICT, MICT seems superior to HIIT in reducing systolic blood pressure (−3.61 mmHg, p < 0.01) and diastolic blood pressure (−2.37 mmHg, p < 0.01). Although, HIIT and MICT induced significant improvement of most other parameters, like HRrest, HRpeak, left ventricular ejection fraction (LVEF), quality of life (QoL), no significant differences were noted between groups. This meta-analysis suggested that HIIT is superior to MICT in increasing VO2peak, anaerobic threshold, peak power in CAD patients. Additionally, the efficacy of HIIT over MICT in improving VO2peaks was influenced by HIIT intervals, work/rest ratio and total caloric consumption. Both HIIT and MICT did not significantly influence resting BP, however, MICT seemed to be more effective in reducing BP than HIIT. HIIT and MICT equally significantly influenced HRrest, HRpeak, HRR1min, OUES, LVEF%, QoL.
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Trajković N, Đorđević D, Stanković M, Petrušič T, Bogataj Š, Peršič V. Exercise-Based Interventions in Middle-Aged and Older Adults after Myocardial Infarction: A Systematic Review. Life (Basel) 2021; 11:life11090928. [PMID: 34575077 PMCID: PMC8466422 DOI: 10.3390/life11090928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
This study summarized the relevant literature and aimed to determine the effect of exercise-based interventions after myocardial infarction in middle-aged and older adults. Studies were identified and analyzed according to the PRISMA guidelines. The following electronic databases were used: Google Scholar, PubMed, Mendeley, Science Direct, and Scopus. The identified studies had to be longitudinal, be published in English, have taken place between 2010 and 2020, involve participants who had suffered myocardial infarction, and address different types of exercise-based interventions to be included. Of the 592 relevant studies identified, 20 were included in the qualitative analysis. After analyzing the results obtained, it could be concluded that different types of exercise-based interventions or their combination have a positive effect after myocardial infarction in middle-aged and elderly adults. It can also be suggested that the combination of a cycle ergometer and a treadmill may be the most effective exercise-based intervention. An adequate choice of intensity and volume is crucial, with the optimal duration of the experimental program and the type(s) of exercises adapted to participants after myocardial infarction.
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Affiliation(s)
- Nebojša Trajković
- Faculty of Sport and Physical Education, University of Niš, 18000 Niš, Serbia; (N.T.); (D.Đ.); (M.S.)
| | - Dušan Đorđević
- Faculty of Sport and Physical Education, University of Niš, 18000 Niš, Serbia; (N.T.); (D.Đ.); (M.S.)
| | - Mima Stanković
- Faculty of Sport and Physical Education, University of Niš, 18000 Niš, Serbia; (N.T.); (D.Đ.); (M.S.)
| | - Tanja Petrušič
- Faculty of Education, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Špela Bogataj
- Department of Nephrology, University Medical Centre, 1000 Ljubljana, Slovenia;
- Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Vanja Peršič
- Department of Nephrology, University Medical Centre, 1000 Ljubljana, Slovenia;
- Correspondence:
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Qin Y, Kumar Bundhun P, Yuan ZL, Chen MH. The effect of high-intensity interval training on exercise capacity in post-myocardial infarction patients: a systematic review and meta-analysis. Eur J Prev Cardiol 2021; 29:475-484. [PMID: 34279621 DOI: 10.1093/eurjpc/zwab060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 11/12/2022]
Abstract
AIMS Exercise-based cardiac rehabilitation has been recommended a treatment for patients with cardiovascular disease. Nevertheless, it remains controversial which exercise characteristics are most beneficial for post-myocardial infarction (MI) patients. We performed a systematic review and meta-analysis to investigate the effects of high-intensity interval training (HIIT) in these patients. METHODS AND RESULTS We searched PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang Dataset (from the earliest date available to February 2021) for randomized controlled trials and cohort studies that evaluated the effects of HIIT on post-MI patients. Studies were selected according to inclusion and exclusion criteria. Data synthesis was performed with R software version 4.0.1. Eight studies met the study criteria, including 387 patients. Compared to the control group [moderate-intensity continuous training (MICT) and/or routine physical activity], HIIT significantly improved peak oxygen uptake (peak VO2) [mean difference = 3.83 mL/kg/min, 95% confidence interval (CI) (3.25, 4.41), P < 0.01]. No significant difference in systolic and diastolic blood pressures, peak and resting heart rate, left ventricular ejection fraction, left ventricular end-diastolic volume, and the quality of life was found between HIIT group and control group. The duration of follow-up ranged from 6 to 12 weeks. The incidence of adverse events was similar between groups [risk difference = 0.01, 95% CI (-0.02, 0.04), P = 0.53]. CONCLUSION Compared with MICT and routine physical activity, HIIT could significantly improve exercise capacity in post-MI patients, and appears to be safe.
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Affiliation(s)
- Yuan Qin
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530000, China
| | - Pravesh Kumar Bundhun
- Department of Internal Medicine, Bruno Cheong Hospital, Centre De Flacq 40601, Mauritius
| | - Zhang-Li Yuan
- Department of Emergency Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530000, China
| | - Meng-Hua Chen
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530000, China
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Zhang X, Xu D, Sun G, Jiang Z, Tian J, Shan Q. Effects of high-intensity interval training in patients with coronary artery disease after percutaneous coronary intervention: A systematic review and meta-analysis. Nurs Open 2021; 8:1424-1435. [PMID: 33528117 PMCID: PMC8046134 DOI: 10.1002/nop2.759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/03/2020] [Accepted: 11/23/2020] [Indexed: 12/17/2022] Open
Abstract
AIM To evaluate whether high-intensity interval training (HIIT) was superior to low-intensity training or usual care among patients after percutaneous coronary intervention. The hypothesis was that HIIT would help patients after percutaneous coronary intervention (PCI) improve cardiopulmonary function, lipid profiles and in-stent restenosis. DESIGN A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA)2009 Checklist. METHODS Randomized controlled trials (RCTs) focusing on HIIT programme in patients after PCI were searched in Cochrane Library, Web of Science Core Collection, EMbase, PubMed, China National Knowledge Infrastructure (CNKI) and SinoMed from the inception to 24 March 2020. Standard Mean difference (SMD) and 95% confidence intervals (CI) were performed to summarize the effect sizes. RESULTS Six RCTs (247 patients) met the criteria. HIIT programme had a statistically significant effect on raising left ventricular ejection function (LVEF) (SMD = 0.38, 95%CI [0.03, 0.73], I2 = 3%), VO2peak (SMD = 0.94, 95%CI [0.61, 1.28], I2 = 0%), as well as improving the serum level of high-density lipoprotein (SMD = 0.55, 95%CI [0.06, 1.03], I2 = 0%) and late luminal loss (SMD = -0.65, 95%CI [-1.07, -0.23], I2 = 0%). But HIIT had no prominent effect on improving heart rate (SMD = -0.04, 95%CI [-0.29, 0.21], I2 = 0%). Summarily, HIIT programme appears to be favourable for CAD patients after PCI by improving cardiopulmonary function, such as LVEF and VO2peak , as well as reducing late luminal loss in per stented arteries. Nevertheless, HIIT has no advantage for adjusting heart rate. More researches with rigorous methods are warranted to explore the controversy about lipid profiles.
