Publish in this journal
Journal Information
Vol. 72. Issue 3.
Pages 233-243 (March 2019)
Share
Share
Download PDF
More article options
Visits
Not available
Vol. 72. Issue 3.
Pages 233-243 (March 2019)
Original article
DOI: 10.1016/j.rec.2018.02.015
Full text access
High-intensity Interval Training Dosage for Heart Failure and Coronary Artery Disease Cardiac Rehabilitation. A Systematic Review and Meta-analysis
Dosis de ejercicio interválico de alta intensidad en la rehabilitación cardiaca de la insuficiencia cardiaca y la enfermedad arterial coronaria: revisión sistemática y metanálisis
Visits
...
Ismael Ballesta Garcíaa, Jacobo Ángel Rubio Ariasb,c, Domingo Jesús Ramos Campob,c, Ignacio Martínez González-Morod, María Carrasco Poyatosa,
Corresponding author
carrasco@ual.es

Corresponding author: Facultad de Educación, Universidad de Almería, Carretera Sacramento s/n, 04120 La Cañada, Almería, Spain.
a Departamento de Educación, Facultad de Educación, Universidad de Almería, Almería, Spain
b Departamento de Actividad Física y Ciencias del Deporte, Facultad del Deporte, Universidad Católica San Antonio, Murcia, Spain
c Centro de Investigación en Alto Rendimiento, Universidad Católica San Antonio, Murcia, Spain
d Departamento de Fisioterapia, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (5)
Show moreShow less
Tables (7)
Table 1. General Characteristics of the Studies Included in the Meta-analysis
Table 2. Characteristics of Aerobic Training Interventions in the Studies Included in the Meta-analysis
Table 3. Subgroup Analyses Assessing Potential Moderating Factors for VO2 Peak Increase in Studies on CAD Disease Included in the Meta-analysis by Population Characteristics
Table 4. Subgroup Analyses Assessing Potential Moderating Factors for VO2 Peak Increase in Studies on HF Disease Included in the Meta-analysis by Population Characteristics
Table 5. Subgroup Analyses Assessing Potential Moderating Factors for VO2 Peak Increase in Studies on HF Disease Included in the Meta-analysis by Exercise Characteristics
Table 6. Subgroup Analyses Assessing Potential Moderating Factors for VO2 Peak Increase in Studies on CAD Disease Included in the Meta-analysis by Exercise Characteristics
Table 7. Recommendations on HIT Protocol for HF and CAD Patients
Show moreShow less
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.

Keywords:
High-interval intensity training
Interval training
Peak VO2
Heart failure
Coronary artery disease
Abbreviations:
CAD
HF
HIT
Peak VO2
Resumen
Introducción y objetivos

Se ha propuesto el ejercicio interválico de alta intensidad (EIAI) en programas de rehabilitación cardiaca para mejorar el VO2máx. Sin embargo, no se conoce cuál es el mejor protocolo EIAI. El objetivo es encontrar la mejor dosis de EIAI para optimizar el VO2máx de pacientes con enfermedad arterial coronaria (EAC) e insuficiencia cardiaca (IC).

Método

Se llevó a cabo una búsqueda en 6 bases de datos (MEDLINE, Web of Science, LILACS, CINAHL, Academic Search Complete y SportDiscus). Se incluyeron los estudios que usaban el protocolo EIAI y midieron el VO2máx de pacientes con EAC e IC. Se utilizó la escala PEDro y las herramientas de la Colaboración Cochrane.

Resultados

El análisis mostró mejoras significativas en el VO2máx tras el EIAI en ambas enfermedades (p = 0,000001), con mayor incremento en los pacientes con IC (p = 0,03). Sin embargo, en estos no hubo mejora si la intensidad de recuperación era ≤ 40% del VO2máx (p = 0,19) o la frecuencia de entrenamiento era ≤ 2 días/semana (p = 0,07). Hubo diferencias significativas según la duración entre los pacientes con EAC, que mostraron resultados superiores cuando era < 12 semanas (p = 0,05). Los pacientes con IC no mostraron mejoras significativas en el VO2máx cuando la duración era < 12 semanas (p = 0,1).

Conclusiones

El EIAI es un método efectivo para mejorar el VO2máx de los pacientes con IC o EAC, con mayor diferencia significativa en los pacientes con IC. Los intervalos de recuperación de los pacientes con IC deben ser activos y estar en un 40-60% del VO2máx. La frecuencia de entrenamiento debería ser ≥ 2 días/semana en la EAC y ≥ 3 días/semana en la IC.

Palabras clave:
Ejercicio interválico de alta intensidad
Ejercicio interválico
VO2máx
Insuficiencia cardiaca
Enfermedad arterial coronaria
Full Text
INTRODUCTION

Coronary artery disease (CAD) is one of the most common causes of death worldwide, affecting 17.5 million people each year.1 Ischemic disease and chronic heart failure (HF) are lethal, causing 8.76 million deaths worldwide,2 resulting in higher health care system spending.3 These CAD reduce either exercise tolerance or peak oxygen uptake (peak VO2), culminating in heart, respiratory, and endothelial dysfunction.4 In addition, HF is the final condition of all cardiovascular diseases, as it affects both cardiac function and cardiovascular circulation.5 For this reason, they are defined as an incapacity syndrome, which creates morbidity and whose symptoms are linked to fatigue, dyspnea, and exercise intolerance.4

Currently, it has been widely proven that one of the benefits of aerobic exercise is an increase in peak VO2,6–9 which is one of the most important survival indicators for people with CAD5,10–13 and HF.5 Continuous aerobic training has been studied for cardiac rehabilitation programs. It consists of performing exercise for a long period of time under moderate intensity and nonvariable aerobic activity (60%-80% of peak VO25,9,11,12,14). However, at present, high-intensity interval training (HIT) protocols are generating better results in peak VO2 in less time.9,13–16 They consist of intermittent short high-intensity work periods (85%-100% of peak VO2) and relative rest periods.10,15 A typical HIT session consists of a 10-minute warm-up at 50% to 70% of peak VO2 followed by a set of four 3- to 4-minute bouts5,10–13,15–23 (HIT protocol with long work interval) or a set of ten 30- to 60-second bouts6–9,24 (HIY protocol with short work interval) at 85% to 95% of peak VO2 interspersed by active pauses at 50% to 70% of peak VO2. It terminates with a cool-down period at 50% to 70% of peak VO225 (Figure 1). However, although HIT is known to produce the greatest effects on peak VO2 in CAD and HF patients,5,13,15,16,21 there have been many differences in the exercise protocols proposed in this topic affecting the frequency (2-5 d/wk),8,11,14,24 volume (30-60min/sessions),15,24,26 intensity of recovery (0%-70% peak VO2),6,9,17,21 number of sessions (> 100 sessions),13 duration of training (4-50 weeks),8,13,16,18 and even in the characteristics of the patients.11,17,21 Recognizing the influence of these variables regarding peak VO2 could help to optimize cardiac rehabilitation programs for HF and CAD patients.

