Superior Cardiovascular Effect of Aerobic Interval Training Versus Moderate Continuous Training in Heart Failure Patients: A Randomized Study

Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Nidaros, Sør-Trøndelag, Norway
Circulation (Impact Factor: 14.43). 07/2007; 115(24):3086-94. DOI: 10.1161/CIRCULATIONAHA.106.675041
Source: PubMed


Exercise training reduces the symptoms of chronic heart failure. Which exercise intensity yields maximal beneficial adaptations is controversial. Furthermore, the incidence of chronic heart failure increases with advanced age; it has been reported that 88% and 49% of patients with a first diagnosis of chronic heart failure are >65 and >80 years old, respectively. Despite this, most previous studies have excluded patients with an age >70 years. Our objective was to compare training programs with moderate versus high exercise intensity with regard to variables associated with cardiovascular function and prognosis in patients with postinfarction heart failure.
Twenty-seven patients with stable postinfarction heart failure who were undergoing optimal medical treatment, including beta-blockers and angiotensin-converting enzyme inhibitors (aged 75.5+/-11.1 years; left ventricular [LV] ejection fraction 29%; VO2peak 13 mL x kg(-1) x min(-1)) were randomized to either moderate continuous training (70% of highest measured heart rate, ie, peak heart rate) or aerobic interval training (95% of peak heart rate) 3 times per week for 12 weeks or to a control group that received standard advice regarding physical activity. VO2peak increased more with aerobic interval training than moderate continuous training (46% versus 14%, P<0.001) and was associated with reverse LV remodeling. LV end-diastolic and end-systolic volumes declined with aerobic interval training only, by 18% and 25%, respectively; LV ejection fraction increased 35%, and pro-brain natriuretic peptide decreased 40%. Improvement in brachial artery flow-mediated dilation (endothelial function) was greater with aerobic interval training, and mitochondrial function in lateral vastus muscle increased with aerobic interval training only. The MacNew global score for quality of life in cardiovascular disease increased in both exercise groups. No changes occurred in the control group.
Exercise intensity was an important factor for reversing LV remodeling and improving aerobic capacity, endothelial function, and quality of life in patients with postinfarction heart failure. These findings may have important implications for exercise training in rehabilitation programs and future studies.

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    • "While the evidence on the effects of HIIT in complex clinical populations (e.g. HF) is sparse, a study by Wisloff et al. (2007) reported in patients with post-infarction HF that HIIT was superior to moderate ET with regards to left ventricular remodelling, aerobic capacity, endothelial function and quality of life. However, it is important to note that while infarctions affecting a large portion of the left ventricle (LV) are undoubtedly a basis for HF, the aetiology, disease progression and molecular fingerprint are fundamentally different from hypertrophy-related (hypertensive) HF. "

    Full-text · Article · Dec 2015 · The Journal of Physiology
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    • "These have consistently shown that exercise using HIIT compared to moderate intensity exercise is more effective on several important prognostic factors ( ˙ V O2peak , ventricular function, endothelial function and quality of life) (Guiraud et al. 2012). HIIT has been found more beneficial in patients with heart failure (Wisloff et al. 2007; Freyssin et al. 2012; Guiraud CrossTalk J Physiol 593.24 et al. 2012; Fu et al. 2013; Haykowsky et al. 2013) or coronary artery disease (Rognmo et al. 2004; Moholdt et al. 2009; Guiraud et al. 2012), in individuals with the metabolic syndrome (Tjonna et al. 2008) or hypertension (Molmen-Hansen et al. 2012), in obese individuals (Schjerve et al. 2008), and in patients with type 2 diabetes (Hollekim-Strand et al. 2014). Also, numerous experimental animal studies support the clinical findings above, using HIIT protocols to improve health and reduce disease (Wisloff et al. 2009). "

    Preview · Article · Dec 2015 · The Journal of Physiology
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    • "Another important factor in the effective translation of preclinical findings to humans is the exercise intervention design. While preclinical and clinical experimental studies demonstrate that high intensity aerobic exercise results in greater cardiac benefits than moderate or low intensity [150] [151], the strenuous exercise prescription applied in most preclinical studies (five days a week, moderate to high intensity, 20–90 minutes) would likely not be tolerable for humans undergoing chemotherapy treatment [152]. One rodent study implemented a more clinically feasible and practical exercise prescription and doxorubicin treatment protocol involving 20 minutes of low intensity exercise, performed five days per week during chronic low dose doxorubicin treatment [23]. "
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