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Affiliation(s)
- Xinyue Zhang
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Dongmei Xu
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Guozhen Sun
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Zhixin Jiang
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jinping Tian
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Qijun Shan
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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10
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Cheng X, Huang J, Zhu J, Li H, Gu H. Clinical evaluation of high intensity interval training exercise in coronary heart disease patients after percutaneous coronary intervention: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25472. [PMID: 33832163 PMCID: PMC8036031 DOI: 10.1097/md.0000000000025472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND: Although the effect of high intensity interval training (HIIT) was gradually explicit, little is explored about the role and the validity of HIIT on patients following percutaneous coronary intervention (PCI). As far as we know, no evidence has been established to assess HIIT program for coronary heart disease (CHD) patients attending cardiac rehabilitation after PCI. Therefore, this systematic review and meta-analysis will be conducted to assess the efficacy and safety of HIIT program for CHD patients attending cardiac rehabilitation after PCI. METHODS: Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library will be searched in March 2021 by 2 independent reviewers. Study included in this systematic review and meta-analysis has to meet all of the following inclusion criteria in the PICOS order: 1. Participants: CHD patients after PCI; 2. Intervention: patients received HIIT; 3. Comparator: patients received other treatment; 4. Outcomes: cardiopulmonary function, lipid profiles and in- stent restenosis; 5. Study design: cohort trials. Data extraction will be performed independently, and any conflict will be resolved before final analysis. Review Manager software (v 5.3; Cochrane Collaboration) is used for the meta-analysis. RESULTS: The results of this research will be delivered in a peer-reviewed journal. CONCLUSION: This study expects to provide credible and scientific clinical evidence for the efficacy and safety of HIIT program for CHD patients attending cardiac rehabilitation after PCI. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/AUMR6.
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Affiliation(s)
| | - Jian Huang
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Jing Zhu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Hui Li
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Haibo Gu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
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Mattioni Maturana F, Martus P, Zipfel S, NIEß AM. Effectiveness of HIIE versus MICT in Improving Cardiometabolic Risk Factors in Health and Disease: A Meta-analysis. Med Sci Sports Exerc 2021; 53:559-573. [PMID: 32890201 DOI: 10.1249/mss.0000000000002506] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE We aimed to investigate differences between high-intensity interval exercise (HIIE, including high-intensity interval training and sprint interval training) and moderate-intensity continuous training (MICT) on physical fitness, body composition, blood pressure, blood lipids, insulin and glucose metabolism, inflammation, and endothelial function. METHODS Differences between HIIE and MICT were summarized using a random-effects meta-analysis on the effect size (Cohen's d). A meta-regression was conducted using the following subgroups: population, age, training duration, men ratio, exercise type, baseline values (clinical relevant ranges), and type of HIIE. Studies were included if at least one of the following outcomes were reported: maximal oxygen uptake (V˙O2max), flow-mediated dilation (FMD), body mass index (BMI), body mass, percent body fat, systolic and diastolic blood pressure, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, total cholesterol, C-reactive protein (CRP), fasting glucose and insulin, glycated hemoglobin (HbA1c), and insulin resistance (HOMA-IR). A total of 55 studies were included. RESULTS Overall, HIIE was superior to MICT in improving V˙O2max (d = 0.40, P < 0.001) and FMD (d = 0.54, P < 0.05). Oppositely, MICT was superior to HIIE in improving HbA1c (d = -0.27, P < 0.05). No differences were observed in BMI (d = -0.02), body mass (d = -0.05), percent body fat (d = 0.04), systolic blood pressure (d = -0.04), diastolic blood pressure (d = 0.03), HDL (d = -0.05), LDL (d = 0.08), triglycerides (d = 0.03), total cholesterol (d = 0.14), CRP (d = -0.11), fasting insulin (d = 0.02), fasting glucose (d = 0.02), and HOMA-IR (d = -0.04). Moderator analyses indicated that the difference between HIIE and MICT was affected by different subgroups. CONCLUSION Overall, HIIE showed to be more effective in improving cardiovascular health and cardiorespiratory fitness, whereas MICT was superior in improving long-term glucose metabolism. In the process of personalized training counseling, health-enhancing effects of exercise training may be improved by considering the individual risk profiles.
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Affiliation(s)
| | - Peter Martus
- Clinical Epidemiology and Applied Biometrics Department, University Hospital of Tübingen, Tübingen, GERMANY
| | - Stephan Zipfel
- Psychosomatic Medicine and Psychotherapy Department, University Hospital of Tübingen, Tübingen, GERMANY
| | - Andreas M NIEß
- Sports Medicine Department, University Hospital of Tübingen, Tübingen, GERMANY
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12
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Taylor JL, Holland DJ, Keating SE, Bonikowske AR, Coombes JS. Adherence to High-Intensity Interval Training in Cardiac Rehabilitation: A REVIEW AND RECOMMENDATIONS. J Cardiopulm Rehabil Prev 2021; 41:61-77. [PMID: 33647920 DOI: 10.1097/hcr.0000000000000565] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE High-intensity interval training (HIIT) is gaining popularity as a training approach for patients attending cardiac rehabilitation (CR). While the literature has focused on the efficacy of HIIT for improving cardiorespiratory fitness (CRF), particularly when compared with moderate intensity exercise, less emphasis has been placed on adherence to HIIT. The aim of this review was to summarize the current literature regarding adherence to HIIT in CR patients with coronary artery disease. REVIEW METHODS A review identified 36 studies investigating HIIT in CR patients with coronary artery disease. Methods and data were extracted for exercise or training adherence (to attendance, intensity, and duration), feasibility of protocols, and CRF. The review summarizes reporting of adherence; adherence to HIIT and comparator/s; the influence of adherence on changes in CRF; and feasibility of HIIT. SUMMARY Adherence to the attendance of HIIT sessions was high and comparable with moderate-intensity exercise. However, adherence to the intensity and duration of HIIT was variable and underreported, which has implications for determining the treatment effect of the exercise interventions being compared. Furthermore, additional research is needed to investigate the utility of home-based HIIT and long-term adherence to HIIT following supervised programs. This review provides recommendations for researchers in the measurement and reporting of adherence to HIIT and other exercise interventions to facilitate a sufficient and consistent approach for future studies. This article also highlights strategies for clinicians to improve adherence, feasibility, and enjoyment of HIIT for their patients.
