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Santos A, Braaten K, MacPherson M, Vasconcellos D, Vis-Dunbar M, Lonsdale C, Lubans D, Jung ME. Rates of compliance and adherence to high-intensity interval training: a systematic review and Meta-analyses. Int J Behav Nutr Phys Act 2023; 20:134. [PMID: 37990239 PMCID: PMC10664287 DOI: 10.1186/s12966-023-01535-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND To determine rates of compliance (i.e., supervised intervention attendance) and adherence (i.e., unsupervised physical activity completion) to high-intensity interval training (HIIT) among insufficiently active adults and adults with a medical condition, and determine whether compliance and adherence rates were different between HIIT and moderate-intensity continuous training (MICT). METHODS Articles on adults in a HIIT intervention and who were either insufficiently active or had a medical condition were included. MEDLINE, EMBASE, PsychINFO, SPORTDiscus, CINAHL, and Web of Science were searched. Article screening and data extraction were completed by two independent reviewers. Risk of bias was assessed using RoB 2.0 or ROBINS-I. Meta-analyses were conducted to discern differences in compliance and adherence between HIIT vs. MICT. Sensitivity analyses, publication bias, sub-group analyses, and quality appraisal were conducted for each meta-analysis. RESULTS One hundred eighty-eight unique studies were included (n = 8928 participants). Compliance to HIIT interventions averaged 89.4% (SD:11.8%), while adherence to HIIT averaged 63% (SD: 21.1%). Compliance and adherence to MICT averaged 92.5% (SD:10.6%) and 68.2% (SD:16.2%), respectively. Based on 65 studies included in the meta-analysis, compliance rates were not different between supervised HIIT and MICT interventions [Hedge's g = 0.015 (95%CI: - 0.088-0.118), p = .78]. Results were robust and low risk of publication bias was detected. No differences were detected based on sub-group analyses comparing medical conditions or risk of bias of studies. Quality of the evidence was rated as moderate over concerns in the directness of the evidence. Based on 10 studies, adherence rates were not different between unsupervised HIIT and MICT interventions [Hedge's g = - 0.313 (95%CI: - 0.681-0.056), p = .096]. Sub-group analysis points to differences in adherence rates dependent on the method of outcome measurement. Adherence results should be interpreted with caution due to very low quality of evidence. CONCLUSIONS Compliance to HIIT and MICT was high among insufficiently active adults and adults with a medical condition. Adherence to HIIT and MICT was relatively moderate, although there was high heterogeneity and very low quality of evidence. Further research should take into consideration exercise protocols employed, methods of outcome measurement, and measurement timepoints. REGISTRATION This review was registered in the PROSPERO database and given the identifier CRD42019103313.
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Affiliation(s)
- Alexandre Santos
- Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Kyra Braaten
- Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Megan MacPherson
- Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Diego Vasconcellos
- Institute for Positive Psychology & Education, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mathew Vis-Dunbar
- Library, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Chris Lonsdale
- Institute for Positive Psychology & Education, Australian Catholic University, Melbourne, Victoria, Australia
| | - David Lubans
- School of Education, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Mary E Jung
- Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada.
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Ekkekakis P, Vallance J, Wilson PM, Ewing Garber C. Extraordinary claims in the literature on high-intensity interval training (HIIT): III. Critical analysis of four foundational arguments from an interdisciplinary lens. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 66:102399. [PMID: 37665861 DOI: 10.1016/j.psychsport.2023.102399] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/21/2022] [Accepted: 01/29/2023] [Indexed: 09/06/2023]
Abstract
Kinesiology aspires to be an integrated, interdisciplinary field that studies human movement from multiple perspectives. However, the main societal deliverables of the field, namely exercise prescriptions and physical activity recommendations, still reflect fragmentation, placing more emphasis on physiological outcomes than on behavioral and other considerations. Recently, researchers have called for the introduction of High-Intensity Interval Training (HIIT) to the domain of public health, based on the argument that HIIT can maximize fitness and health benefits for a fraction of the time recommended by the prevailing model of physical activity in public-health guidelines. Here, we show that an unintended side-effect of arguments underpinning the implementation of HIIT in the domain of public health might have been the exacerbation of segmentation. To highlight the value of interdisciplinarity, four foundational claims in support of HIIT are critiqued by tapping into cognate literatures: (1) the primary reason people do not exercise is lack of time, (2) HIIT is relevant to public health, (3) HIIT is being proposed as merely another option, so there is no basis for controversy, and (4) HIIT is safe and well tolerated. These claims are contradicted by credible lines of evidence. To improve the accuracy and effectiveness of its public claims, kinesiology should remain committed to the ideals of integration and interdisciplinarity.