Figure 1.

Schematic illustration for HIT_S and HIT_L. HIT, high-intensity interval training groups; HIT_L, protocol of HIT with long work intervals; HIT_S, protocol of HIT with short work intervals.

(0.23MB).

Moreover, other studies have focused on identifying which kind of HIT intervention is more effective for improving the functional capacity of HF and CAD patients, as the rehabilitation process and the disabilities produced by the 2 diseases differ.10,27 However, which HIT protocol training is better for one disease or the other, or the best dosage of this type of exercise to improve the cardiac rehabilitation program of each disease is currently not known.

Therefore, the aim of the present study was to conduct a meta-analysis to a) identify the best doses of HIT to optimize HIT training for HF and CAD patients, and b) determine how the HIT protocol affects HF and CAD patients in terms of their peak VO2.

METHODSStudy Design

The systematic review and meta-analysis were undertaken in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement.28 The search was carried out by 2 of the authors (I. Ballesta García and J.A. Rubio Arias), and all the authors reached an agreement regarding methods, article inclusion, and statistical analysis. The articles were organized in order to delete duplicates. Full-text articles were retrieved and evaluated based on the proposed selection criteria. Variables related to the training method such as frequency, total duration of the session, exercise duration, and recovery intervals, number of total sessions, percentage of intensity of each interval, as well as the age, body mass index, sex and number of patients in each study were extracted to an excel workbook.

Search Strategy

Electronic database searches were performed using MEDLINE, Web of Science, LILACS, CINAHL, Academic Search Complete and SportDiscus. The search terms chosen were: (“Heart disease” OR “Heart Failure” OR “Coronary Artery Disease” OR CAD) AND (“High-intensity” OR “High intensity” OR HIT OR “Interval training”). The search results and final study selection are shown in Figure 2.

Figure 2.

Systematic review and meta-analysis flow diagram. WOS, Web of Science.

(0.28MB).
Inclusion Criteria

Inclusion criteria were determined by the authors. We included randomized controlled trials, written in English or Spanish, published from January 2004 to March 2017, using a HIT protocol in patients with CAD or HF, measuring peak VO2. We excluded studies based on aquatic HIT programs, combining HIT with strength training, home-based HIT, not considering CAD and HF results of peak VO2 independently, using people with transplants, grafts or with valve disease, and testing with food supplements, nutritional or pharmacological aids.

Statistical Analysis

The meta-analysis and statistical analysis were developed using Review Manager software (RevMan 5.2; Cochrane Collaboration, Oxford, United Kingdom)29 and Comprehensive Meta-analysis software (Version 2; Biostat, Englewood, New Jersey, United States). A random effects meta-analysis was conducted to determine which disease most benefited from HIT and if there were differences between HIT protocols for each condition. The work-rest ratio, the work interval duration and intensity, and the protocol frequency variables were taken into account to determine changes in each variable.

Due to the heterogeneity of the protocol (Table 1), mean differences were used, dividing the mean values between 2 different groups. The differences in means were grouped using the random effects model. Heterogeneity between studies was analyzed using I2 statistics. The dichotomous and continuous variables of the studies were compared with extracted potential peak VO2 moderator factors. The medians of continuous variables were used to group the studies. Afterwards, HIT differences between pre- and post-values were expressed and analyzed as potential moderator variable changes. The publication bias for the different conditions analyzed (pre-vs-post) was assessed by examining the asymmetry of a funnel plot using Egger's test, and P ≤ .05 was considered to be statistically significant. We assessed the methodological quality of the studies by using the PEDro Scale. The risk of bias was assessed using the modified Cochrane Collaboration tools. Bias was assessed as a judgment (high, low, or unclear) for individual elements from 5 domains: selection, performance, attrition, reporting and any other bias (criteria inclusion of patients in the studies and the country in which the study was conducted).

Table 1.

General Characteristics of the Studies Included in the Meta-analysis

Research studies  Study location, country  Disease  n_HIT  Men, %  Age, y  BMI, cm/kg2 
Benda et al.24  Nijmegen, Netherlands  HF  10  100  63.0 ± 8  28.1 ± 7.5 
Cardozo et al.11  Rio de Janerio, Brasil  CAD  23  63  56.0 ± 12  27.5 ± 5.9 
Chrysohoou et al.6  Rio de Janerio, Brasil  HF  33  88  63.0 ± 9  28.8 ± 4.2 
Conraads et al.18  Athens, Greece  CAD  100  85  57.0 ± 8.8  28 ± 4.4 
Currie et al.9  Hamilton, Canada  CAD  11  91  67.2 ± 6  27.9 ± 4.9 
Dimopoulos et al.27  Athens, Greece  HF  10  90  59.2 ± 12.2  26.5 ± 4.1 
Freyssin et al.8  Reunion island, France  HF  13  50  54.0 ± 9  24.8 ± 4 
Fu et al.16  Keelung, Taiwan  HF  14  61  67.5 ± 1.8   
Huang et al.19  Taoyuan, Taiwan  HF  33  78  60.0 ± 3   
Isaksen et al.17  Stavanger, Norway  HF  24  88  65.0 ± 9  27.8 ± 4 
Kim et al.15  Seoul, Korea  CAD  14  86  57.0 ± 11.5  24.2 ± 2.9 
Koufaki et al.30  Staffordshire, England  HF  16  87  59.8 ± 7.4  28.9 ± 4.7 
Madssen et al.13  Trondheim, Norway  CAD  24  75  64.4 [47-78]  28 ± 3.9 
Moholdt et al.31  Trondheim, Norway  CAD  28  86  60.2 ± 6.9  26 ± 6.2 
Moholdt et al.21  Trondheim, Norway  CAD  11  83  57.7 ± 9.3  26.6 ± 3 
Roditis et al.7  Athens, Greece  HF  11  90  63.0 ± 2  25.9 ± 2.8 
Rognmo et al.32  Trondheim, Norway  CAD  75  62.9 ± 11.2  26.7 ± 4.1 
Smart et al.33  Athens, Greece  HF  10  100  59.1 ± 11  28.9 ± 6.1 
Warburton et al.34  Vancouver, Canada  CAD  100  55.0 ± 7   

BMI, body mass index; CAD, coronary artery disease; HF, heart failure; n_HIT number of participants in high-intensity interval training groups.

Data are presented as the mean, mean ± standard deviation, range or No.

RESULTS

According to our inclusion criteria, 19 studies were included in this meta-analysis, 10 in HF and 9 in CAD. The Egger test provided statistical evidence of funnel plot symmetry (Figure 3), suggesting the absence of a significant publication bias.

Figure 3.

Funnel plot of comparison: CAD vs HF. CAD, coronary artery disease; HF, heart failure; MD, mean difference; SE, standard error.

(0.04MB).

Risk-of-bias assessment is shown in Figure 4. It was high in almost all studies due to lack of blinding of participants and personnel. However, this issue could not be omitted due to the peculiarity of the intervention (exercise vs no exercise) and should be considered in perspective.