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Affiliation(s)
- Jenna L Taylor
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Taylor and Bonikowske); Centre for Research on Exercise, Physical activity, and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia (Drs Taylor, Holland, Keating, and Coombes); and Department of Cardiology, Sunshine Coast University Hospital, Birtinya, Australia (Dr Holland)
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13
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Keating CJ, Párraga Montilla JÁ, Latorre Román PÁ, Moreno Del Castillo R. Comparison of High-Intensity Interval Training to Moderate-Intensity Continuous Training in Older Adults: A Systematic Review. J Aging Phys Act 2020; 28:798-807. [PMID: 32303000 DOI: 10.1123/japa.2019-0111] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/16/2019] [Accepted: 12/28/2019] [Indexed: 11/18/2022]
Abstract
High-intensity interval training (HIIT) is emerging as a safe and effective means to combat chronic diseases. The objective of this work was to perform a systematic review of the effect of HIIT interventions in an aging population. Three electronic databases were searched for randomized trials comparing the effect of HIIT and moderate-intensity continuous training in older adults. After a thorough screening process, 15 articles were identified as meeting the inclusion criteria. All studies expressed a comparable or superior effect of HIIT in cardiorespiratory fitness measures. No studies reported a lessened effect of HIIT in comparison with moderate-intensity continuous training. This systematic review demonstrates that HIIT is a useful exercise regimen, which can be used in older adults to increase cardiorespiratory fitness. More research is needed to determine the effects of HIIT in an aging, predominately female population.
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14
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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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15
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Way KL, Vidal-Almela S, Keast ML, Hans H, Pipe AL, Reed JL. The feasibility of implementing high-intensity interval training in cardiac rehabilitation settings: a retrospective analysis. BMC Sports Sci Med Rehabil 2020; 12:38. [PMID: 32612840 PMCID: PMC7325048 DOI: 10.1186/s13102-020-00186-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/22/2020] [Indexed: 12/03/2022]
Abstract
Background Cardiovascular disease is the leading cause of death worldwide. Notwithstanding the well-known benefits of cardiac rehabilitation (CR), adherence to CR remains low, particularly in women. High-intensity interval training (HIIT) has received specific attention as an emerging exercise-training paradigm that addresses frequently cited barriers to CR (i.e. lack of motivation/enjoyment and time, perceiving exercise regime as tiring/boring) and improves cardiovascular risk factors. Previous studies have examined the safety of HIIT in CR; there is little evidence on the feasibility of HIIT in CR. The aims of this study were to evaluate the feasibility of HIIT within a CR setting and examine the sex differences regarding the feasibility of such programming. Methods Patients attended an on-site HIIT CR program (10-min warm-up, 25 min of interspersed high-intensity [HI - 4 min at 85–95% HRpeak] and lower intensity [LO - 3 min at 60–70% HRpeak] intervals, 10-min cool-down) twice weekly for 10 weeks. Heart rate (HR) and the Borg rating of perceived exertion (RPE) scale (6–20 points) were recorded at each session. Feasibility was assessed by: [1] attendance and compliance: the number of sessions attended and the compliance to the prescribed HI and LO HR ranges; [2] the patient experience: patients’ perceived effort, program difficulty, if the program was challenging and satisfying; and, [3] safety. Descriptive statistics were used to report the means and their variations. Mann-Whitney U tests and Chi-square analyses were performed to examine sex-differences. Results A total of 151 patients (33% women, 57.5 ± 9.1 years) attended the HIIT program and completed 16 ± 5 classes with a low attrition rate (11.3%). Most patients met or exceeded the prescribed target HR for the HI (80%) and LO (84%) intervals, respectively. Patients reported a “somewhat hard” RPE for HI (14 ± 2 points) and “very light” for LO (10 ± 2 points) intervals. All patients were satisfied with the program and found it challenging. Most patients found HIIT to be difficult (7 ± 2 points, scale range 0–10 points), yet safe (97%). Three vasovagal episodes occurred and more women dropped-out of the program than men (p < 0.01). Conclusions HIIT is a feasible, safe and well-received exercise paradigm in a CR setting.
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Affiliation(s)
- Kimberley L Way
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Sol Vidal-Almela
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Hôpital Montfort, Ottawa, Canada
| | - Marja-Leena Keast
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Harleen Hans
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Andrew L Pipe
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
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16
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The Effect and Safety of Aerobic Interval Training According to Exercise Intensity in Acute Coronary Syndrome. J Cardiopulm Rehabil Prev 2020; 40:178-182. [DOI: 10.1097/hcr.0000000000000455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Xing Y, Yang SD, Wang MM, Feng YS, Dong F, Zhang F. The Beneficial Role of Exercise Training for Myocardial Infarction Treatment in Elderly. Front Physiol 2020; 11:270. [PMID: 32390856 PMCID: PMC7194188 DOI: 10.3389/fphys.2020.00270] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/09/2020] [Indexed: 12/11/2022] Open
Abstract
Worldwide, elderly people have a higher prevalence of myocardial infarction (MI), which is associated with body function aging and a sedentary lifestyle. In addition to medication, exercise training is a well-established supplementary method to prevent and treat cardiovascular diseases (CVDs). Substantial evidence has shown the value of different intensity exercise programs in the prevention and treatment of MI, and exercise rehabilitation programs are also applicable to elderly patients with MI. Although exercise rehabilitation programs could significantly improve function, quality of life (QoL), and lower mortality and morbidity for people with MI, such programs are underused because their mechanisms are not accurately elucidated. To promote the application of exercise therapy for MI, this review summarizes the benefits and mechanisms of exercise rehabilitation for post-MI patients and provides rationalized proposals for outpatient cardiac rehabilitation.