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Affiliation(s)
| | - Jeff Vallance
- Faculty of Health Disciplines, Athabasca University, Canada
| | | | - Carol Ewing Garber
- Department of Biobehavioral Sciences, Teachers College, Columbia University, USA
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Garneau L, Terada T, Mistura M, Mulvihill EE, Reed JL, Aguer C. Exercise training reduces circulating cytokines in male patients with coronary artery disease and type 2 diabetes: A pilot study. Physiol Rep 2023; 11:e15634. [PMID: 36905198 PMCID: PMC10006733 DOI: 10.14814/phy2.15634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
Low-grade inflammation is central to coronary artery disease (CAD) and type 2 diabetes (T2D) and is reduced by exercise training. The objective of this study was to compare the anti-inflammatory potential of moderate-to-vigorous intensity continuous training (MICT) and high-intensity interval training (HIIT) in patients with CAD with or without T2D. The design and setting of this study is based on a secondary analysis of registered randomized clinical trial NCT02765568. Male patients with CAD were randomly assigned to either MICT or HIIT, with subgroups divided according to T2D status (non-T2D-HIIT n = 14 and non-T2D-MICT n = 13; T2D-HIIT n = 6 and T2D-MICT n = 5). The intervention was a 12-week cardiovascular rehabilitation program consisting of either MICT or HIIT (twice weekly sessions) and circulating cytokines measured pre- and post-training as inflammatory markers. The co-occurrence of CAD and T2D was associated with increased plasma IL-8 (p = 0.0331). There was an interaction between T2D and the effect of the training interventions on plasma FGF21 (p = 0.0368) and IL-6 (p = 0.0385), which were further reduced in the T2D groups. An interaction between T2D, training modalities, and the effect of time (p = 0.0415) was detected for SPARC, with HIIT increasing circulating concentrations in the control group, while lowering them in the T2D group, and the inverse occurring with MICT. The interventions also reduced plasma FGF21 (p = 0.0030), IL-6 (p = 0.0101), IL-8 (p = 0.0087), IL-10 (p < 0.0001), and IL-18 (p = 0.0009) irrespective of training modality or T2D status. HIIT and MICT resulted in similar reductions in circulating cytokines known to be increased in the context of low-grade inflammation in CAD patients, an effect more pronounced in patients with T2D for FGF21 and IL-6.
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Affiliation(s)
- Léa Garneau
- Institut du Savoir Montfort – RechercheOntarioOttawaCanada
- Department of Biochemistry, Microbiology and Immunology, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Tasuku Terada
- Exercise Physiology and Cardiovascular Health LabUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of Cardiac Prevention and RehabilitationUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Matheus Mistura
- Exercise Physiology and Cardiovascular Health LabUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of Cardiac Prevention and RehabilitationUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Erin E. Mulvihill
- Department of Biochemistry, Microbiology and Immunology, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- Energy Substrate Metabolism Research LabUniversity of Ottawa Heart InstituteOttawaOntarioCanada
| | - Jennifer L. Reed
- Exercise Physiology and Cardiovascular Health LabUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- Division of Cardiac Prevention and RehabilitationUniversity of Ottawa Heart InstituteOttawaOntarioCanada
- School of Human Kinetics, Faculty of Health SciencesUniversity of OttawaOttawaOntarioCanada
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Céline Aguer
- Institut du Savoir Montfort – RechercheOntarioOttawaCanada
- Department of Biochemistry, Microbiology and Immunology, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
- School of Human Kinetics, Faculty of Health SciencesUniversity of OttawaOttawaOntarioCanada
- Department of Physiology, Faculty of Medicine and Health SciencesMcGill UniversityMontrealQuebecCanada
- Interdisciplinary School of Health Sciences, Faculty of Health SciencesUniversity of OttawaOttawaOntarioCanada
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Yin Y, He Q, Zhang R, Cheng H, Zhang Y, Zhang J. Predictors of adherence of enhanced external counterpulsation in patients with coronary heart disease after discharge: A mixed-methods study. Front Cardiovasc Med 2022; 9:1005958. [PMID: 36505377 PMCID: PMC9732892 DOI: 10.3389/fcvm.2022.1005958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/03/2022] [Indexed: 11/26/2022] Open
Abstract
Background Although enhanced external counter pulsation (EECP) has been included in the cardiac rehabilitation prescription for coronary heart disease (CHD) in China, because the total treatment duration of a course of EECP is 36-36 h, the average hospital stay of CHD patients is short, and the adherence after discharge remains unclear. The purpose of this study is to investigate the adherence to EECP in CHD patients after discharge, and analyze the related influencing factors. Methods A retrospective mixed method study combining qualitative and quantitative methods. Quantitative component included CHD patients who had received EECP treatment between March 2020 and August 2021. The qualitative component included in-depth interviews with patients who did not adhere to EECP after discharge. Binary Logistic regression was used to analyze the predictors of EECP adherence after discharge. In-depth interviews with patients were conducted to explore the reasons for dropping out of the EECP after discharge. Results Among 1,304 patients, only 24.23% adhered to EECP treatment after discharge. Binary logistic regression results showed that patients with disease duration < 2 years (OR = 3.13, 95%CI: 2.31-4.24), high school or below (OR = 2.81, 95%CI: 1.98-4.01), distance between residence and hospital more than 20km (OR = 2.08, 95%CI: 1.47-2.96), age over 60 (OR = 2.00, 95%CI: 1.46-2.74), female (OR = 1.64, 95%CI: 1.78-2.29), and angina pectoris (OR = 1.65, 95%CI: 1.16-2.34) were more likely to not adhere to EECP treatment after discharge. However, patients with monthly family income over 8000¥ (OR = 0.46, 95%CI: 0.28-0.75) were more likely to adhere to EECP treatment after discharge than those with household monthly income below 4,000¥. In the qualitative results, the reasons why patients do not adhere to EECP after discharge mainly include insufficient understanding, restricted objective conditions and psychosocial factors. Conclusions The adherence of CHD patients to EECP treatment after discharge was poor. It is necessary to develop effective intervention measures, such as brochures or videos to improve patients' understanding of the importance of adherence to EECP treatment after discharge. In addition, offering EECP treatment during off-hours and weekends may also improve adherence in more young patients.