Figure 4.

Assessment of risk of bias in included randomized controlled trials.

(0.31MB).

The main characteristics of the studies and of training interventions are described in Table 1 and Table 2, respectively.

Table 2.

Characteristics of Aerobic Training Interventions in the Studies Included in the Meta-analysis

Studies  Disease  Type  Frequency, wks  Session duration, min  Interval work, min  Interval recovery, min  Duration, wks  Number of sessions  Work intensity, % peak VO2a  Increase VO2 peak, %b 
Benda et al.24  HF  HIT_S  30  12  24  90  0.5  6.8 
Cardozo et al.11  CAD  HIT_L  28  16  48  90  1.33  18.44 
Chrysohoou et al.6  HF  HIT_S  45  0.5  0.5  12  36  100  31.25 
Conraads et al.18  CAD  HIT_L  28  12  36  90-95  1.33  21.7 
Currie et al.9  CAD  HIT_S  20  12  24  80-100  23.73 
Dimopoulos et al.27  HF  HIT_S  36  0.5  0.5  12  36  100  7.79 
Freyssin et al.8  HF  HIT_S  69  0.5  40  80-95  0.5  27.1 
Fu et al.16  HF  HIT_L  30  12  36  80  22.5 
Huang et al.19  HF  HIT_L  42  12  36  80  13.41 
Isaksen et al.17  HF  HIT_L  28  12  36  85  1.33  5.74 
Kim et al.15  CAD  HIT_L  28  18  85-95  1.33  22.16 
Koufaki et al.30  HF  HIT_S  —  0.5  24  72  100  0.5  15.68 
Madssen et al.13  CAD  HIT_L  28  52  156  85-95  1.33  3.22 
Moholdt et al.31  CAD  HIT_L  28  20  90  1.33  12.17 
Moholdt et al.21  CAD  HIT_L  28  12  36  85-95  1.33  14.55 
Roditis et al.7  HF  HIT_S  40  0.5  0.5  18  100  8.45 
Rognmo et al.32  CAD  HIT_L  28  10  30  80-90  1.33  18.86 
Smart et al.33  HF  HIT_S  60  48  16  70  0.5  20.49 
Warburton et al.34  CAD  HIT_S  —  16  48  85-95  0.66  17.28 

CAD, coronary artery disease; HF, heart failure; HIT, high-intensity interval training groups; HIT_L, protocol of HIT with long work interval; HIT_S, protocol of HIT with short work interval; peak VO2, peak oxygen uptake; R: work/recovery ratio.

a

Percentage of peak VO2 of the interval work.

b

Percentage of increase of VO2 peak posttraining.

The meta-analyzed effects of HIT found in both diseases were beneficial (P < .000001) for peak VO2 (3.98; 95%CI, 2.94-5.02mL/kg/min for CAD patients and 2.55; 95%CI, 1.73-3.36mL/kg/min for HF patients) (Figure 5). However, there were significant differences in peak VO2 between the 2 diseases in favor of HF patients (P = .03) (Figure 5).

Figure 5.

A: MD between post- and pre-HIT intervention peak VO2 (mL/kg/min) for patients with CAD. B: MD between post- and pre-HIT intervention peak VO2 (mL/kg/min) for patients with HF. Squares represent the MD for each trial. The diamond represents the pooled MD across trials. Weight determines how much each individual study contributes to the pooled estimate.35 Total is the number of participants in HIT groups. 95%CI, confidence interval; CAD, coronary artery disease; HF, heart failure; HIT, high-intensity interval training groups; MD, mean difference; SD: standard deviation; IV: inverse variance.

(0.54MB).

Following the moderating variables, the results showed statistical improvements in peak VO2 in each subgroup analyzed for both diseases (P < .05) (Table 3 and Table 4). There were no statistically significant differences between subgroups according to population characteristics in CAD or HF (Table 3 and Table 4).

Table 3.

Subgroup Analyses Assessing Potential Moderating Factors for VO2 Peak Increase in Studies on CAD Disease Included in the Meta-analysis by Population Characteristics

  Research studiesPeak VO2
Group  HIT groups  References  MD (95%CI)  I2  Pb  P-differencec 
No. of participantsa
< 14  Currie et al.,9 Moholdt et al.,21 Rognmo et al.,32 Warburton et al.34  4.12 (1.75-6.48)  .0006  .81 
≥ 14  Cardozo et al.,11 Conraads et al.,18 Kim et al.,15 Madssen et al.,13 Moholdt et al.31  3.77 (2.14-5.40)  42  < .00001   
BMI
25-29.9 kg/m2  Cardozo et al.,11 Conraads et al.,18 Currie et al.,9 Moholdt et al.,31 Moholdt et al.,21 Rognmo et al.32  4.46 (3.27-6.65)  .00001  .48 
≤ 24.9 kg/m2  Kim et al.15  6.30 (1.34-11.26)  < .01   
Sex
Men  Rognmo et al.,32 Warburton et al.34  3.21 (-0.63-7.04)  .1  .71 
Men and women  Cardozo et al.,11 Conraads et al.,18 Currie et al.,9 Kim et al.,15 Madssen et al.,13 Moholdt et al.,31 Moholdt et al.21  3.97 (2.74-5.20)  16  < .00001   
Age, y
> 57  Currie et al.,9 Moholdt et al.,31 Moholdt et al.,21 Rognmo et al.32  3.97 (2.02-5.91)  < .00001  .86 
≤ 57  Cardozo et al.,11 Conraads et al.,18 Kim et al.,15 Wanburton et al.34  3.97 (2.02-5.91)  43  < .00001   
Methodological quality
> 7 points  Cardozo et al.,11 Conraads et al.,18 Currie et al.,9 Madssen et al.,13Moholdt et al.31  3.72 (2.26-5.19)  36  < .00001  .66 
≤ 7 points  Kim et al.,15 Madssen et al.,13 Moholdt et al.,21 Wanburton et al.34  4.41 (1.69-7.13)  .001   

95%CI, 95% confidence interval; BMI, body mass index; HIT, high-intensity interval training groups; I2, heterogeneity; MD, mean difference; peak VO2, peak oxygen uptake.

Certain studies were not included because they did not report the value used for subgroup analysis.

a

Number of subjects of the HIT group.

b

Test for overall effect.

c

Test for subgroup differences.

Table 4.