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Affiliation(s)
- Ying Xing
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Si-Dong Yang
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Man-Man Wang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya-Shuo Feng
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fang Dong
- Department of Clinical Laboratory Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Feng Zhang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Provincial Orthopedic Biomechanics Key Laboratory, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Feng Zhang,
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18
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Wewege MA, Ahn D, Yu J, Liou K, Keech A. High-Intensity Interval Training for Patients With Cardiovascular Disease-Is It Safe? A Systematic Review. J Am Heart Assoc 2019; 7:e009305. [PMID: 30376749 PMCID: PMC6404189 DOI: 10.1161/jaha.118.009305] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Cardiac rehabilitation (CR) for patients with cardiovascular disease has traditionally involved low‐ to moderate‐intensity continuous aerobic exercise training (MICT). There is growing and robust evidence that high‐intensity interval training (HIIT) shows similar or greater efficacy compared with MICT across a range of cardiovascular and metabolic measures, in both healthy populations and populations with a chronic illness. However, there is understandable concern about the safety aspects of applying HIIT in CR settings. This systematic review analyzed safety data drawn from recent proof‐of‐concept studies of HIIT during CR among patients with cardiovascular disease. Methods and Results We included trials comparing HIIT with either MICT or usual care in patients with coronary artery disease or heart failure participating in tertiary care services, such as phase 2 (outpatient) CR. Adverse events occurring during or up to 4 hours after an exercise training session were collated. There were 23 studies included, which analyzed 1117 participants (HIIT=547; MICT=570). One major cardiovascular adverse event occurred in relation to an HIIT session, equating to 1 major cardiovascular event per 17 083 training sessions (11 333 training hours). One minor cardiovascular adverse events and 3 noncardiovascular adverse events (primarily musculoskeletal complaints) were also reported for HIIT. Two noncardiovascular events were reported in relation to MICT. Conclusions HIIT has shown a relatively low rate of major adverse cardiovascular events for patients with coronary artery disease or heart failure when applied within CR settings.
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Affiliation(s)
- Michael A Wewege
- 1 Department of Exercise Physiology School of Medical Sciences University of New South Wales Sydney Australia
| | - Dohee Ahn
- 1 Department of Exercise Physiology School of Medical Sciences University of New South Wales Sydney Australia
| | - Jennifer Yu
- 2 Department of Cardiology Prince of Wales Hospital and the Prince of Wales Clinical School University of New South Wales Sydney Australia
| | - Kevin Liou
- 2 Department of Cardiology Prince of Wales Hospital and the Prince of Wales Clinical School University of New South Wales Sydney Australia
| | - Andrew Keech
- 1 Department of Exercise Physiology School of Medical Sciences University of New South Wales Sydney Australia
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19
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Kim C, Sung J, Lee JH, Kim WS, Lee GJ, Jee S, Jung IY, Rah UW, Kim BO, Choi KH, Kwon BS, Yoo SD, Bang HJ, Shin HI, Kim YW, Jung H, Kim EJ, Lee JH, Jung IH, Jung JS, Lee JY, Han JY, Han EY, Won YH, Han W, Baek S, Joa KL, Lee SJ, Kim AR, Lee SY, Kim J, Choi HE, Lee BJ, Kim S. Clinical Practice Guideline for Cardiac Rehabilitation in Korea: Recommendations for Cardiac Rehabilitation and Secondary Prevention after Acute Coronary Syndrome. Korean Circ J 2019; 49:1066-1111. [PMID: 31646772 PMCID: PMC6813162 DOI: 10.4070/kcj.2019.0194] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023] Open
Abstract
Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular (CV) disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of thirty-three authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers CV mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine-Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine-Regional Cardiocerebrovascular Center, Dong-A Medical Center, Busan, Korea
| | - Won Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Gyeonggi Regional Cardiocerebrovascular Center, Seongnam, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University College of Medicine, Cheongju, Korea.
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine-Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Daejeon, Korea
| | - Il Young Jung
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine-Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Daejeon, Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Byung Ok Kim
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University School of Medicine, Goyang, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyung Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Wook Kim
- Department and Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Heeyoune Jung
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | | | - In Hyun Jung
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Anam Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Young Han
- Department of Rehabilitation Medicine, Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Woosik Han
- Department of Thoracic Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine-Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
| | - Kyung Lim Joa
- Department of Rehabilitation Medicine, Inha University Hospital, Incheon, Korea
| | - Sook Joung Lee
- Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jihee Kim
- Department of Rehabilitation Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byeong Ju Lee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea
| | - Soon Kim
- Research Institute for Social Science, Ewha Woman's University, Seoul, Korea
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20
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Kim C, Sung J, Lee JH, Kim WS, Lee GJ, Jee S, Jung IY, Rah UW, Kim BO, Choi KH, Kwon BS, Yoo SD, Bang HJ, Shin HI, Kim YW, Jung H, Kim EJ, Lee JH, Jung IH, Jung JS, Lee JY, Han JY, Han EY, Won YH, Han W, Baek S, Joa KL, Lee SJ, Kim AR, Lee SY, Kim J, Choi HE, Lee BJ, Kim S. Clinical Practice Guideline for Cardiac Rehabilitation in Korea. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:248-285. [PMID: 31404368 PMCID: PMC6687042 DOI: 10.5090/kjtcs.2019.52.4.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 06/29/2019] [Accepted: 07/06/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. RESULTS CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. CONCLUSION Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine,
Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine–Heart Vascular Stroke Institute, Samsung Medical Center, Seoul,
Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine–Regional Cardiocerebrovascular Center, Dong-A Medical Center, Busan,
Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine,
Korea
- Gyeonggi Regional Cardiocerebrovascular Center, Seongnam,
Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju,
Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Il-Young Jung
- Department of Rehabilitation Medicine, Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon,
Korea
| | - Byung Ok Kim
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine,
Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University School of Medicine, Goyang,
Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Seoul,
Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju,
Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Yong Wook Kim
- Department and Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Heeyoune Jung
- National Traffic Injury Rehabilitation Hospital, Yangpyeong,
Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | | | - In Hyun Jung
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine,
Korea
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jae-Young Han
- Department of Rehabilitation Medicine, Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju,
Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju,
Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University–Biomedical Research Institute of Chonbuk National University Hospital, Jeonju,
Korea
| | - Woosik Han
- Department of Thoracic Surgery, Chungnam National University Hospital, Daejeon,
Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine–Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon,
Korea
| | - Kyung-Lim Joa
- Department of Rehabilitation Medicine, Inha University Hospital, Incheon,
Korea
| | - Sook Joung Lee
- Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon,
Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu,
Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju,
Korea
| | - Jihee Kim
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan,
Korea
| | - Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan,
Korea
| | - Byeong-Ju Lee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan,
Korea
| | - Soon Kim
- Research Institute for Social Science, Ewha Woman’s University, Seoul,
Korea
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21
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Dun Y, Smith JR, Liu S, Olson TP. High-Intensity Interval Training in Cardiac Rehabilitation. Clin Geriatr Med 2019; 35:469-487. [PMID: 31543179 DOI: 10.1016/j.cger.2019.07.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recently, high-intensity interval training (HIIT) has been recognized as a safe and effective alternative to moderate-intensity continuous training for older patients with cardiovascular disease (CVD) in cardiac rehabilitation settings in an effort to improve health outcomes. This brief review considers general principles and suggestions for prescription of HIIT for older patients with CVD, specific challenges pertaining to older adults, the physiologic mechanisms by which HIIT contributes to improvements in peak Vo2, and the effects of HIIT on cardiovascular health in older patients with coronary artery disease and heart failure.