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Affiliation(s)
- Yuhuan Yin
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Qinli He
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
| | - Rong Zhang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Hu Cheng
- Clinical Educational Department, Gansu Provincial Hospital, Lanzhou, China
| | - Yiyin Zhang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Juxia Zhang
- Clinical Educational Department, Gansu Provincial Hospital, Lanzhou, China,*Correspondence: Juxia Zhang
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Cardiometabolic and perceptual responses to different forms of interval training in patients with type 2 diabetes. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2022. [DOI: 10.1007/s12662-022-00841-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vidal-Almela S, Terada T, Cole CA, O’Neill CD, Comeau K, Marçal IR, Pipe AL, Reed JL. A case series of acute responses to high-intensity interval training in four males with permanent atrial fibrillation. Eur Heart J Case Rep 2022; 6:ytac320. [PMID: 35965609 PMCID: PMC9366644 DOI: 10.1093/ehjcr/ytac320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/08/2022] [Accepted: 07/29/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Atrial fibrillation (AF) is a serious medical condition and a burgeoning patient population. Chronic exercise training, including high-intensity interval training (HIIT), has been shown to improve symptoms and quality of life in patients with AF. Yet, the acute responses to HIIT in this population remain understudied, leaving clinicians and patients hesitant about prescribing and engaging in high-intensity exercise, respectively.
Case summary
This case series describes acute exercise responses [i.e. power output, heart rate (HR), blood pressure (BP), ratings of perceived exertion (RPE), symptoms] to 10 weeks (3 days/week) of HIIT. Participants were four white males (58–80 years old) with permanent AF, co-morbidities (diabetes, coronary artery disease, Parkinson’s disease), and physical limitations. The increases in HR and BP during HIIT were modest across all participants, regardless of age and medication use. Differences in RPE were observed; the oldest participant perceived the sessions as more challenging despite a lower HR response. All patients complied with the HIIT prescription of 80–100% of peak power output by week 4. No adverse events were reported.
Discussion
Patients’ concerns regarding high-intensity exercise may discourage them from participating in HIIT, our results demonstrated no abnormal HR or BP (e.g. hypotension) responses during HIIT or cool-down. These findings align with the typical exercise responses noted in other cardiovascular populations. Notwithstanding the high metabolic demands of HIIT, male patients with permanent AF tolerated HIIT without problem. Further investigation of HIIT as an approach to enable those with AF to recover physical capacity and minimize symptomatology is warranted.
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Affiliation(s)
- Sol Vidal-Almela
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa , Ottawa , Canada K1Y 4W7
| | - Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
| | - Christie A Cole
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
| | - Carley D O’Neill
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
| | - Katelyn Comeau
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa , Ottawa , Canada K1Y 4W7
| | - Isabela R Marçal
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa , Ottawa , Canada K1Y 4W7
| | - Andrew L Pipe
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
- School of Medicine, Faculty of Medicine, University of Ottawa , Ottawa , Canada K1H 8M5
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa , Ottawa , Canada K1Y 4W7
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa , Ottawa , Canada K1H 8M5
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7
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Amir NH, Dorobantu DM, Wadey CA, Caputo M, Stuart AG, Pieles GE, Williams CA. Exercise training in paediatric congenital heart disease: fit for purpose? Arch Dis Child 2022; 107:525-534. [PMID: 34535443 DOI: 10.1136/archdischild-2020-321390] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/30/2021] [Indexed: 11/03/2022]
Abstract
Exercise and physical activity (PA) have been shown to be effective, safe and feasible in both healthy children and children with congenital heart disease (CHD). However, implementing exercise training as an intervention is still not routine in children with CHD despite considerable evidence of health benefits and well-being. Understanding how children with CHD can safely participate in exercise can boost participation in PA and subsequently reduce inactivity-related diseases. Home-based exercise intervention, with the use of personal wearable activity trackers, and high-intensity interval training have been beneficial in adults' cardiac rehabilitation programmes. However, these remain underutilised in paediatric care. Therefore, the aims of this narrative review were to synthesise prescribed exercise interventions in children with CHD, identify possible limitation to exercise training prescription and provide an overview on how to best integrate exercise intervention effectively for this population into daily practice.