Subgroup Analyses Assessing Potential Moderating Factors for VO2 Peak Increase in Studies on HF Disease Included in the Meta-analysis by Population Characteristics

  Research studiesPeak VO2
Group  HIT groups  References  MD (95%CI)  I2  Pb  P-differencec 
No. of participantsa
< 14  Benda et al.,24 Dimopoulos et al.,27 Freyssin et al.,8 Koufaki et al.,30 Roditis et al.,7 Smart et al.33  1.79 (0.40-3.19)  .01  .24
≥ 14  Chrysohoou et al.,6 Fu et al.,16 Huang et al.,19 Isaksen et al.17  2.87 (1.75-4.00)  72  < .00001 
Sex
Men  Benda et al.,24 Smart et al.33  1.80 (−1.01-4.61)    .6
Men and women  Chrysohoou,6 Dimopoulos et al.,27 Freyssin et al.,8 Fu et al.,16 Koufaki et al.,30 Huang et al.,19 Isaksen et al.,17 Roditis et al.7  2.59 (1.68-3.50)  58  <. 00001 
Age, y
≥ 62  Benda et al.,24 Chrysohoou et al.,6 Fu et al.,16 Isaksen et al.,17 Roditis et al.7  2.66 (0.21-5.11)  67  .03  .73
< 62  Dimopoulos et al.,27 Freyssin et al.,8 Huang et al.,19 Smart et al.,33 Koufaki et al.30  2.22 (1.87-2.58)  <. 00001 
BMI
25-29.9 kg/m2  Benda et al.,24 Chrysohoou et al.,6 Dimopoulos et al.,27 Isaksen et al.,17 Roditis et al.,7 Smart et al.,33 Koufaki et al.30  2.04 (0.70-3.38)  14  .003  .36
≤ 24.9 kg/m2  Freyssin et al.,8 Fu et al.,16 Huang et al.19  2.85 (1.72-3.99)  79  < .00001 
Methodological quality
> 6 points  Chrysohoou et al.6  5.00 (2.34-7.66)  —  .0002  .07
≤ 6 points  Benda et al.,24 Dimopoulos et al.,27 Freyssin et al.,8 Fu et al.,16 Huang et al.,19 Isaksen et al.,17 Roditis et al.,7 Smart et al.,33 Koufaki et al.30  2.41 (1.64-3.17)  40  <. 00001 

95%CI, 95% confidence interval; BMI, body mass index; HIT, high-intensity interval training groups; I2, heterogeneity; MD, mean difference; peak VO2, peak oxygen uptake.

Certain enrolled studies were not included because the value used for subgroup analysis was not reported in them.

a

Number of subjects of the HIT group.

b

Test for overall effect.

c

Test for subgroup differences.

Regarding exercise characteristics, there were statistically significant improvements in peak VO2 in each CAD patient subgroup analyzed (P < .05). Nevertheless, in HF patients, there were no improvements in peak VO2 when the intensity of recovery was ≤ 40% peak VO2 (P = .19), when the type of recovery was passive (P = .09), and in the ≤ 2 d/wk protocols (P = .07)9,24 (Table 5).

Table 5.

Subgroup Analyses Assessing Potential Moderating Factors for VO2 Peak Increase in Studies on HF Disease Included in the Meta-analysis by Exercise Characteristics

      Peak VO2
Group  HIT groups  References  MD (95%CI)  I2  Pa  P-differenceb 
Number of sessions
≥ 36 sessions  Chrysohoou et al.,6 Dimopoulos et al.,27 Freyssin et al.,8 Fu,16 Huang et al.,19 Isaksen et al.,17 Koufaki et al.,30 Smart et al.33  2.69 (1.78-3.60)  56  <. 00001  .26
< 36 sessions  Benda et al.,24 Roditis et al.7  1.24 (–1.12-3.61)  <. 00001 
Duration
> 12 wks  Koufaki et al.,30 Smart et al.33  2.45 (–0.48-5.37)  .1  .96
≤ 12 wks  Benda et al.,24 Chrysohoou et al.,6 Dimopoulos et al.,27 Freyssin,8 Fu et al.,16 Huang et al.,19 Isaksen et al.,17 Roditis et al.7  2.53 (1.62-3.44)  59  <. 00001 
HIT frequency
≥ 5 d/wk  Freyssin8  2.90 (0.61-5.19)  —  .01  .77
3 or 4 d/wk  Chrysohoou et al.,6 Dimopoulos et al.,27 Fu et al.,16 Huang et al.,19 Isaksen et al.,17 Koufaki et al.,30 Roditis et al.,7 Smart et al.33  2.55 (1.59-3.50)  58  <. 00001 
≤ 2 d/wk  Benda et al.24  1.30 (–2.38-4.98)  —  .49 
Session duration
> 42 min  Chrysohoou et al.,6 Freyssin et al.,8 Koufaki et al.,30 Smart et al.33  3.44 (1.95-4.94)  <. 00001  .19
≤ 42 min  Benda et al.,24 Fu et al.,16 Huang et al.,19 Isaksen et al.,17 Roditis et al.7  2.23 (1.23-3.23)  62  <. 00001 
Interval work
> 45 sec  Benda et al.,24 Fu et al.,16 Huang et al.,19 Isaksen et al.,17 Smart et al.33  2.53 (1.50-3.55)  34  .002  1.00
≤ 45 sec  Chrysohoou et al.,6 Dimopoulos et al.,27 Freyssin et al.,8 Koufaki et al.,30 Roditis et al.7  2.52 (0.89-4.15)  63  <. 00001 
Interval recovery
> 1 min  Benda et al.,24 Fu et al.,16 Huang,19 Isaksen et al.17  2.46 (1.35-3.58)  73  <. 00001  .84
≤ 1 min  Chrysohoou et al.,6 Dimopoulos et al.,27 Freyssin et al.,8 Koufaki et al.,30 Roditis et al.,7 Smart et al.33  2.65 (1.27-4.03)  12  .0002 
HIT protocol
HIT_L  Fu et al.,16 Huang et al.,19 Isaksen et al.,17 Roditis et al.7  2.45 (1.22-3.69)  <. 00001  .87
HIT_S  Benda et al.,24 Chrysohoou et al.,6 Dimopoulos et al.,27 Freyssin et al.,8 Koufaki et al.,30 Smart et al.33  2.60 (1.37-3.82)  81  <. 00001 
Type of recovery
Active (≥ 20%)  Benda et al.,24 Freyssin et al.,8 Fu et al.,16 Huang et al.,19 Isaksen et al.,17 Koufaki et al.,30 Roditis et al.7  2.51 (1.68-3.33)  49  <.00001  .91
Passive (< 20%)  Chrysohoou et al.,6 Dimopoulos et al.,27 Smart et al.33  2.70 (–0.38-5.78)  60  .09 
Active recovery intensity
≥ 40%  Freyssin et al.,8 Fu et al.,16 Huang et al.,19 Isaksen et al.,17 Roditis et al.7  2.60 (1.68-3.51)  58  <. 00001  .59
< 40%  Benda et al.,24 Koufaki et al.30  1.81 (–0.88-4.50)  .19 
R (W/R)
≥ 1  Chrysohoou et al.,6 Dimopoulos et al.,27 Fu et al.,16 Huang et al.,19 Isaksen et al.,17 Roditis et al.7  2.53 (1.45-3.62)  70  <. 00001  .94
< 1  Benda et al.,24 Freyssin et al.,8 Koufaki et al.,30 Smart et al.33  2.45 (0.83-4.07)  <. 00001 

HF, heart failure; HIT, high-intensity interval training groups; HIT_L, protocol of HIT with long work interval; HIT_S, protocol of HIT with short work interval; I2, heterogeneity; MD, mean difference; peak VO2, peak oxygen uptake; R (W/R), work-recovery ratio.