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Affiliation(s)
- Yaoshan Dun
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, Hunan, P.R. China; Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Joshua R Smith
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Suixin Liu
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, Hunan, P.R. China.
| | - Thomas P Olson
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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22
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Kim C, Sung J, Lee JH, Kim WS, Lee GJ, Jee S, Jung IY, Rah UW, Kim BO, Choi KH, Kwon BS, Yoo SD, Bang HJ, Shin HI, Kim YW, Jung H, Kim EJ, Lee JH, Jung IH, Jung JS, Lee JY, Han JY, Han EY, Won YH, Han W, Baek S, Joa KL, Lee SJ, Kim AR, Lee SY, Kim J, Choi HE, Lee BJ, Kim S. Clinical Practice Guideline for Cardiac Rehabilitation in Korea. Ann Rehabil Med 2019; 43:355-443. [PMID: 31311260 PMCID: PMC6637050 DOI: 10.5535/arm.2019.43.3.355] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/31/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. METHODS This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and two general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, three rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. PRINCIPAL CONCLUSIONS CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University School of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Jidong Sung
- Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine–Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine–Regional Cardiocerebrovascular Center, Dong-A Medical Center, Busan, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Gyeonggi Regional Cardiocerebrovascular Center, Seongnam, Korea
| | - Goo Joo Lee
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Cheongju, Korea
| | - Sungju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine–Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Daejeon, Korea
| | - Il-Young Jung
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine–Daejeon Chungcheong Regional Cardiocerebrovascular Center, Chugnam National University Hospital, Daejeon, Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Byung Ok Kim
- Department of Internal Medicine, Inje University School of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Kyoung Hyo Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bum Sun Kwon
- Department of Rehabilitation Medicine, Dongguk University School of Medicine, Goyang, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Cheongju, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Yong Wook Kim
- Department and Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Heeyoune Jung
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Eung Ju Kim
- Division of Cardiology, Department of Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | | | - In Hyun Jung
- Department of Internal Medicine, Inje University School of Medicine, Sanggye Paik Hospital, Seoul, Korea
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Anam Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Young Han
- Department of Rehabilitation Medicine, Gwangju-Jeonnam Regional Cardiocerebrovascular Center, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Research Institute of Clinical Medicine of Chonbuk National University–Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Woosik Han
- Department of Thoracic Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University School of Medicine–Kangwon Regional Cardiocerebrovascular Center, Kangwon National University Hospital, Chuncheon, Korea
| | - Kyung-Lim Joa
- Department of Rehabilitation Medicine, Inha University Hospital, Incheon, Korea
| | - Sook Joung Lee
- Daejeon St. Mary’s Hospital. College of Medicine, The Catholic university of Korea, Daejeon, Korea
| | - Ae Ryoung Kim
- Department of Rehabilitation Medicine, School of Medicine Kyungpook National University, Daegu, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Korea
| | - Jihee Kim
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Hee Eun Choi
- Department of Physical Medicine and Rehabilitation, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byeong-Ju Lee
- Department of Rehabilitation Medicine, Pusan National University Hospital, Busan, Korea
| | - Soon Kim
- Research Institute for Social Science, Ewha Woman’s University, Seoul, Korea
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23
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Effects of interval training on risk markers for arrhythmic death: a randomized controlled trial. Clin Rehabil 2019; 33:1320-1330. [DOI: 10.1177/0269215519840388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To compare the effects of high-intensity interval training versus moderate-intensity continuous training on risk markers of arrhythmic death in patients who recently suffered from an acute coronary syndrome. Design: Double-blind (patient and evaluator) randomized controlled trial. Setting: Cardiovascular Prevention and Rehabilitation Centre (EPIC Centre) of the Montreal Heart Institute, Montreal, Canada. Subjects: A total of 43 patients were randomized following an acute coronary syndrome. Interventions: Patients were assigned to either high-intensity interval training (n = 18) or isocaloric moderate-intensity continuous training (n = 19), three times a week for a total of 36 sessions. Main measures: Heart rate recovery for 5 minutes, heart rate variability for 24 hours, occurrence of ventricular arrhythmias, and QT dispersion were measured before and after the 36 sessions of training. Results: Among the 43 patients randomized, 6 participants in the high-intensity interval training group stopped training for reasons unrelated to exercise training and were excluded from the analyses. Heart rate recovery improved solely in the high-intensity interval training group, particularly at the end of recovery period ( p < 0.05). There were no differences in heart rate variability, occurrence of ventricular arrhythmias, or QT dispersion parameters between the groups at study end. Conclusion: Despite the lack of power to detect any large difference between the two interventions with respect to risk markers of arrhythmic death, high-intensity interval training appears safe and may be more effective at improving heart rate recovery relative to moderate-intensity continuous training in our patients following acute coronary syndrome.
