High-intensity interval training in cardiac resynchronization therapy: a randomized control trial



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.

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Fig. 1
Fig. 2
Fig. 3



Chronic heart failure




Cardiopulmonary exercise testing duration


Cardiac resynchronization therapy


High-intensity interval training


Heart rate

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


Left ventricular ejection fraction

LV mass:

Left ventricular mass


Left ventricular end-diastolic volume


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


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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.


This research was supported by National funding from the Portuguese Foundation for Science and Technology (PTDC/DES/120249/2010).

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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.

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Correspondence to Xavier Melo.

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Communicated by Keith Phillip George.

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Lost to follow-up registered during the study period (docx 15 kb)


Quality of Life, Functional Class, Exercise Performance and Echocardiographic parameters including all patients in CRT as randomized. Values were expressed as mean ± SEM. * Significant time effects (p<0.05). Abbreviations: HIIT, High intensity interval Training; CRT, Cardiac resynchronization therapy; CON, Control; P change score, significance of differences between change scores (HIIT vs CON); NYHA, New York Heart Association Functional Class; 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; %-predicted VO2, calculated according to normative values proposed by Wasserman and Hansen et al (2012); CPET duration, Cardiopulmonary exercise testing duration; RER, Respiratory Exchange Ratio; HR recovery 1’, Heart rate recovery at 1’ after CPET; HR recovery 3’, Heart rate recovery at 3’ after CPET; LVEF, Left Ventricular Ejection Fraction; LV Mass, Left Ventricular Mass; LVEDV, Left Ventricular End-Diastolic Volume; LVESV, Left Ventricular End-Systolic Volume. (docx 15 kb)

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Santa-Clara, H., Abreu, A., Melo, X. et al. High-intensity interval training in cardiac resynchronization therapy: a randomized control trial. Eur J Appl Physiol 119, 1757–1767 (2019). https://doi.org/10.1007/s00421-019-04165-y

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  • Exercise capacity
  • Chronic heart failure
  • Reduced ejection fraction
  • Exercise training