High-intensity interval training in cardiac resynchronization therapy: a randomized control trial
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To determine the effects of high-intensity interval training (HIIT) following cardiac resynchronization therapy (CRT) implantation in patients with chronic heart failure (CHF), on noninvasive estimates of systolic ventricular function, exercise performance, severity of symptoms and quality of life.
Cardiopulmonary exercise testing, resting transthoracic echocardiogram and health-related quality of life assessment were obtained before and at 6 months after CRT implantation in 37 patients with moderate-to-severe CHF. Patients were randomized after CRT to either a 24-week HIIT group (90–95% peak heart rate, 2 days per week) or to a usual care group (CON). Mixed design 2 × 2 repeated measures ANOVA were used to test for differences within and in-between groups.
Improvements in health-related quality of life (HIIT = 98.54%, CON = 123.47%), NYHA class (HIIT = 43.44%, CON = 38.30%) HR recovery at minute 1 (HIIT = 32.32%, CON = 42.94%), pulse pressure at peak effort (HIIT = 14.06%, CON = 9.52%, LVEF (HIIT = 42.17%, CON = 51.10%) and LV Mass (HIIT = 13.26%, CON = 11.88%) were similar in both groups (p > 0.05). Significant increases in CPET duration in the HIIT group (25.94%), and increases in peak VO2 (HIIT = 8.64%, CON = 4.85%) and percent-predicted VO2 (HIIT = 10.57%, CON = 4.26%) in both groups, were observed in the intention-to-treat analysis.
Six months of HIIT in patients in CRT did not further improved indices of functional capacity and health-related quality of life, and LV structure and function, compared to CRT alone. However, HIIT led to further improvements in exercise performance. It remains unclear whether HIIT benefits patients in CRT to a similar degree as more conventional forms of exercise training previously shown to maximize benefits in CRT.
Clinical trial registration
http://www.clinicaltrials.gov. Unique identifier: NCT02413151.
KeywordsExercise capacity Chronic heart failure Reduced ejection fraction Exercise training
Chronic heart failure
Cardiopulmonary exercise testing duration
Cardiac resynchronization therapy
High-intensity interval training
- HR recovery 1 min
Heart rate recovery at 1 min after CPET
- HR recovery 3 min
Heart rate recovery at 3 min after CPET
Left ventricular ejection fraction
- LV mass
Left ventricular mass
- LV EDV
Left ventricular end-diastolic volume
- LV ESV
Left ventricular end-systolic volume
New York Heart Association Functional Scale
- Peak PP
Pulse pressure at peak effort during cardiopulmonary exercise testing
- Peak RPP
Rate pressure product at peak effort during cardiopulmonary exercise testing
- Peak HR
Heart rate at peak effort during cardiopulmonary exercise testing
- Peak VO2
Oxygen consumption at peak effort during cardiopulmonary exercise testing
Respiratory exchange ratio
The authors would like to thank Dr. Neil Oldridge’s suggestions on the manuscript. We would also acknowledge the contributions of the cardiopulmonary technicians and the medical interns in cardiology from Hospital Santa-Marta, and Mafalda Carinha from Faculdade de Motricidade Humana, Universidade de Lisboa.
HSC, AA contributed to conception and design, critically revised the manuscript, and gave final approval. VS contributed to acquisition, analysis, critically revised the manuscript and gave final approval. XM contributed to acquisition, analysis, interpretation, drafted the manuscript and gave final approval. RP and BF contributed to interpretation, critically revised manuscript, and gave final approval. PC, MO, MMC contributed to acquisition, critically revised the manuscript, and gave final approval.
This research was supported by National funding from the Portuguese Foundation for Science and Technology (PTDC/DES/120249/2010).
Compliance with ethical standards
Conflict of interest
The authors have no competing interests.
- Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J, Evaluation MSGMIRC (2002) Cardiac resynchronization in chronic heart failure. N Engl J Med 346(24):1845–1853. https://doi.org/10.1056/NEJMoa013168 CrossRefGoogle Scholar
- Auricchio A, Stellbrink C, Sack S, Block M, Vogt J, Bakker P, Huth C, Schondube F, Wolfhard U, Bocker D, Krahnefeld O, Kirkels H (2002) Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 39(12):2026–2033CrossRefGoogle Scholar
- Bartlett JD, Close GL, MacLaren DP, Gregson W, Drust B, Morton JP (2011) High-intensity interval running is perceived to be more enjoyable than moderate-intensity continuous exercise: implications for exercise adherence. J Sports Sci 29(6):547–553. https://doi.org/10.1080/02640414.2010.545427 CrossRefPubMedGoogle Scholar
- Belardinelli R, Capestro F, Misiani A, Scipione P, Georgiou D (2006) Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy. Eur J Cardiovasc Prev Rehabil 13(5):818–825CrossRefPubMedGoogle Scholar
- Bjarnason-Wehrens B, McGee H, Zwisler AD, Piepoli MF, Benzer W, Schmid JP, Dendale P, Pogosova NG, Zdrenghea D, Niebauer J, Mendes M, Cardiac Rehabilitation Section European of Cardiovascular Prevention and Rehabilitation (2010) Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey. Eur J Cardiovasc Prev Rehabil 17(4):410–418. https://doi.org/10.1097/HJR.0b013e328334f42d CrossRefPubMedGoogle Scholar
- Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE (ESC) ESoC (EHRA) EHRA (2013) 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace 15(8):1070–1118. https://doi.org/10.1093/europace/eut206 CrossRefGoogle Scholar
- Conraads VM, Vanderheyden M, Paelinck B, Verstreken S, Blankoff I, Miljoen H, De Sutter J, Beckers P (2007) The effect of endurance training on exercise capacity following cardiac resynchronization therapy in chronic heart failure patients: a pilot trial. Eur J Cardiovasc Prev Rehabil 14(1):99–106CrossRefPubMedGoogle Scholar
- Dimopoulos S, Anastasiou-Nana M, Sakellariou D, Drakos S, Kapsimalakou S, Maroulidis G, Roditis P, Papazachou O, Vogiatzis I, Roussos C, Nanas S (2006) Effects of exercise rehabilitation program on heart rate recovery in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 13(1):67–73CrossRefPubMedGoogle Scholar
- 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(9):839–849. https://doi.org/10.1161/circulationaha.116.022924 CrossRefPubMedPubMedCentralGoogle Scholar
- Evangelista A, Flachskampf F, Lancellotti P, Badano L, Aguilar R, Monaghan M, Zamorano J, Nihoyannopoulos P, Echocardiography EAo (2008) European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr 9(4):438–448. https://doi.org/10.1093/ejechocard/jen174 CrossRefGoogle Scholar
- Goldenberg I, Moss AJ, Hall WJ, Foster E, Goldberger JJ, Santucci P, Shinn T, Solomon S, Steinberg JS, Wilber D, Barsheshet A, McNitt S, Zareba W, Klein H, Executive Committee MADIT-CRT (2011) Predictors of response to cardiac resynchronization therapy in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT). Circulation 124(14):1527–1536. https://doi.org/10.1161/CIRCULATIONAHA.110.014324 CrossRefPubMedGoogle Scholar
- Iellamo F, Manzi V, Caminiti G, Vitale C, Castagna C, Massaro M, Franchini A, Rosano G, Volterrani M (2013) Matched dose interval and continuous exercise training induce similar cardiorespiratory and metabolic adaptations in patients with heart failure. Int J Cardiol 167(6):2561–2565. https://doi.org/10.1016/j.ijcard.2012.06.057 CrossRefPubMedGoogle Scholar
- Kutyifa V, Solomon SD, Bourgoun M, Shah AM, Pouleur AC, Knappe D, McNitt S, Wang PJ, Merkely B, Pfeffer M, Moss AJ, Zareba W (2013) Effects of cardiac resynchronization therapy on left ventricular mass and wall thickness in mild heart failure patients in MADIT-CRT. Heart Rhythm 10(3):354–360. https://doi.org/10.1016/j.hrthm.2012.11.007 CrossRefPubMedGoogle Scholar
- Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270. https://doi.org/10.1093/ehjci/jev014 CrossRefPubMedGoogle Scholar
- Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Members ATF (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200. https://doi.org/10.1093/eurheartj/ehw128 CrossRefGoogle Scholar
- Roditis P, Dimopoulos S, Sakellariou D, Sarafoglou S, Kaldara E, Venetsanakos J, Vogiatzis J, Anastasiou-Nana M, Roussos C, Nanas S (2007) The effects of exercise training on the kinetics of oxygen uptake in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 14(2):304–311. https://doi.org/10.1097/HJR.0b013e32808621a3 CrossRefPubMedGoogle Scholar
- Santos V, Abreu A, Pinto R, Melo X, Cunha P, Oliveira M, Selas M, Soares R, Ferreira R, Sardinha LB, Fernhall B (2015) Effect of high intensity interval training on cardiac remodeling following cardiac resynchronization therapy: RCT. Med Sci Sports Exerc. https://doi.org/10.1249/01.mss.0000477584.48099.97 CrossRefPubMedGoogle Scholar
- Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I (1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 2(5):358–367CrossRefGoogle Scholar
- Smolis-Bąk E, Dąbrowski R, Piotrowicz E, Chwyczko T, Dobraszkiewicz-Wasilewska B, Kowalik I, Kazimierska B, Jędrzejczyk B, Smolis R, Gepner K, Maciąg A, Sterliński M, Szwed H (2015) Hospital-based and telemonitoring guided home-based training programs: effects on exercise tolerance and quality of life in patients with heart failure (NYHA class III) and cardiac resynchronization therapy. A randomized, prospective observation. Int J Cardiol 199:442–447. https://doi.org/10.1016/j.ijcard.2015.07.041 CrossRefPubMedGoogle Scholar
- St John Sutton MG, Plappert T, Abraham WT, Smith AL, DeLurgio DB, Leon AR, Loh E, Kocovic DZ, Fisher WG, Ellestad M, Messenger J, Kruger K, Hilpisch KE, Hill MR, Multicenter InSync Randomized Clinical Evaluation (MIRACLE) Study Group (2003) Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation 107(15):1985–1990. https://doi.org/10.1161/01.cir.0000065226.24159.e9 CrossRefPubMedGoogle Scholar
- St John Sutton M, Ghio S, Plappert T, Tavazzi L, Scelsi L, Daubert C, Abraham WT, Gold MR, Hassager C, Herre JM, Linde C, Group RrRiSlvdRS (2009) Cardiac resynchronization induces major structural and functional reverse remodeling in patients with New York Heart Association class I/II heart failure. Circulation 120(19):1858–1865. https://doi.org/10.1161/circulationaha.108.818724 CrossRefPubMedGoogle Scholar
- Wasserman K, Hansen J, Sue D, Stringer W, Sietsema K, Sun X-G, Whipp B (2012) Principles of exercise testing and interpretation. Normal values, 5th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
- Wisloff U, Stoylen A, Loennechen JP, Bruvold M, Rognmo O, Haram PM, Tjonna AE, Helgerud J, Slordahl SA, Lee SJ, Videm V, Bye A, Smith GL, Najjar SM, Ellingsen O, Skjaerpe T (2007) Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation 115(24):3086–3094. https://doi.org/10.1161/CIRCULATIONAHA.106.675041 CrossRefPubMedPubMedCentralGoogle Scholar
- Yu CM, Chau E, Sanderson JE, Fan K, Tang MO, Fung WH, Lin H, Kong SL, Lam YM, Hill MR, Lau CP (2002) Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 105(4):438–445CrossRefPubMedGoogle Scholar
- Zeitler EP, Piccini JP, Hellkamp AS, Whellan DJ, Jackson KP, Ellis SJ, Kraus WE, Keteyian SJ, Kitzman DW, Ewald GA, Fleg JL, Piña IL, O’Connor CM, Investigators H-A (2015) Exercise training and pacing status in patients with heart failure: results from HF-ACTION. J Card Fail 21(1):60–67. https://doi.org/10.1016/j.cardfail.2014.10.004 CrossRefPubMedGoogle Scholar