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24
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Ballesta García I, Rubio Arias JÁ, Ramos Campo DJ, Martínez González-Moro I, Carrasco Poyatos M. Dosis de ejercicio interválico de alta intensidad en la rehabilitación cardiaca de la insuficiencia cardiaca y la enfermedad arterial coronaria: revisión sistemática y metanálisis. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.02.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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25
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Pattyn N, Beulque R, Cornelissen V. Aerobic Interval vs. Continuous Training in Patients with Coronary Artery Disease or Heart Failure: An Updated Systematic Review and Meta-Analysis with a Focus on Secondary Outcomes. Sports Med 2018; 48:1189-1205. [PMID: 29502328 DOI: 10.1007/s40279-018-0885-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In a previous meta-analysis including nine trials comparing aerobic interval training with aerobic continuous training in patients with coronary artery disease, we found a significant difference in peak oxygen uptake favoring aerobic interval training. OBJECTIVE The objective of this study was to (1) update the original meta-analysis focussing on peak oxygen uptake and (2) evaluate the effect on secondary outcomes. METHODS We conducted a systematic review with a meta-analysis by searching PubMed and SPORTDiscus databases up to March 2017. We included randomized trials comparing aerobic interval training and aerobic continuous training in patients with coronary artery disease or chronic heart failure. The primary outcome was change in peak oxygen uptake. Secondary outcomes included cardiorespiratory parameters, cardiovascular risk factors, cardiac and vascular function, and quality of life. RESULTS Twenty-four papers were identified (n = 1080; mean age 60.7 ± 10.7 years). Aerobic interval training resulted in a higher increase in peak oxygen uptake compared with aerobic continuous training in all patients (1.40 mL/kg/min; p < 0.001), and in the subgroups of patients with coronary artery disease (1.25 mL/kg/min; p = 0.001) and patients with chronic heart failure with reduced ejection fraction (1.46 mL/kg/min; p = 0.03). Moreover, a larger increase of the first ventilatory threshold and peak heart rate was observed after aerobic interval training in all patients. Other cardiorespiratory parameters, cardiovascular risk factors, and quality of life were equally affected. CONCLUSION This meta-analysis adds further evidence to the clinically significant larger increase in peak oxygen uptake following aerobic interval training vs. aerobic continuous training in patients with coronary artery disease and chronic heart failure. More well-designed randomized controlled trials are needed to establish the safety of aerobic interval training and the sustainability of the training response over longer periods.
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Affiliation(s)
- Nele Pattyn
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium. .,Department of Cardiology, KU Leuven, Leuven, Belgium.
| | - Randy Beulque
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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26
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Blackwell JEM, Doleman B, Herrod PJJ, Ricketts S, Phillips BE, Lund JN, Williams JP. Short-Term (<8 wk) High-Intensity Interval Training in Diseased Cohorts. Med Sci Sports Exerc 2018; 50:1740-1749. [PMID: 29683925 PMCID: PMC6133203 DOI: 10.1249/mss.0000000000001634] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM Exercise training regimes can lead to improvements in measures of cardiorespiratory fitness (CRF), improved general health, and reduced morbidity and overall mortality risk. High-intensity interval training (HIIT) offers a time-efficient approach to improve CRF in healthy individuals, but the relative benefits of HIIT compared with traditional training methods are unknown in across different disease cohorts. METHODS This systematic review and meta-analysis compares CRF gains in randomized controlled trials of short-term (<8 wk) HIIT versus either no exercise control (CON) or moderate continuous training (MCT) within diseased cohorts. Literature searches of the following databases were performed: MEDLINE, EMBASE, CINAHL, AMED, and PubMed (all from inception to December 1, 2017), with further searches of Clinicaltrials.gov and citations via Google Scholar. Primary outcomes were effect on CRF variables: V˙O2peak and anaerobic threshold. RESULTS Thirty-nine studies met the inclusion criteria. HIIT resulted in a clinically significant increase in V˙O2peak compared with CON (mean difference [MD] = 3.32 mL·kg·min, 95% confidence interval [CI] = 2.56-2.08). Overall HIIT provided added benefit to V˙O2peak over MCT (MD = 0.79 mL·kg·min, 95% CI = 0.20-1.39). The benefit of HIIT was most marked in patients with cardiovascular disease when compared with MCT (V˙O2peak: MD = 1.66 mL·kg·min, 95% CI = 0.60-2.73; anaerobic threshold: MD = 1.61 mL·kg·min, 95% CI = 0.33-2.90). CONCLUSIONS HIIT elicits improvements in objective measures of CRF within 8 wk in diseased cohorts compared with no intervention. When compared with MCT, HIIT imparts statistically significant additional improvements in measures of CRF, with clinically important additional improvements in V˙O2peak in cardiovascular patients. Comparative efficacy of HIIT versus MCT combined with an often reduced time commitment may warrant HIIT's promotion as a viable clinical exercise intervention.
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Affiliation(s)
- James E M Blackwell
- University of Nottingham, Nottingham, UNITED KINGDOM
- Royal Derby Hospital, Derby, UNITED KINGDOM
| | - Brett Doleman
- University of Nottingham, Nottingham, UNITED KINGDOM
- Royal Derby Hospital, Derby, UNITED KINGDOM
| | - Philip J J Herrod
- University of Nottingham, Nottingham, UNITED KINGDOM
- Royal Derby Hospital, Derby, UNITED KINGDOM
| | | | | | - Jonathan N Lund
- University of Nottingham, Nottingham, UNITED KINGDOM
- Royal Derby Hospital, Derby, UNITED KINGDOM
| | - John P Williams
- University of Nottingham, Nottingham, UNITED KINGDOM
- Royal Derby Hospital, Derby, UNITED KINGDOM
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27
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Hannan AL, Hing W, Climstein M, Coombes JS, Furness J, Jayasinghe R, Byrnes J. Australian cardiac rehabilitation exercise parameter characteristics and perceptions of high-intensity interval training: a cross-sectional survey. Open Access J Sports Med 2018; 9:79-89. [PMID: 29750058 PMCID: PMC5933362 DOI: 10.2147/oajsm.s160306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose This study explored current demographics, characteristics, costs, evaluation methods, and outcome measures used in Australian cardiac rehabilitation (CR) programs. It also determined the actual usage and perceptions of high-intensity interval training (HIIT). Methods A cross-sectional observational web-based survey was distributed to 328 Australian CR programs nationally. Results A total of 261 programs completed the survey (79.6% response rate). Most Australian CR programs were located in a hospital setting (76%), offered exercise sessions once a week (52%) for 6-8 weeks (49%) at moderate intensity (54%) for 46-60 min (62%), and serviced 101-500 clients per annum (38%). HIIT was reported in only 1% of programs, and 27% of respondents believed that it was safe while 42% of respondents were unsure. Lack of staff (25%), monitoring resources (20%), and staff knowledge (18%) were the most commonly reported barriers to the implementation of HIIT. Overall, Australian CR coordinators are unsure of the cost of exercise sessions. Conclusion There is variability in CR delivery across Australia. Only half of programs reassess outcome measures postintervention, and cost of exercise sessions is unknown. Although HIIT is recommended in international CR guidelines, it is essentially not being used in Australia and clinicians are unsure as to the safety of HIIT. Lack of resources and staff knowledge were perceived as the biggest barriers to HIIT implementation, and there are inconsistent perceptions of prescreening and monitoring requirements. This study highlights the need to educate health professionals about the benefits and safety of HIIT to improve its usage and patient outcomes.