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Affiliation(s)
- Nurul Hidayah Amir
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Faculty of Sports Science and Recreation, Universiti Teknologi MARA Cawangan Perlis, Kampus Arau, Arau, Perlis, Malaysia
| | - Dan M Dorobantu
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, UK
| | - Curtis A Wadey
- Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, UK
| | - Massimo Caputo
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR), Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK
| | - A Graham Stuart
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research (NIHR), Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK
| | - Guido E Pieles
- Department of Translational Health Sciences and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK .,National Institute for Health Research (NIHR), Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
| | - Craig A Williams
- Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, UK
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Sex and Age Differences in Anxiety and Depression Levels Before and After Aerobic Interval Training in Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2022; 42:15-21. [PMID: 34793363 DOI: 10.1097/hcr.0000000000000617] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE The objective of this study was to investigate sex and age differences in anxiety and depression among patients with cardiovascular disease at baseline and following aerobic interval training (AIT)-based cardiac rehabilitation (CR) and secondarily to compare dropout rates between sexes and age groups. METHODS Participants were younger (≤44 yr), middle-aged (45-64 yr), and older adults (≥65 yr). The AIT protocol consisted of: 4 × 4-min of high-intensity work periods at 85-95% peak heart rate (HR) interspersed with 3 min of lower-intensity intervals at 60-70% peak HR, twice weekly for 10 wk. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale at baseline and following CR. RESULTS At baseline, of 164 participants (32% female), 14 (35% female) were younger, 110 (33% female) were middle-aged, and 40 (30% female) were older. Older adults reported lower anxiety levels versus younger (4.4 ± 2.6 vs 7.8 ± 3.4 points, P = .008) and middle-aged adults (4.4 ± 2.6 vs 6.1 ± 3.6 points, P = .05). Baseline depression levels did not differ between age groups (P = .749). All age groups experienced a reduction in anxiety (younger =-2.67; middle-aged =-1.40; older =-0.85) and depression (younger =-1.50; middle-aged =-0.83; older =-0.70) levels following CR. Differences in dropout rates were observed between age groups (χ2[1] = 13.4, P = .001). Within each age group, 43% (female n = 2, male n = 4) of younger, 10% (female n = 8, male n = 3) of middle-aged, and 2.5% (female n = 0, male n = 1) of older participants dropped out. CONCLUSIONS Younger and middle-aged adults experience higher levels of anxiety upon entry into CR compared with older adults. Cardiac rehabilitation was associated with significant reductions in anxiety and depression severity, yet dropout rates were highest among younger adults.
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Franklin BA, Quindry J. High level physical activity in cardiac rehabilitation: Implications for exercise training and leisure-time pursuits. Prog Cardiovasc Dis 2021; 70:22-32. [PMID: 34971650 DOI: 10.1016/j.pcad.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Regular moderate-to-vigorous physical activity and increased levels of cardiorespiratory fitness (CRF) are widely promoted as cardioprotective measures in secondary prevention interventions. OBSERVATIONS A low level of CRF increases the risk of cardiovascular disease (CVD) to a greater extent than merely being physically inactive. An exercise capacity <5 metabolic equivalents (METs), generally corresponding to the bottom 20% of the fitness continuum, indicates a higher mortality group. Accordingly, a key objective in early cardiac rehabilitation (CR) is to increase the intensity of training to >3 METs, to empower patients to vacate this "high risk" group. Moreover, a "good" exercise capacity, expressed as peak METs, identifies individuals with a favorable long-term prognosis, regardless of the underlying extent of coronary disease. On the other hand, vigorous-to-high intensity physical activity, particularly when unaccustomed, and some competitive sports are associated with a greater incidence of acute cardiovascular events. Marathon and triathlon training/competition also have limited applicability and value in CR, are associated with acute cardiac events each year, and do not necessarily provide immunity to the development of or the progression of CVD. Furthermore, extreme endurance exercise regimens are associated with an increased incidence of atrial fibrillation and accelerated coronary artery calcification. CONCLUSIONS AND RELEVANCE High-intensity training offers a time-saving alternative to moderate intensity continuous training, as well as other potential advantages. Additional long-term studies assessing safety, adherence, and morbidity and mortality are required before high-intensity CR training can be more widely recommended, especially in previously sedentary patients with known or suspected CVD exercising in non-medically supervised settings.
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Affiliation(s)
- Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation, Beaumont Health, Royal Oak, MI, United States of America; Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, United States of America.
| | - John Quindry
- Integrative Physiology and Athletic Training, University of Montana, Missoula, Montana, Bulgaria; International Heart Institute - St Patrick's Hospital, Providence Medical Center, Missoula, Montana, Bulgaria
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The Effects of High-Intensity Interval Training (HIIT) on Fall Risk Factors in Healthy Older Adults: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211809. [PMID: 34831565 PMCID: PMC8618957 DOI: 10.3390/ijerph182211809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/03/2023]
Abstract
High-intensity interval training (HIIT) improves functional capacity, muscle power and physical performance in older adults with and without comorbidities. The aim of this study was to explore the effectiveness of HIIT as a method for reducing major fall risk factors (balance, muscle strength and physical activity) in older adults. A systematic literature search was conducted following the PRISMA guidelines. A computerized search was conducted using electronic databases (PubMed, CINAHL, Cochrane Library, APA PsycInfo, Web of Science, Scopus, PEDro, and AgeLine) published up to July 2021. Eleven papers (9 studies) of moderate quality (mean of 5.5 in Pedro scale) involving 328 healthy older adults met the inclusion criteria. Studies were characterized by high heterogeneity in terms of methodology, HIIT modality and protocol, subject characteristics, and outcome measures. Results indicate that HIIT cannot be recommended as a single modality for fall prevention in older adults due to insufficient data and no consensus among the studies. HIIT appears to be a safe and well-tolerated supplement to proven fall prevention programs, due to its effects on lower limb strength reflected in functional performance tests, and on dynamic balance and subjective balance perception. However, caution is warranted following HIIT, especially after the first session, due to possible temporary instability.