Certain studies were not included because they did not report the value used for subgroup analysis.

a

Test for overall effect.

b

Test for subgroup differences.

With regards to protocol duration, there were significant differences in CAD patients, who showed higher peak VO2 improvements when the program was performed for < 12 weeks (P = .05) (Table 6). By contrast, there were no significant differences in HF patients when comparing a program ≥ 12 weeks and a program ≤ 12 weeks (P = .96). However, a program lasting ≥ 12 weeks did not produce significant improvements in peak VO2 in HF patients (P = .1; I2 = 0) (Table 5).

Table 6.

Subgroup Analyses Assessing Potential Moderating Factors for VO2 Peak Increase in Studies on CAD Disease Included in the Meta-analysis by Exercise Characteristics

      Peak VO2
Group  HIT groups  References  MD (95%CI)  I2  Pa  P-differenceb 
Number of sessions
≥ 36 sessions  Cardozo et al.,11 Conraads et al.,18 Madssen et al.,13 Moholdt et al.,21 Warburton et al.34  3.57 (1.86-5.28)  <. 00001  .6 
< 36 sessions  Currie et al.,9 Kim et al.,15 Moholdt et al.,31 Rognmo et al.32  4.25 (2.35-6.14)  35  <. 00001   
Duration
> 12 ws  Cardozo et al.,11 Madssen et al.,13 Warburton et al.34  2.45 (0.62-4.29)  .009  .05 
≤ 12 ws  Conraads et al.,18 Currie et al.,9 Kim, et al.,15 Moholdt et al.,31 Moholdt et al.,21 Rognmo et al.32  4.70 (3.44-5.96)  <. 00001   
HIT frequency
≥ 5 d/wk  Moholdt et al.31  3.30 (0.67-5.93)  –  .01  .82
3 or 4 d/wk  Cardozo et al.,11 Conraads et al.,18 Rognmo et al.,32 Warburton et al.,34 Kim et al.,15 Madssen et al.,13 Moholdt et al.21  3.91 (2.48-5.33)  16  <. 00001 
≤ 2 d/wk  Currie et al.9  4.70 (1.26-8.14)  —  .007   
Session duration
≥ 28 min  Cardozo et al.,11 Conraads et al.,18 Kim et al.,15 Madssen et al.,13 Moholdt et al.,31 Moholdt et al.,21 Rognmo et al.32  3.87 (2.71-5.02)  <. 00001  .65 
< 28 min  Currie et al.9  4.70 (1.26-8.14)  —  .007   
Interval work
≥ 4 min  Cardozo et al.,11 Conraads et al.,18 Kim et al.,15 Madssen et al.,13 Moholdt et al.,31 Moholdt et al.,21 Rognmo et al.32  3.90 (2.59-5.22)  16  <.00001  .99 
< 4 min  Currie et al.,9 Warburton et al.34  3.92 (1.28-6.55)  .004   
Interval recovery
≥ 3 min  Cardozo et al.,11 Conraads et al.,18 Kim et al.,15 Madssen et al.,13 Moholdt et al.,31 Moholdt et al.,21 Rognmo et al.,32 Warburton et al.34  3.87 (2.71-5.02)  <. 00001  .65 
< 3 min  Currie et al.9  4.70 (1.26-8.14)  —  .007   
HIT Protocol
HIT-L  Cardozo et al.,11 Conraads et al.,18 Kim et al.,15 Madssen et al.,13 Moholdt et al.,31 Moholdt et al.,21 Rognmo et al.32  3.90 (2.59-5.22)  16  <. 00001  .99 
HIT-S  Currie et al.,9 Warburton et al.34  3.92 (1.28-6.55)  .004   
Type of recovery
Active (≥20%)  Cardozo et al.,11 Conraads et al.,18 Rognmo et al.,32 Warburton et al.,34 Kim et al.,15 Moholdt et al.,31 Madssen et al.,13 Moholdt et al.21  3.87 (2.71-5.02)  <. 00001  .65 
Passive (<20%)  Currie et al.9  4.70 (1.26-8.14)  —  .007   
Active recovery intensity
≥ 65%  Cardozo et al.,11 Conraads et al.,18 Moholdt et al.,31 Moholdt et al.21  4.44 (3.24-5.63)    <. 00001  .27 
< 65%  Kim et al.,15 Madssen et al.,13 Rognmo et al.,32 Warburton et al.34  2.86 (0.32-5.41)       
R (W/R)
≥ 1.33  Cardozo et al.,11 Conraads et al.,18 Kim et al.,15 Madssen et al.,13 Moholdt et al.,31 Moholdt et al.,21 Rognmo et al.32  3.87 (2.71-5.02)  <. 00001  .65 
< 1.33  Currie et al.,9 Warburton et al.34  4.70 (1.26-8.14)  —  .007   

CAD, coronary artery disease; HIT, high-intensity interval training groups; HIT_L, protocol of HIT with long work interval; HIT_S, protocol of HIT with short work interval; I2, heterogeneity; MD, mean difference; peak VO2: peak oxygen uptake; R (W/R), work-recovery ratio.

Certain studies were not included because they did not report the value used for subgroup analysis.

a

Test for overall effect.

b

Test for subgroup differences.

Likewise, there were no significant differences between HIT protocols with short exercise intervals and protocols with long exercise intervals in either of the 2 diseases (P = .87), although both of them showed significant improvements in peak VO2 (P = < .000001). In contrast, there were significant differences in peak VO2 between the 2 diseases in favor of HF patients (P = .03) (Figure 5).

DISCUSSION

This meta-analysis determined how different HIT protocols modify the peak VO2 of HF and CAD patients, describing the most effective doses of HIT to optimize their training. The main finding was that HIT was more effective for improving the peak VO2 of patients with HF than that of those with CAD. However, the maximum benefits in peak VO2 were obtained between weeks 6 and 12 for both diseases. In addition, HF patients did not obtain significant peak VO2 improvements when the HIT protocol was > 12 weeks. This result may be due to the fact that only 2 studies30,33 followed a protocol > 12 weeks while 8 studies6–8,16,17,19,24,27 followed protocols of ≤ 12 weeks. In fact, no significant differences were found between the 2 subgroups (P = .96). Likewise, CAD patients achieved greater improvements in peak VO2 when the duration of the protocol was < 12 weeks, with the differences being significant between the 2 subgroups (P = .05).

Regarding age, there were no statistically significant differences between subgroups (≥ 57 years and < 57 years, CAD patients [56-65 years old], and ≥ 62 years and < 62 years [54-68 years], HF patients). This result indicated that age does not influence improvements in peak VO2, although some research asserts that age is a determining factor for the occurrence of HF and CAD due to diseases associated with age.35,36 According to Amundsen et al.,12 these results suggest that HIT induces changes in cardiac contractility and increases filling of the left ventricle. Thus, we found peak VO2 improvements derived from improvements in left ventricular ejection fraction, regardless of age.