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Affiliation(s)
- Amanda L Hannan
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Wayne Hing
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Mike Climstein
- Exercise Health and Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - James Furness
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Rohan Jayasinghe
- Cardiology Department, Gold Coast University Hospital, Gold Coast, QLD, Australia.,Griffith University, Gold Coast, QLD, Australia.,Macquarie University, Sydney, NSW, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Logan, QLD, Australia
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High-intensity Interval Training Dosage for Heart Failure and Coronary Artery Disease Cardiac Rehabilitation. A Systematic Review and Meta-analysis. ACTA ACUST UNITED AC 2018; 72:233-243. [PMID: 29650445 DOI: 10.1016/j.rec.2018.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/19/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES High-interval intensity training (HIT) has been suggested to improve peak VO2 in cardiac rehabilitation programs. However, the optimal HIT protocol is unknown. The objective of this study was to identify the most effective doses of HIT to optimize peak VO2 in coronary artery disease (CAD) and heart failure (HF) patients. METHODS A search was conducted in 6 databases (MEDLINE, Web of Science, LILACS, CINAHL, Academic Search Complete, and SportDiscus). Studies using a HIT protocol in CAD or HF patients and measuring peak VO2 were included. The PEDro Scale and Cochrane Collaboration tools were used. RESULTS Analyses reported significant improvements in peak VO2 after HIT in both diseases (P = .000001), with a higher increase in HF patients (P = .03). Nevertheless, in HF patients, there were no improvements when the intensity recovery was ≤ 40% of peak VO2 (P = .19) and the frequency of training was ≤ 2 d/wk (P = .07). There were significant differences regarding duration in CAD patients, with greater improvements in peak VO2 when the duration was < 12 weeks (P = .05). In HF, programs lasting < 12 weeks did not significantly improve peak VO2 (P = .1). CONCLUSIONS The HIT is an effective method for improving peak VO2 in HF and CAD, with a significantly greater increase in HF patients. The recovery intervals should be active and be between 40% and 60% of peak VO2 in HF patients. Training frequency should be ≥ 2 d/wk for CAD patients and ≥ 3 d/wk for HF patients.
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Hannan AL, Hing W, Simas V, Climstein M, Coombes JS, Jayasinghe R, Byrnes J, Furness J. High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation: a systematic review and meta-analysis. Open Access J Sports Med 2018; 9:1-17. [PMID: 29416382 PMCID: PMC5790162 DOI: 10.2147/oajsm.s150596] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Aerobic capacity has been shown to be inversely proportionate to cardiovascular mortality and morbidity and there is growing evidence that high-intensity interval training (HIIT) appears to be more effective than moderate-intensity continuous training (MICT) in improving cardiorespiratory fitness within the cardiac population. Previously published systematic reviews in cardiovascular disease have neither investigated the effect that the number of weeks of intervention has on cardiorespiratory fitness changes, nor have adverse events been collated. OBJECTIVE We aimed to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) within the cardiac population that investigated cardiorespiratory fitness changes resulting from HIIT versus MICT and to collate adverse events. METHODS A critical narrative synthesis and meta-analysis was conducted after systematically searching relevant databases up to July 2017. We searched for RCTs that compared cardiorespiratory fitness changes resulting from HIIT versus MICT interventions within the cardiac population. RESULTS Seventeen studies, involving 953 participants (465 for HIIT and 488 for MICT) were included in the analysis. HIIT was significantly superior to MICT in improving cardiorespiratory fitness overall (SMD 0.34 mL/kg/min; 95% confidence interval [CI; 0.2-0.48]; p<0.00001; I2=28%). There were no deaths or cardiac events requiring hospitalization reported in any study during training. Overall, there were more adverse events reported as a result of the MICT (n=14) intervention than the HIIT intervention (n=9). However, some adverse events (n=5) were not classified by intervention group. CONCLUSION HIIT is superior to MICT in improving cardiorespiratory fitness in participants of cardiac rehabilitation (CR). Improvements in cardiorespiratory fitness are significant for CR programs of >6-week duration. Programs of 7-12 weeks' duration resulted in the largest improvements in cardiorespiratory fitness for patients with coronary artery disease. HIIT appears to be as safe as MICT for CR participants.
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Affiliation(s)
- Amanda L Hannan
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Wayne Hing
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Vini Simas
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Mike Climstein
- Exercise Health and Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Water Based Research Unit, Bond University, Gold Coast, QLD, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Rohan Jayasinghe
- Cardiology Department, Gold Coast University Hospital, Gold Coast, QLD, Australia
- Griffith University, Gold Coast, QLD, Australia
- Macquarie University, Sydney, NSW, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Logan, QLD, Australia
| | - James Furness
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
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30
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Xie B, Yan X, Cai X, Li J. Effects of High-Intensity Interval Training on Aerobic Capacity in Cardiac Patients: A Systematic Review with Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5420840. [PMID: 28386556 PMCID: PMC5366197 DOI: 10.1155/2017/5420840] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 01/07/2017] [Accepted: 01/19/2017] [Indexed: 02/05/2023]
Abstract
Purpose. The aim of this study was to compare the effects of high-intensity interval training (INTERVAL) and moderate-intensity continuous training (CONTINUOUS) on aerobic capacity in cardiac patients. Methods. A meta-analysis identified by searching the PubMed, Cochrane Library, EMBASE, and Web of Science databases from inception through December 2016 compared the effects of INTERVAL and CONTINUOUS among cardiac patients. Results. Twenty-one studies involving 736 participants with cardiac diseases were included. Compared with CONTINUOUS, INTERVAL was associated with greater improvement in peak VO2 (mean difference 1.76 mL/kg/min, 95% confidence interval 1.06 to 2.46 mL/kg/min, p < 0.001) and VO2 at AT (mean difference 0.90 mL/kg/min, 95% confidence interval 0.0 to 1.72 mL/kg/min, p = 0.03). No significant difference between the INTERVAL and CONTINUOUS groups was observed in terms of peak heart rate, peak minute ventilation, VE/VCO2 slope and respiratory exchange ratio, body mass, systolic or diastolic blood pressure, triglyceride or low- or high-density lipoprotein cholesterol level, flow-mediated dilation, or left ventricular ejection fraction. Conclusions. This study showed that INTERVAL improves aerobic capacity more effectively than does CONTINUOUS in cardiac patients. Further studies with larger samples are needed to confirm our observations.