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11
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Hayes LD, Elliott BT, Yasar Z, Bampouras TM, Sculthorpe NF, Sanal-Hayes NEM, Hurst C. High Intensity Interval Training (HIIT) as a Potential Countermeasure for Phenotypic Characteristics of Sarcopenia: A Scoping Review. Front Physiol 2021; 12:715044. [PMID: 34504439 PMCID: PMC8423251 DOI: 10.3389/fphys.2021.715044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/20/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Sarcopenia is defined as a progressive and generalized loss of skeletal muscle quantity and function associated predominantly with aging. Physical activity appears the most promising intervention to attenuate sarcopenia, yet physical activity guidelines are rarely met. In recent years high intensity interval training (HIIT) has garnered interested in athletic populations, clinical populations, and general population alike. There is emerging evidence of the efficacy of HIIT in the young old (i.e. seventh decade of life), yet data concerning the oldest old (i.e., ninth decade of life onwards), and those diagnosed with sarcopenic are sparse. Objectives: In this scoping review of the literature, we aggregated information regarding HIIT as a potential intervention to attenuate phenotypic characteristics of sarcopenia. Eligibility Criteria: Original investigations concerning the impact of HIIT on muscle function, muscle quantity or quality, and physical performance in older individuals (mean age ≥60 years of age) were considered. Sources of Evidence: Five electronic databases (Medline, EMBASE, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials [CENTRAL]) were searched. Methods: A scoping review was conducted using the Arksey and O'Malley methodological framework (2005). Review selection and characterization were performed by two independent reviewers using pretested forms. Results: Authors reviewed 1,063 titles and abstracts for inclusion with 74 selected for full text review. Thirty-two studies were analyzed. Twenty-seven studies had a mean participant age in the 60s, two in the 70s, and three in the 80s. There were 20 studies which examined the effect of HIIT on muscle function, 22 which examined muscle quantity, and 12 which examined physical performance. HIIT was generally effective in Improving muscle function and physical performance compared to non-exercised controls, moderate intensity continuous training, or pre-HIIT (study design-dependent), with more ambiguity concerning muscle quantity. Conclusions: Most studies presented herein utilized outcome measures defined by the European Working Group on Sarcopenia in Older People (EWGSOP). However, there are too few studies investigating any form of HIIT in the oldest old (i.e., ≥80 years of age), or those already sarcopenic. Therefore, more intervention studies are needed in this population.
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Affiliation(s)
- Lawrence D Hayes
- School of Health and Life Sciences, University of the West of Scotland, Hamilton, United Kingdom
| | - Bradley T Elliott
- Translational Physiology Research Group, School of Life Sciences, University of Westminster, London, United Kingdom
| | - Zerbu Yasar
- Active Ageing Research Group, Institute of Health, University of Cumbria, Lancaster, United Kingdom
| | - Theodoros M Bampouras
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom.,The Centre for Ageing Research, Lancaster University, Lancaster, United Kingdom
| | - Nicholas F Sculthorpe
- School of Health and Life Sciences, University of the West of Scotland, Hamilton, United Kingdom
| | | | - Christopher Hurst
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals National Health Service Foundation Trust and Newcastle University, Newcastle upon Tyne, United Kingdom
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Ma J, Tai Y, Fan M, Wang Z. Cardiac Rehabilitation of Patients with Acute ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention in a Han Population in Northern China: A Prospective Cohort Study. Int J Gen Med 2021; 14:4959-4965. [PMID: 34483684 PMCID: PMC8409762 DOI: 10.2147/ijgm.s326725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022] Open
Abstract
Background Cardiac rehabilitation (CR) has been associated with improved cardiac function in cardiovascular diseases. Our aim was to explore the factors associated with cardiac function and CR. Methods This prospective cohort study had 473 STEMI patients admitted for primary percutaneous coronary intervention (PCI) who were divided into a CR group (group A, n = 104) and a non-CR group (group B, n = 369) based on whether they could complete CR. Patients’ clinical features, such as age, hyperlipidemia, family history of premature coronary heart disease (FHPCHD), smoking history, body mass index (BMI, kg/m2), number of diseased vessels, arrhythmia during PCI, N-terminal pro–B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF) and major adverse cardiac events (MACEs) at 6 months after PCI were compared. Then, the clinical characteristics of patients were further analyzed according to those with MACEs (n = 78) and those without MACEs (n = 395). Results After CR of 6 months, NT-proBNP levels (p = 0.027), 6-MWD (meter, P = 0.000), LVEF (P = 0.000) were significantly improved in group A compared to group B, but not for SMWA (P = 0.875). Multivariate analysis indicated that even though patients in group A (OR 3.06, 95% CI 1.132–8.274, p = 0.03) have a higher incidence of hyperlipidemia, their MACEs (OR 0.191, 95% CI 0.038–0.961, p = 0.05) at 6 months were significantly lower than in group B, mainly because the average patient low age (<65 years, OR 0.917, 95% CI 0.859–0.979, p = 0.01) and significant improvement of 6-MWD (OR 7.999, 95% CI 4.342–14.737, P = 0.00) and the LVEF at 6 months (OR 1.112, 95% CI 1.072–1.154, p = 0.00). Further analysis based on the MACES outcomes showed that there were 6 factors associated with the occurrence of MACEs, they were age >65 years (OR 1.032, 95% CI 1.009–1.009, p = 0.007), smoking history (OR 0.485, 95% CI 0.238–0.989, p = 0.046), education level (OR 2.646, 95% CI 1.370–5.108, p = 0.004), 6-MWD (OR 1.688, 95% CI 1.104–2.811, p = 0.044), LVEF (OR 0.958, 95% CI 0.926–0.991, p = 0.013) and CR (OR 6.271, 95% CI 2.236–17.590, p = 0.000). Conclusion CR, including exercise rehabilitation, is a beneficial option to reduce MACEs in STEMI patients treated with primary PCI.
