This study investigated the effectiveness and safety of interval training during in-hospital treatment of patients with advanced heart failure. Twenty-four consecutive patients with advanced symptomatic heart failure who were referred for cardiac transplant evaluation were recruited. After performing aerobic exercise for approximate intensity, high-intensity interval training (HIIT) was performed. The protocol consisted of 3 or 4 sessions of 1-min high-intensity exercise aimed at 80% of peak VO2 or 80% heart rate reserve, followed by 4-min recovery periods of low intensity. In addition to the necessary laboratory data, hand grip strength and knee extensor strength were evaluated at the start of exercise training and both at the start and the end of HIIT. Knee extensor strength was standardized by body weight. The BNP level at the start of exercise training was 432 (812) pg/mL and it significantly decreased to 254 (400) pg/mL (p < 0.001) at the end of HIIT. Hand grip strength did not change during course. By contrast, knee extensor strength significantly increased during HIIT [4.42 ± 1.43 → 5.28 ± 1.45 N/kg, p < 0.001], whereas the improvement of knee extensor strength was not significant from the start of exercise training to the start of HIIT. In addition, the change in knee extensor strength during HIIT was significantly associated with the hemoglobin A1c level at the start of exercise (R = − 0.55; p = 0.015). HIIT has a positive impact on skeletal muscle strength among in-hospital patients with advanced heart failure.
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Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, Lough F, Rees K, Singh S (2014) Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev 4:CD003331
Erbs S, Höllriegel R, Linke A, Beck EB, Adams V, Gielen S, Möbius-Winkler S, Sandri M, Kränkel N, Hambrecht R, Schuler G (2010) Exercise training in patients with advanced chronic heart failure (NYHA IIIb) promotes restoration of peripheral vasomotor function, induction of endogenous regeneration, and improvement of left ventricular function. Circ Heart Fail 3:486–494
Fülster S, Tacke M, Sandek A, Ebner N, Tschöpe C, Doehner W, Anker SD, von Haehling S (2013) Muscle wasting in patients with chronic heart failure: results from the studies investigating co-morbidities aggravating heart failure (SICA-HF). Eur Heart J 34:512–519
Bekfani T, Pellicori P, Morris DA, Ebner N, Valentova M, Steinbeck L, Wachter R, Elsner S, Sliziuk V, Schefold JC, Sandek A, Doehner W, Cleland JG, Lainscak M, Anker SD, von Haehling S (2016) Sarcopenia in patients with heart failure with preserved ejection fraction: impact on muscle strength, exercise capacity, and quality of life. Int J Cardiol 222:41–46
Harrington D, Coats AJ (1997) Skeletal muscle abnormalities and evidence for their role in symptom generation in chronic heart failure. Eur Heart J 18:1865–1872
Anker SD, Ponikowski P, Varney S, Chua TP, Clark AL, Webb-Peploe KM, Harrington D, Kox WJ, Poole-Wilson PA, Coats AJ (1997) Wasting as independent risk factor for mortality in chronic heart failure. Lancet 349:1050–1053
Cerri AP, Bellelli G, Mazzone A, Pittella F, Landi F, Zambon A, Annoni G (2015) Sarcopenia and malnutrition in acutely ill hospitalized elderly: prevalence and outcomes. Clin Nutr 34:745–751
Takabayashi K, Ikuta A, Okazaki Y, Ogami M, Iwatsu K, Matsumura K, Ikeda T, Ichinohe T, Morikami Y, Yamamoto T, Fujita R, Takenaka K, Takenaka H, Haruna Y, Muranaka H, Ozaki M, Kitamura T, Kitaguchi S, Nohara R (2016) Clinical characteristics and social frailty of super-elderly patients with heart failure—the Kitakawachi Clinical Background and Outcome of Heart Failure Registry. Circ J 81:69–76
Jacobs RA, Flück D, Bonne TC, Bürgi S, Christensen PM, Toigo M, Lundby C (2013) Improvements in exercise performance with high-intensity interval training coincide with an increase in skeletal muscle mitochondrial content and function. J Appl Physiol 115:785–793
Conraads VM, Pattyn N, De Maeyer C, Beckers PJ, Coeckelberghs E, Cornelissen VA, Denollet J, Frederix G, Goetschalckx K, Hoymans VY, Possemiers N, Schepers D, Shivalkar B, Voigt JU, Van Craenenbroeck EM, Vanhees L (2015) Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the SAINTEX-CAD study. Int J Cardiol 179:203–210
Fu TC, Wang CH, Lin PS, Hsu CC, Cherng WJ, Huang SC, Liu MH, Chiang CL, Wang JS (2013) Aerobic interval training improves oxygen uptake efficiency by enhancing cerebral and muscular hemodynamics in patients with heart failure. Int J Cardiol 167:41–50
Turkiewicz A, Timpka S, Thorlund JB, Ageberg E, Englund M (2017) Knee extensor strength and body weight in adolescent men and the risk of knee osteoarthritis by middle age. Ann Rheum Dis 76(10):1657–1661
Eriksrud O, Bohannon RW (2003) Relationship of knee extension force to independence in sit-to-stand performance in patients receiving acute rehabilitation. Phys Ther 83:544–551