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Affiliation(s)
- Bin Xie
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Xianfeng Yan
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Xiangna Cai
- Department of Plastic Surgery, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
- *Xiangna Cai: and
| | - Jilin Li
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
- *Jilin Li:
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Ribeiro PA, Boidin M, Juneau M, Nigam A, Gayda M. High-intensity interval training in patients with coronary heart disease: Prescription models and perspectives. Ann Phys Rehabil Med 2017; 60:50-57. [DOI: 10.1016/j.rehab.2016.04.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/04/2016] [Accepted: 04/09/2016] [Indexed: 01/01/2023]
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Pattyn N, Cornelissen VA, Buys R, Lagae AS, Leliaert J, Vanhees L. Are aerobic interval training and continuous training isocaloric in coronary artery disease patients? Eur J Prev Cardiol 2016; 23:1486-95. [DOI: 10.1177/2047487316645468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/31/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Nele Pattyn
- Department of Rehabilitation Sciences, KU Leuven, Belgium
| | | | - Roselien Buys
- Department of Rehabilitation Sciences, KU Leuven, Belgium
| | | | | | - Luc Vanhees
- Department of Rehabilitation Sciences, KU Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals of Leuven, Belgium
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33
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Tao L, Bei Y, Zhang H, Xiao J, Li X. Exercise for the heart: signaling pathways. Oncotarget 2016; 6:20773-84. [PMID: 26318584 PMCID: PMC4673228 DOI: 10.18632/oncotarget.4770] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 07/10/2015] [Indexed: 12/30/2022] Open
Abstract
Physical exercise, a potent functional intervention in protecting against cardiovascular diseases, is a hot topic in recent years. Exercise has been shown to reduce cardiac risk factors, protect against myocardial damage, and increase cardiac function. This improves quality of life and decreases mortality and morbidity in a variety of cardiovascular diseases, including myocardial infarction, cardiac ischemia/reperfusion injury, diabetic cardiomyopathy, cardiac aging, and pulmonary hypertension. The cellular adaptation to exercise can be associated with both endogenous and exogenous factors: (1) exercise induces cardiac growth via hypertrophy and renewal of cardiomyocytes, and (2) exercise induces endothelial progenitor cells to proliferate, migrate and differentiate into mature endothelial cells, giving rise to endothelial regeneration and angiogenesis. The cellular adaptations associated with exercise are due to the activation of several signaling pathways, in particular, the growth factor neuregulin1 (NRG1)-ErbB4-C/EBPβ and insulin-like growth factor (IGF)-1-PI3k-Akt signaling pathways. Of interest, microRNAs (miRNAs, miRs) such as miR-222 also play a major role in the beneficial effects of exercise. Thus, exploring the mechanisms mediating exercise-induced benefits will be instrumental for devising new effective therapies against cardiovascular diseases.
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Affiliation(s)
- Lichan Tao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yihua Bei
- Regeneration and Ageing Lab and Experimental Center of Life Sciences, School of Life Science, Shanghai University, Shanghai 200444, China.,Shanghai Key Laboratory of Bio-Energy Crops, School of Life Science, Shanghai University, Shanghai 200444, China
| | - Haifeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Junjie Xiao
- Regeneration and Ageing Lab and Experimental Center of Life Sciences, School of Life Science, Shanghai University, Shanghai 200444, China.,Shanghai Key Laboratory of Bio-Energy Crops, School of Life Science, Shanghai University, Shanghai 200444, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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34
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Schwarz S, Boscheri A, Christle J, Duvinage A, Esefeld K, Fricke H, Pitsch N, Pressler A, Weichenberger M, Halle M. [Exercise training in the therapy of heart diseases: Current evidence and future options]. Herz 2016; 41:159-69; quiz 170-1. [PMID: 26914583 DOI: 10.1007/s00059-016-4403-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Exercise training has been firmly established as an additional therapeutic strategy in addition to pharmacological and interventional treatment in patients with cardiovascular disease. Benefits for quality of life as well as prognosis have been confirmed for cardiovascular risk factors, ischemic heart disease, after myocardial infarction, in heart failure with preserved as well as reduced ejection fraction, in atrial fibrillation and in patients after catheter-assisted aortic valve implantation (TAVI), with an implantable cardioverter defibrillator (ICD) or with left ventricular assist devices (VAD). Training programs have to be tailored according to the disease, stage of disease, comorbidities, age of the patient, medication as well as exercise capacity. For prescribing exercise mode and intensity, a maximum exercise test has to be performed. Ideally, this is accompanied by spirometry to assess maximum values such as maximum oxygen consumption. Training intensity will then be prescribed according to the optimal training range and maximum training intensity.
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Affiliation(s)
- S Schwarz
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - A Boscheri
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - J Christle
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - A Duvinage
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), Munich Heart Alliance, München, Deutschland
| | - K Esefeld
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - H Fricke
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - N Pitsch
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - A Pressler
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - M Weichenberger
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland
| | - M Halle
- Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, TU München, Georg-Brauchle-Ring 56, 80992, München, Deutschland.
- Deutsches Zentrum für Herzkreislaufforschung (DZHK), Munich Heart Alliance, München, Deutschland.
- Else Kröner-Fresenius-Zentrum, Klinikum rechts der Isar, München, Deutschland.
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35
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Górski A, Weber-Dabrowska B. The potential role of endogenous bacteriophages in controlling invading pathogens. Cell Mol Life Sci 2005; 62:511-9. [PMID: 15747058 PMCID: PMC11365883 DOI: 10.1007/s00018-004-4403-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bacteriophages (phages) are omnipresent in our environment, and recent studies highlight their potential impact on the microbial world. Phages can also be present in mammalian organisms, including man (intestines, oral cavity, urine, sputum and serum). Data are available which suggest that those endogenous phages could play an important role in eliminating bacteria and regulating the body ecosystem. Furthermore, our most recent findings suggest that phages can exert immunosuppressive action in the gut, helping control local inflammatory and autoimmune reactions, and demonstrate anticancer activity. We hypothesize that phages could act in concert with the immune system in immunosurveillance against bacteria, viruses and cancer.
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Affiliation(s)
- Andrzej Górski
- L. Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53114, Wroclaw, Poland.
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