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Affiliation(s)
- Jingru Ma
- Department of Cardiology, The Second Affiliated Hospital, Shenyang Medical College, Shenyang, 110035, People's Republic of China
| | - Yuling Tai
- Department of Cardiology, Tongliao City Hospital, Tongliao, 028000, People's Republic of China
| | - Mengmeng Fan
- Department of Cardiology, Xinxiang Central Hospital, Xinxiang, 453000, People's Republic of China
| | - Zhansheng Wang
- Department of Cardiology, Fourth People's Hospital of Shenyang, Shenyang, 110034, People's Republic of China
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Vidal-Almela S, Way KL, Terada T, Tulloch HE, Keast ML, Pipe AL, Chirico D, Reed JL. Sex differences in physical and mental health following high-intensity interval training in adults with cardiovascular disease who completed cardiac rehabilitation. Appl Physiol Nutr Metab 2021; 47:1-9. [PMID: 34375540 DOI: 10.1139/apnm-2021-0265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This pre-post study examined sex-differences in peak aerobic power (V̇O2peak) and physical- and mental-health outcomes in adults with cardiovascular disease who completed high-intensity interval training (HIIT)-based cardiac rehabilitation. HIIT consisted of 25 minutes of alternating higher- (4×4 minutes 85-95% heart rate peak (HRpeak)) and lower- (3×3 minutes 60-70% HRpeak) intensity intervals twice weekly for 10 weeks. V̇O2peak estimated from a graded exercise test using the American College of Sports Medicine equation, body mass index (BMI), waist circumference, blood pressure, blood biomarkers and anxiety and depression were assessed at baseline and follow-up. Linear mixed-effects models for repeated measures were performed to examine differences over time between sexes. Of 140 participants (mean ± standard deviation: 58 ± 9 years), 40 were female. Improvements in V̇O2peak did not differ between sexes (interaction: p = 0.273, females: 28.4 ± 6.4 to 30.9 ± 7.6; males: 34.3 ± 6.3 to 37.4 ± 6.0 mL/kg/min). None of the time by sex interactions were significant. Significant main effects of time showed reductions in waist circumference, triglycerides, low-density lipoprotein (LDL), total cholesterol (TC)/high-density lipoprotein (HDL) and anxiety, and increases in V̇O2peak and HDL from baseline to follow-up. Significant main effects of sex revealed smaller V̇O2peak, BMI and waist circumference, and higher LDL, TC and HDL in females than males. HIIT led to similar improvements in estimated V̇O2peak (females: 8.8%, males: 9.0%) and additional health outcomes between sexes. Novelty: HIIT-based cardiac rehabilitation led to similar improvements in estimated V̇O2peak and other physical and mental health outcomes between sexes. The number of sessions attended was high (>70%) and did not differ by sex. Both sexes showed good compliance with the exercise protocol (HR target).