In relation to the HIT protocol, the studies suggested conducting a work ratio (work/recovery) ≤ 1.33 (0.66-1.33) for patients with CAD, as it provides the same benefits as ratios > 1.33. Moreover, it would be better to use work ratios < 1 (0.5-1.33) for patients with HF. These results support some researchers’ arguments that patients prefer shorter or less-intense protocols,10 favoring adherence to the long-term protocol due to greater patient comfort.10,37

Concerning work and recovery periods, there were no statistically significant differences regarding work interval duration (from 30seconds to 4minutes) in HF patients. Nevertheless, there were statistically significant differences in recovery intensity, as recoveries ≤ 40% peak VO2 and passive recovery did not produce adaptations in peak VO2. The reason may be that an active recovery at greater intensity allows for the optimization of phosphocreatine resynthesis, greater lactate oxidation, and optimization of lactate neoglucogenesis.38 However, although some authors have recommended passive recoveries,10 these were not as effective as active recoveries.26 For patients with CAD, there were no statistically significant differences in the work and recovery interval duration, the type of recovery, or active recovery intensity. Thus, patients with CAD had faster recoveries than HF patients. This finding could be due to CAD patients being less affected at the cardiovascular level than patients with HF, therefore having a faster recovery within the parameters mentioned.39 Consequently, to improve the cardiac rehabilitation process, the design of the HIT protocol for HF patients should include active recoveries ≥ 40% peak VO2.

Regarding HIT frequency, there were no statistically significant improvements in the peak VO2 of patients with HF when with protocols ≤ 2 d/wk (P = .07),24 although an improvement was found in the 3 and 4 d/wk protocols (P < .00001),6,7,16,17,19,27,30,33 and ≥ 5 d/wk protocols (P < .01).8 Nevertheless, these results were not found in patients with CAD, whose peak VO2 improved regardless of frequency (2-5 d/wk). Therefore, to obtain HIT-related peak VO2 improvements, training frequency should be at least 3 sessions/wk for patients with HF and at least 2 sessions/wk for patients with CAD. The differences between diseases may be related to the cardiac muscle injury of HF patients, requiring a greater training frequency to obtain similar improvements compared with patients with CAD who did not have problems with the cardiac muscle.37

Our systematic review and meta-analysis results indicate that peak VO2 significantly increased (P < .00001) after HIT in patients with CAD regardless of the duration of the program. Nevertheless, there were significant differences between the protocol durations of > 12 and ≤ 12 weeks (P = .05). However, for patients with HF, even though the programs > 12 weeks did not produce significant improvements in peak VO2 (P = .1), there were improvements with protocols ≤ 12 weeks (P = .00001), although there were no significant differences between them (P = .96). This finding suggests that, in both diseases, the exponential improvements in peak VO2 were produced in the first 12 weeks, when the HIT protocol was more effective. These results were probably due to the nonincremental workload included in the design of their training session, which failed to adhere to the principle of progression.40 This is explained by the fact that when a series of effective stimuli is applied, the organism generates adaptations, such as an increase in the muscle cross-sectional area, adaptations of energy reserves, or increased synchronization of motor units. The unchanging variability of these stimuli were therefore no longer sufficient to generate heterostasis. Thus, a coherent and progressive increase of workloads is required.41

Likewise, there were no statistical differences between patients with CAD or HF in the number of sessions (≥ 36 sessions6,8,11,13,16–19,21,27,30,33,34 and < 36 sessions7,9,15,24,31,32 [18-156 sessions for CAD patients and 18-72 sessions for HF patients]) and session duration (≥ 28minutes11,13,15,18,21,31,32 and < 28minutes9 for patients with CAD [20-28minutes] and > 42minutes6,8,30,33 and ≤ 42minutes7,16,17,19,24 for patients with HF [28-69minutes]). These results implied that HIT interventions should not necessarily be composed of a high number of sessions or long session durations to achieve an improvement in peak VO2 of patients with CAD or HF. The minimum frequency of training needed to produce significant adaptations in peak VO2 was 6 weeks for both CAD18 and HF6,16,19 patients. These results, together with those obtained in this meta-analysis, suggest that the maximum benefits in peak VO2 would be obtained between weeks 6 and 12. There is therefore a need to accomplish an adequate training period to perceive the effects produced in peak VO2 by long-term training protocols. For this reason, it is important to optimize training through adherence to the general principles of training.

In relation to the HIT protocol, this meta-analysis confirms the results that both HIT protocols with short work intervals and protocol of HIT with long work intervals produce significant improvements in peak VO2 in patients with CAD9,14,18 and in patients with HF.6,8,16,19 Likewise, no significant differences were found between performing an HIT protocol with short work interval or long work interval in either disease. These results may be due to the improvements in peak VO2 of cardiovascular diseases being more closely related to the intensity rather than to the duration of the HIT protocol.5 This is because intensity is the parameter that produces greater adaptations in the cardiovascular system such as an increase in muscle cross-sectional area, adaptations of energy reserves, or increased synchronization of motor units.33,34 Therefore, the type of protocol is not as important in the peak VO2 improvement as the training intensity and frequency, for CAD and HF patients.

According to our meta-analysis, HIT improved peak VO2 in patients with CAD or HF, although there were statistically significant differences between these diseases with a greater improvement in patients with HF (P = .03). These results may be due to the initial differences in peak VO2 (16.2-31.8mL/kg/min-1 in CAD patients and 10.7-19.1mL/kg/min-1 in HF patients), derived from the fact that HF patients have impaired cardiac function and the cardiac muscle was not able to pump enough blood to supply the tissues.32 However, CAD patients saw a lesser impact on their peak VO2, as they probably had better myocardial contractility, particularly if they had undergone coronary intervention.42

As has been previously suggested, this should allow the possibility of a higher increase in cardiac output because of a higher systolic volume, resulting in a greater increase in left ventricular ejection fraction in HF patients due to their having a lower threshold of adaptation to the stimulus.7 Similarly, this improvement could be caused by a larger relative increase in exercise-induced vasodilation, hemoglobin, the skeletal muscle oxidative capacity,5,8,18 or by the sum of all these factors.

Although it was not an objective of this study, there are studies that compare the effects on peak VO2 between HIT and continuous training. Although most studies have suggested that HIT is superior to continuous exercise,15,16,21,23,43 some studies have reported that HIT was not superior to continuous exercise programs in relation to peak VO2 in the 2 diseases.5,7,9,17–20,44,45

The present study makes an important contribution to the understanding of the effectiveness of HIT training programs in heart diseases. Thus, this study provides evidence for the potential applicability of HIT training programs as part of the treatments used for CAD and HF.

Practical Application

The results of this study indicate that HIT positively affects peak VO2 in people with HF or CAD, providing greater advantages in HF patients. These findings could be used by physicians, physical conditioning trainers and heart rehabilitation teams to develop specific training programs in order to optimize the functioning of the patient's heart. However, other variables have to be taken into account, such as age, training frequency, the duration of program, and the type of recovery. The HIT program should therefore be adapted to the individual characteristics of each patient. The recommended dosage for each disease is shown in Table 7.