Ellingsen Ø, Halle M, Conraads V, Støylen A, Dalen H, Delagardelle C, Larsen AI, Hole T, Mezzani A, Van Craenenbroeck EM, Videm V, Beckers P, Christle JW, Winzer E, Mangner N, Woitek F, Höllriegel R, Pressler A, Monk-Hansen T, Snoer M, Feiereisen P, Valborgland T, Kjekshus J, Hambrecht R, Gielen S, Karlsen T, Prescott E, Linke A, SMARTEX Heart Failure Study (Study of Myocardial Recovery After Exercise Training in Heart Failure) Group (2017) High-Intensity Interval Training in Patients With Heart Failure With Reduced Ejection Fraction. Circulation 135:839–849
Wisløff U, Støylen A, Loennechen JP, Bruvold M, Rognmo Ø, Haram PM, Tjønna AE, Helgerud J, Slørdahl SA, Lee SJ, Videm V, Bye A, Smith GL, Najjar SM, Ellingsen Ø, Skjaerpe T” instead of “Ellingsen Ø, Halle M, Conraads V, Støylen A, Dalen H, Delagardelle C, Larsen AI, Hole T, Mezzani A, Van Craenenbroeck EM, Videm V, Beckers P, Christle JW, Winzer E, Mangner N, Woitek F, Höllriegel R, Pressler A, Monk-Hansen T, Snoer M, Feiereisen P, Valborgland T, Kjekshus J, Hambrecht R, Gielen S, Karlsen T, Prescott E, Linke A; SMARTEX Heart Failure Study (Study of Myocardial Recovery After Exercise Training in Heart Failure) Group (2007) Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation 115:3086–3094
Ades PA, Keteyian SJ, Balady GJ, Houston-Miller N, Kitzman DW, Mancini DM, Rich MW (2013) Cardiac rehabilitation exercise and self-care for chronic heart failure. JACC Heart Fail 1:540–547
Chung CJ, Wu C, Jones M, Kato TS, Dam TT, Givens RC, Templeton DL, Maurer MS, Naka Y, Takayama H, Mancini DM, Schulze PC (2014) Reduced handgrip strength as a marker of frailty predicts clinical outcomes in patients with heart failure undergoing ventricular assist device placement. J Card Fail 20:310–315
Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A Jr, Orlandini A, Seron P, Ahmed SH, Rosengren A, Kelishadi R, Rahman O, Swaminathan S, Iqbal R, Gupta R, Lear SA, Oguz A, Yusoff K, Zatonska K, Chifamba J, Igumbor E, Mohan V, Anjana RM, Gu H, Li W, Yusuf S, Prospective Urban Rural Epidemiology (PURE) Study investigators (2015) Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 386:266–273
Lavie CJ, Forman DE, Arena R (2016) Bulking up skeletal muscle to improve heart failure prognosis. JACC Heart Fail 4:274–276
Alley DE, Koster A, Mackey D, Cawthon P, Ferrucci L, Simonsick EM, Yu B, Hardy S, Goodpaster B, Sarkisian C, Houston DK, Kritchevsky SB, Cummings S, Lee JS, Tylavsky FA, Newman A, Harris T (2010) Health, aging and body composition study. Hospitalization and change in body composition and strength in a population-based cohort of older persons. J Am Geriatr Soc 58:2085–2091
Harber MP, Konopka AR, Undem MK, Hinkley JM, Minchev K, Kaminsky LA, Trappe TA, Trappe S (2012) Aerobic exercise training induces skeletal muscle hypertrophy and age-dependent adaptations in myofiber function in young and older men. J Appl Physiol 113:1495–1504
Park SW, Goodpaster BH, Strotmeyer ES, de Rekeneire N, Harris TB, Schwartz AV, Tylavsky FA, Newman AB (2006) Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes 55:1813–1818
Khawaja T, Chokshi A, Ji R, Kato TS, Xu K, Zizola C, Wu C, Forman DE, Ota T, Kennel P, Takayama H, Naka Y, George I, Mancini D, Schulze CP (2014) Ventricular assist device implantation improves skeletal muscle function, oxidative capacity, and growth hormone/insulin-like growth factor–1 axis signaling in patients with advanced heart failure. J Cachexia Sarcopenia Muscle 5:297–305
Park SW, Goodpaster BH, Strotmeyer ES, Kuller LH, Broudeau R, Kammerer C, de Rekeneire N, Harris TB, Schwartz AV, Tylavsky FA, Cho YW, Newman AB (2007) Health, aging, and body composition study. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care 30:1507–1512
Nishitani M, Shimada K, Sunayama S, Masaki Y, Kume A, Fukao K, Sai E, Yamashita H, Ohmura H, Onishi T, Shioya M, Sato H, Shimada A, Yamamoto T, Amano A, Daida H (2011) Impact of diabetes on muscle mass, muscle strength, and exercise tolerance in patients after coronary artery bypass grafting. J Cardiol 58:173–180
Meyer P, Gayda M, Juneau M, Nigam A (2013) High-intensity aerobic interval exercise in chronic heart failure. Curr Heart Fail Rep 10:130–138
Kamiya K, Masuda T, Matsue Y, Inomata T, Hamazaki N, Matsuzawa R, Tanaka S, Nozaki K, Maekawa E, Noda C, Yamaoka-Tojo M, Matsunaga A, Izumi T, Ako J (2016) Complementary role of arm circumference to body mass index in risk stratification in heart failure. JACC Heart Fail 4:265–273
This work was supported by The Ministry of Education, Culture, Sports, Science and Technology of Japan through Grant-in-aid 26,461,103 (to Amiya E).
Conflict of interest
The author(s) declare that they have no competing interests.
The original version of this article was revised: The unit of hand in Fig. 2 was incorrectly published and corrected in this version.
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Taya, M., Amiya, E., Hatano, M. et al. High-intensity aerobic interval training can lead to improvement in skeletal muscle power among in-hospital patients with advanced heart failure. Heart Vessels 33, 752–759 (2018). https://doi.org/10.1007/s00380-018-1120-x
- Cardiac rehabilitation
- Heart failure
- Muscle strength
- High-intensity interval training