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Affiliation(s)
- Sol Vidal-Almela
- Exercise Physiology and Cardiovascular Health lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Institut du savoir Montfort, Hôpital Montfort, Ottawa, ON, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Kimberley L Way
- Exercise Physiology and Cardiovascular Health lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Tasuku Terada
- Exercise Physiology and Cardiovascular Health lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Heather E Tulloch
- School of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Marja-Leena Keast
- Exercise Physiology and Cardiovascular Health lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Andrew L Pipe
- School of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Daniele Chirico
- Exercise Physiology and Cardiovascular Health lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
- TotalCardiologyTM Rehabilitation and Risk Reduction, Calgary, AB, Canada
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Reed JL, Terada T, Cotie LM, Tulloch HE, Leenen FH, Mistura M, Hans H, Wang HW, Vidal-Almela S, Reid RD, Pipe AL. The effects of high-intensity interval training, Nordic walking and moderate-to-vigorous intensity continuous training on functional capacity, depression and quality of life in patients with coronary artery disease enrolled in cardiac rehabilitation: A randomized controlled trial (CRX study). Prog Cardiovasc Dis 2021; 70:73-83. [PMID: 34245777 DOI: 10.1016/j.pcad.2021.07.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) patients undergoing revascularization procedures often experience ongoing, diminished functional capacity, high rates of depression and markedly low quality of life (QoL). In CAD patients, studies have demonstrated that high-intensity interval training (HIIT) is superior to traditional moderate-to-vigorous intensity continuous training (MICT) for improving functional capacity, whereas no differences between Nordic walking (NW) and MICT have been observed. Mental health is equally as important as physical health, yet few studies have examined the impact of HIIT and NW on depression and QoL. The purpose of this randomized controlled trial (RCT) was to compare the effects of 12 weeks of HIIT, NW and MICT on functional capacity in CAD patients. The effects on depression severity, brain-derived neurotrophic factor (BDNF) and QoL were also examined. METHODS CAD patients who underwent coronary revascularization procedures were randomly assigned to: (1) HIIT (4 × 4-min of high-intensity work periods at 85%-95% peak heart rate [HR]), (2) NW (resting HR [RHR] + 20-40 bpm), or (3) MICT (RHR + 20-40 bpm) twice weekly for 12 weeks. Functional capacity (six-min walk test [6MWT]), depression (Beck Depression Inventory-II [BDI-II]), BDNF (from a blood sample), and general (Short-Form 36 [SF-36]) and disease-specific (HeartQoL) QoL were measured at baseline and follow-up. Linear mixed-effects models for repeated measures were used to test the effects of time, group and time × group interactions. RESULTS N = 135 CAD patients (aged 61 ± 7 years; male: 85%) participated. A significant time × group interaction (p = 0.042) showed greater increases in 6MWT distance (m) for NW (77.2 ± 60.9) than HIIT (51.4 ± 47.8) and MICT (48.3 ± 47.3). BDI-II significantly improved (HIIT: -1.4 ± 3.7, NW: -1.6 ± 4.0, MICT: -2.3 ± 6.0 points, main effect of time: p < 0.001) whereas BDNF concentrations did not change (HIIT: -2.5 ± 9.6, NW: -0.4 ± 7.7, MICT: -1.2 ± 6.4 ng/mL, main effect of time: p > 0.05). Significant improvements in SF-36 and HeartQoL values were observed (main effects of time: p < 0.05). HIIT, NW and MICT participants attended 17.7 ± 7.5, 18.3 ± 8.0 and 16.1 ± 7.3 of the 24 exercise sessions, respectively (p = 0.387). CONCLUSIONS All exercise programmes (HIIT, NW, MICT) were well attended, safe and beneficial in improving physical and mental health for CAD patients. NW was, however, statistically and clinically superior in increasing functional capacity, a predictor of future cardiovascular events.
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Affiliation(s)
- Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
| | - Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
| | - Lisa M Cotie
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
| | - Heather E Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; School of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - Frans H Leenen
- School of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Brain and Heart Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
| | - Matheus Mistura
- Exercise Physiology and Cardiovascular Health Lab, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
| | - Harleen Hans
- Exercise Physiology and Cardiovascular Health Lab, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
| | - Hong-Wei Wang
- Brain and Heart Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
| | - Sol Vidal-Almela
- Exercise Physiology and Cardiovascular Health Lab, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; Institut du savoir Montfort, Hôpital Montfort, Ottawa, Canada.
| | - Robert D Reid
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; School of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; School of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
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Lu X, Wang Z, Yang L, Yang C, Song M. Risk Factors of Atrial Arrhythmia in Patients With Liver Cirrhosis: A Retrospective Study. Front Cardiovasc Med 2021; 8:704073. [PMID: 34291096 PMCID: PMC8286998 DOI: 10.3389/fcvm.2021.704073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: Liver cirrhosis is known to be associated with atrial arrhythmia. However, the risk factors for atrial arrhythmia in patients with liver cirrhosis remain unclear. This retrospective study aimed to investigate the risk factors for atrial arrhythmia in patients with liver cirrhosis. Methods: In the present study, we collected data from 135 patients with liver cirrhosis who were admitted to the Department of Gastroenterology at Shanghai Tongji Hospital. We examined the clinical information recorded, with the aim of identifying the risk factors for atrial arrhythmia in patients with liver cirrhosis. Multiple logistic regression analysis was used to screen for significant factors differentiating liver cirrhosis patients with atrial arrhythmia from those without atrial arrhythmia. Results: The data showed that there were seven significantly different factors that distinguished the group with atrial arrhythmia from the group without atrial arrhythmia. The seven factors were age, white blood cell count (WBC), albumin (ALB), serum Na+, B-type natriuretic peptide (BNP), ascites, and Child-Pugh score. The results of multivariate logistic regression analysis suggested that age (β = 0.094, OR = 1.098, 95% CI 1.039-1.161, P = 0.001) and ascites (β =1.354, OR = 3.874, 95% CI 1.202-12.483, P = 0.023) were significantly associated with atrial arrhythmia. Conclusion: In the present study, age and ascites were confirmed to be risk factors associated with atrial arrhythmia in patients with liver cirrhosis.