Table 7.

Recommendations on HIT Protocol for HF and CAD Patients

Disease  Frequency, d-wk  Duration program, wks  Session duration, min  Intensity of recovery, peak VO2, %  Ratio, work/recovery 
HF  ≥ 3 (2-5)  ≥ 6 (6-24)  30-60 (28-60)  ≥ 40% (40-70%)  ≥ 1.33 (0.66-1.33) 
CAD  ≥ 2 (2-5)  ≥ 6 (4-52)  30-60 (28-60)  ≥ 40% (0-70%)  ≥ 1 (0.5-1.33) 

CAD, coronary artery disease; HF, heart failure; HIT, high-intensity interval training groups; peak VO2: peak oxygen uptake.

Limitations

The main limitations of this study are as follow: a) the randomized controlled trials did not use the same methods to control the intensity of the training sessions; b) the protocols and the age of the participants were widely heterogeneous; c) most of the included studies had a sample with few patients; and d) in HIT protocols, one aspect is the design and another the intensity that patients are capable of achieving. Therefore, the possibility that a patient has not been able to accomplish the planned intensities should be considered.

CONCLUSIONS

The results of this study show that HIT is an effective method for the treatment of HF and CAD by improving peak VO2, with the increase being significantly higher in HF patients. To optimize these benefits, recovery intervals should be active at intensities between 40% to 60% of peak VO2 for HF patients, and the frequency should be ≥ 2 d/wk for CAD patients and ≥ 3 d/wk for HF patients. This study opens a new line of research that could be used to optimize high-quality exercise training protocols in an effort to develop the most effective and efficient method for the treatment of heart disease and other diseases.

CONFLICTS OF INTEREST

None declared.

WHAT IS KNOWN ABOUT THE TOPIC?

  • The HIT produces positive cardiovascular adaptations in HF and CAD patients.

  • The HIT improves peak VO2 in HF and CAD patients.

WHAT DOES THIS STUDY ADD?

  • The HIT is more effective in improving peak VO2 in HF patients than in CAD patients.

  • To obtain improvements in peak VO2 through HIT, ≥ 3 sessions per week for at least 6 weeks are needed for HF patients, and ≥ 2 sessions per week for at least 6 weeks for CAD patients.

  • Active recovery at intensities between 40% to 60% of peak VO2 should be used to improve peak VO2 in HF patients.

.

Acknowledgements

We thank all authors of the original works cited in the present study, who readily assisted us by either sharing their manuscripts or providing additional data required for this meta-analysis.