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Affiliation(s)
- Xiya Lu
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhijing Wang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liu Yang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Changqing Yang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Meiyi Song
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Strengthening the Case for Cluster Set Resistance Training in Aged and Clinical Settings: Emerging Evidence, Proposed Benefits and Suggestions. Sports Med 2021; 51:1335-1351. [PMID: 33983613 DOI: 10.1007/s40279-021-01455-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/13/2022]
Abstract
Resistance training (RT) is a fundamental component of exercise prescription aimed at improving overall health and function. RT techniques such as cluster set (CS) configurations, characterized by additional short intra-set or inter-repetition rest intervals, have been shown to maintain acute muscular force, velocity, and 'power' outputs across a RT session, and facilitate positive longer-term neuromuscular adaptations. However, to date CS have mainly been explored from a human performance perspective despite potential for application in health and clinical exercise settings. Therefore, this current opinion piece aims to highlight emerging evidence and provide a rationale for why CS may be an advantageous RT technique for older adults, and across several neurological, neuromuscular, cardiovascular and pulmonary settings. Specifically, CS may minimize acute fatigue and adverse physiologic responses, improve patient tolerance of RT and promote functional adaptations (i.e., force, velocity, and power). Moreover, we propose that CS may be a particularly useful exercise rehabilitation technique where injury or illness, persistent fatigue, weakness and dysfunction exist. We further suggest that CS offer an alternative RT strategy that can be easily implemented alongside existing exercise/rehabilitation programs requiring no extra cost, minimal upskilling and/or time commitment for the patient and professional. In light of the emerging evidence and likely efficacy in clinical exercise practice, future research should move toward further direct investigation of CS-based RT in a variety of adverse health conditions and across the lifespan given the already demonstrated benefits in healthy populations.
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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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WAY KIMBERLEYL, VIDAL-ALMELA SOL, MOHOLDT TRINE, CURRIE KATHARINED, AKSETØY INGERLISEAAMOT, BOIDIN MAXIME, CORNELISSEN VERONIQUEA, JOA KYUNGLIM, KEECH ANDREW, JAYO-MONTOYA JONANDER, TAYLOR JENNAL, FOURINER KARINE, REED JENNIFERL. Sex Differences in Cardiometabolic Health Indicators after HIIT in Patients with Coronary Artery Disease. Med Sci Sports Exerc 2021; 53:1345-1355. [PMID: 33449604 DOI: 10.1249/mss.0000000000002596] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Cardiorespiratory fitness (CRF) is an independent predictor of mortality, and females typically achieve smaller improvements in CRF than males after exercise-based cardiac rehabilitation. High-intensity interval training (HIIT) has been shown to produce superior improvements in CRF than traditional cardiac rehabilitation, but the sex differences are unknown. The purpose of this systematic review and meta-analysis was to evaluate sex differences for changes in CRF and cardiometabolic health indicators after HIIT in adults with coronary artery disease (CAD). METHODS AND RESULTS A systemic search of five electronic databases for studies examining the effect of HIIT on measured CRF and cardiometabolic health indicators in adults with CAD was performed. Data (published and unpublished) from 14 studies were included in the meta-analyses with approximately eightfold greater male than female participation (n = 836 vs n = 103). Males with CAD achieved a near-significant absolute improvement in CRF (mean difference [MD] = 1.07, 95% confidence interval [CI] = -0.08 to 2.23 mL·kg-1⋅min-1, P = 0.07) after HIIT when compared with control; there were insufficient data to conduct such an analysis in females. Significantly smaller improvements in CRF were experienced by females than males (MD = -1.10, 95% CI = -2.08 to -0.12 mL·kg-1⋅min-1, P = 0.03); there was no sex difference for the relative (percentage) change in CRF after HIIT. Females achieved significantly smaller reductions in body mass index (MD = -0.25, 95% CI = -0.03 to -0.47 kg·m-2, P = 0.02) and fasting blood glucose (MD = -0.38, 95% CI = -0.05 to -0.72, P = 0.03); no sex differences were observed for other cardiometabolic health indicators. CONCLUSION There are no sex differences for relative improvements in CRF after HIIT; however, females are greatly underrepresented in trials. Future studies should increase female participation and perform sex-based analyses to determine sex-specific outcomes following HIIT.
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Keech A, Way K, Holgate K, Fildes J, Indraratna P, Yu J. HIIT for post-COVID patients within cardiac rehabilitation: Response to letter to the editor. Int J Cardiol 2020; 322:291-292. [PMID: 32882289 PMCID: PMC7456951 DOI: 10.1016/j.ijcard.2020.08.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/25/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Andrew Keech
- Department of Exercise Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia.
| | - Kimberley Way
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia; Exercise Physiology and Cardiovascular Health Lab, Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Katie Holgate
- Cardiac Rehabilitation, Prince of Wales Hospital, Sydney, Australia
| | - Jennifer Fildes
- Cardiac Rehabilitation, Prince of Wales Hospital, Sydney, Australia
| | - Praveen Indraratna
- Department of Cardiology, Prince of Wales Hospital and the Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Jennifer Yu
- Department of Cardiology, Prince of Wales Hospital and the Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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