References
[1]
World Health Organization. Cardiovascular diseases 2016. Available at: www.who.int/mediacentre/factsheets/fs317/es/. Accessed 22 Sep 2016.
[2]
World Health Organization. The top 10 causes of death 2017. Available at: www.who.int/mediacentre/factsheets/fs310/en/. Accessed 29 May 17.
[3]
I. Ferreira-González.
The epidemiology of coronary heart disease.
Rev Esp Cardiol., 67 (2014), pp. 139-144
[4]
I. Sayago-Silva, F. García-López, J. Segovia-Cubero.
Epidemiology of Heart Failure in Spain Over the Last 20 Years.
Rev Esp Cardiol., 66 (2013), pp. 649-656
[5]
U. Wisløff, A. Støylen, J.P. Loennechen, et al.
Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study.
Circulation., 115 (2007), pp. 3086-3094
[6]
C. Chrysohoou, A. Angelis, G. Tsitsinakis, et al.
Cardiovascular effect of high-intensity interval aerobic training combined with strength exercise in patients with chronic heart failure. A randomized phase III clinical trial.
Int J Cardiol., 179 (2015), pp. 269-274
[7]
P. Roditis, S. Dimopoulos, D. Sakellariou, et al.
The effects of exercise training on the kinetics of oxygen uptake in patients with chronic heart failure.
Eur J Cardiovasc Prev Rehabil., 14 (2007), pp. 304-311
[8]
C. Freyssin, C. Verkindt, F. Prieur, P. Benaich, S. Maunier, P. Blanc.
Cardiac rehabilitation in chronic heart failure: effect of an 8-week, high-intensity interval training versus continuous training.
Arch Phys Med Rehabil., 93 (2012), pp. 1359-1364
[9]
K.D. Currie, J.B. Dubberley, R.S. McKelvie, M.J. MacDonald.
Low-volume, high-intensity interval training in patients with CAD.
Med Sci Sports Exerc., 45 (2013), pp. 1436-1442
[10]
T. Guiraud, M. Juneau, A. Nigam, et al.
Optimization of high intensity interval exercise in coronary heart disease.
Eur J Appl Physiol., 108 (2010), pp. 733-740
[11]
C.G. Cardozo, R.B. Oliveira, P.T. Farinatti.
Effects of high intensity versus moderate continuous training on markers of ventilatory and cardiac efficiency in coronary heart disease patients.
ScientificWorldJournal., 2015 (2015), pp. 192479
[12]
B.H. Amundsen, Ø. Rognmo, G. Hatlen-Rebhan, S.A. Slødahl.
High-intesity aerobic exercise improves diastolic function in coronary artery disease.
Scand Cardiovasc J., 42 (2008), pp. 110-117
[13]
E. Madssen, I. Arbo, I. Granøien, L. Walderhaug, T. Moholdt.
Peak oxygen uptake after cardiac rehabilitation: a randomized controlled trial of a 12-month maintenance program versus usual care.
PloS One., 9 (2014), pp. 1-8
[14]
T. Moholdt, E. Madssen, Ø. Rognmo, I.L. Aamot.
The higher the better?.
Interval training intensity in coronary heart disease. J Sci Med Sports Med Aust., 17 (2014), pp. 506-510
[15]
C. Kim, H.E. Choi, M.H. Lim.
Effect of High Interval Training in Acute Myocardial Infarction Patients with Drug-Elunting Stent.
Am J Phys Med Rehabil Assoc Acad Physiatr., 94 (2015), pp. 879-886
[16]
T.-C. Fu, C.-H. Wang, P.-S. Lin, et al.
Aerobic interval training improves oxygen uptake efficiency by enhancing cerebral and muscular hemodynamics in patients with heart failure.
Int J Cardiol., 167 (2013), pp. 41-50
[17]
K. Isaksen, P.S. Munk, T. Valborgland, A.I. Larsen.
Aerobic interval training in patients with heart failure and an implantable cardioverter defibrillator: a controlled study evaluating feasibility and effect.
Eur J Prev Cardiol., 22 (2015), pp. 296-303
[18]
V.M. Conraads, N. Pattyn, C. De Maeyer, et al.
Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the SAINTEX-CAD study.
Int J Cardiol., 179 (2015), pp. 203-210
[19]
S.-C. Huang, M.-K. Wong, P.-J. Lin, et al.
Modified high-intensity interval training increases peak cardiac power output in patients with heart failure.
Eur J Appl Physiol., 114 (2014), pp. 1853-1862
[20]
F. Iellamo, V. Manzi, G. Caminiti, et al.
Marched dose interval and continuous exercise training induce similar cardiorespiratory and metabolic adaptations in patients with heart failure.
Int J Cardiol., 167 (2013), pp. 2561-2565
[21]
T. Moholdt, I.L. Aamot, I. Granøien, et al.
Aerobic interval training increases peak oxygen uptake more than usual care exercise training in myocardial infarction patients: a randomized controlled study.
Clin Rehabil., 26 (2012), pp. 33-44
[22]
F. Iellamo, G. Caminiti, B. Sposato, et al.
Effect of High-Intensity interval training versus moderate continuous training on 24-h blood pressure profile and insulin resistance in patients with chronic heart failure.
Intern Emerg Med., 9 (2014), pp. 547-552
[23]
S.J. Keteyian, B.A. Hibner, K. Bronsteen, et al.
Greater improvement in cardiorespiratory fitness using high-intensity interval training in the standar cardiac rehabilitation setting.
J Cardiopulm Rehabil Prev., 34 (2014), pp. 98-105
[24]
N.M. Benda, J.P. Seeger, G.G. Stevens, et al.
Effects of High-intensity Interval Training versus Continuous Training on Physical Fitness, Cardiovascular Function and Quality of Life in Heart Failure Patients.
PloS One., 10 (2015), pp. 1-16
[25]
Ø. Rognmo, T. Moholdt, H. Bakken, et al.
Cardiovascular Risk of High- Versus Moderate-Intensity Aerobic Exercise in Coronary Heart Disease Patients.
Circulation., 126 (2012), pp. 1436-1440
[26]
G. Dupont, W. Moalla, C. Guinhouya, S. Ahmaidi, S. Berthoin.
Passive versus active recovery during high-intensity intermittent exercises.
Med Sci Sports Exerc., 36 (2004), pp. 302-308
[27]
S. Dimopoulos, M. Anastasiou-Nana, D. Sakellariou, et al.
Effects of exercise rehabilitation program on heart rate recovery in patients with chronic heart failure.
Eur J Cardiovasc Prev Rehabil., 13 (2006), pp. 67-73
[28]
G. Urrutia, X. Bonfill.
PRISMA declaration: a proposal to improve the publication of systematic reviews and meta-analyses.
Med Clin (Barc)., 135 (2010), pp. 507-511
[29]
Review Manager (RevMan) [Computer program]. Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2011. Available at: http://community.cochrane.org/tools/review-production-tools/revman-5. Accessed 19 Feb 2018.
[30]
P. Koufaki, T.H. Mercer, K.P. George, J. Nolan.
Low-volume high-intensity interval training vs continuous aerobic cycling in patients with chronic heart failure: a pragmatic randomised clinical trial of feasibility and effectiveness.
J Rehabil Med., 46 (2014), pp. 348-356
[31]
T.T. Moholdt, B.H. Amundsen, L.A. Rustad, et al.
Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: a randomized study of cardiovascular effects and quality of life.
Am Heart J., 158 (2009), pp. 1031-1037
[32]
Ø. Rognmo, E. Hetland, J. Helgerud, J. Hoff, S.A. Slødahl.
High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease.
Eur J Cardiovasc Prev Rehabil., 11 (2004), pp. 216-222
[33]
N.A. Smart, G. Dieberg, F. Giallauria.
Intermittent versus continuous exercise training in chronic heart failure: a meta-analysis.
Int J Cardiol., 166 (2013), pp. 352-358
[34]
D.E. Warburton, D.C. McKenzie, M.J. Haykowsky, et al.
Effectiveness of high-intesity interval training for the rehabilitation of patients with coronary artery disease.
Am J Cardiol., 95 (2005), pp. 1080-1084
[35]
J.B. Strait, E.G. Lakatta.
Aging-associated cardiovascular changes and their relationship to heart failure.
Heart Fail Clin., 8 (2012), pp. 143-164
[36]
R. Nakazato, R. Arsanjani, S. Achenbach, et al.
Age-related risk of major adverse cardiac event risk and coronary artery disease extent and severity by coronary CT angiography: results from 15 187 patients from the International Multisite CONFIRM Study.
Eur Heart J Cardiovasc Imaging., 15 (2014), pp. 586-594
[37]
T. Guiraud, A. Nigam, V. Gremeaux, P. Meyer, M. Juneau, L. Bosquet.
High-intensity interval training in cardiac rehabilitation.
Sports Med Auckl NZ., 42 (2012), pp. 587-605
[38]
T. Gerber.
The metabolic responses of high intensity intermittent exercise in healthy untrained adults.
Victoria University, (2013),
Available at: http://vuir.vu.edu.au/25066/. Accessed 2 Feb 2017
[39]
L. Purek, K. Laule-Kilian, A. Christ, et al.
Coronary artery disease and outcome in acute congestive heart failure.
Heart., 92 (2006), pp. 598-602
[40]
Heisz JJ, Tejada MG, Paolucci EM, Muir C. Disfrute por el Ejercicio de Intervalos de Alta Intensidad Aumenta Durante las Primeras Seis Semanas de Entrenamiento: Implicancias Para Promover la Adhesión del Ejercicio en Adultos Sedentarios. PubliCE Prem. Available at: https://g-se.com/disfrute-por-el-ejercicio-de-intervalos-de-alta-intensidad-aumenta-durante-las-primeras-seis-semanas-de-entrenamiento-implicancias-para-promover-la-adhesion-del-ejercicio-en-adultos-sedentarios-2237-sa-v58935b9780c91. Accessed 2 Feb 2017.
[41]
J.M. García-Manso, M. Navarro, J.A. Ruíz.
Planificación del entrenamiento deportivo.
Gymnos, (1996),
[42]
J. Segovia Cubero, L. Alonso-Pulpón Rivera, R. Peraira Moral, L. Silva Melchor.
Heart Failure: Etiology and Approach to Diagnosis.
Rev Esp Cardiol., 57 (2004), pp. 250-259
[43]
K. Liou, S. Ho, J. Fildes, S.Y. Ooi.
High intensity interval versus Moderate intensity continuous training in patients with Coronary Artery Disease: A meta-analysis of physiological and clinical parameters.
Heart Lung Circ., 25 (2016), pp. 166-174
[44]
M. Tschentscher, J. Eichinger, A. Egger, S. Droese, M. Schönfelder, J. Niebauer.
High-intensity interval training is not superior to other forms of endurance training during cardiac rehabilitation.
Eur J Prev Cardiol., 23 (2016), pp. 14-20
[45]
Ø. Ellingsen, M. Halle, V. Conraads, et al.
High intensity interval training is Heart Failure patients with reduced ejection fraction.
Circulation., 135 (2017), pp. 839-849
Copyright © 2018. Sociedad Española de Cardiología
Idiomas
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?