Estimated peak functional capacity: an accurate method for assessing change in peak oxygen consumption after cardiac rehabilitation?

Nichols, Simon; Gleadall-Siddall, Damien; Antony, Renjith; Clark, Andrew L.; Cleland, John G.F.; Carroll, Sean; Ingle, Lee

doi:10.1111/cpf.12468

Cited by 13 publications

(16 citation statements)

References 38 publications

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“…A UK multi-centre study including 950 patients reported that estimated VȮ 2peak increased by as little as 1.8 ml•kg• −1 min −1 (0.52 METs) following six to eight weeks (6 to 16 sessions) of exercise-based CR [13]. We have shown that estimated VȮ 2peak over-estimates measured changes in VȮ 2peak by 0.7 ml•kg• −1 min −1 (−4•7 to 5•9 ml•kg• −1 min −1 ) [18]. Thus, improvements in peak aerobic fitness resulting from routine exercise-based CR in the UK may be minimal.…”

Section: Introductionmentioning

confidence: 79%

Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study

Nichols

Taylor

Goodman

et al. 2020

International Journal of Cardiology

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Background: Recent evidence suggests that routine exercise-based cardiac rehabilitation (CR) may not lead to a substantial increase in estimated peak oxygen uptake (VȮ 2peak ). This could reduce the potential benefits of CR and explain why CR no longer improves patient survival in recent studies. We aimed to determine whether routine exercise-based CR increases VȮ 2peak using gold-standard maximal cardiopulmonary exercise testing (CPET), and to quantify the exercise training stimulus which might be insufficient in patients undertaking CR. Methods: We studied the effects of a routine, twice weekly, exercise-based CR programme for eight weeks (intervention group) compared with abstention from supervised exercise training (control group) in patients with coronary heart disease. The primary outcome was VȮ 2peak measured using CPET. We also measured changes in body composition using dual X-ray absorptiometry, carotid intima-media thickness, hs-CRP and N-terminal pro B-type natriuretic peptide at baseline, 10 weeks and 12 months. We also calculated the Calibre 5-year all-cause mortality risk score. Results: Seventy patients (age 63.1 SD10.0 years; BMI 29.2 SD4.0 kg•m −2 ; 86% male) were recruited (n = 48 intervention; n = 22 controls). The mean aerobic exercise training duration was 23 min per training session, and the mean exercise training intensity was 45.9% of heart rate reserve. VȮ 2peak was 23•3 ml•kg -1 •min −1 at baseline, and there were no changes in VȮ 2peak between groups at any time point. The intervention had no effect on any of the secondary endpoints. Conclusion: Routine CR does not lead to an increase in VȮ 2peak and is unlikely to improve long-term physiological outcomes.

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Section: Introductionmentioning

confidence: 79%

Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study

Nichols

Taylor

Goodman

et al. 2020

International Journal of Cardiology

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“…Field-tests may provide a useful indication of a patients' aerobic fitness, the presence of a 'normal response' to exercise, and provide information that can be used to inform exercise prescription. However, estimating VO 2peak may be inaccurate, particularly when measuring changes in VO 2peak after exercise-based CR [90]. Maximal cycle ergometry data from patients with CHD, collected by our group, showed that estimating changes in VO 2peak resulted in significant measurement error, when compared to directly determined VO 2peak (limits or agreement − 4.7 to 5.9 ml • kg 1 • min).…”

Section: Frequencymentioning

confidence: 86%

Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure

et al. 2020

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AbstractCardiac rehabilitation is a package of lifestyle secondary prevention strategies designed for patients with coronary heart disease and chronic heart failure. A community-based cardiac rehabilitation programme provides patients with a structured exercise training intervention alongside educational support and psychological counselling. This review provides an update regarding the clinical benefits of community-based cardiac rehabilitation from a psycho-physiological perspective, and also focuses on the latest epidemiological evidence regarding potential survival benefits. Behaviour change is key to long-term adoption of a healthy and active lifestyle following a cardiac event. In order for lifestyle interventions such as structured exercise interventions to be adopted by patients, practitioners need to ensure that behaviour change programmes are mapped against patient’s priorities and values, and adapted to their level of readiness and intention to engage with the target behaviour. We review the evidence regarding behaviour change strategies for cardiac patients and provide practitioners with the latest guidance. The ‘dose’ of exercise training delivered to patients attending exercise-based cardiac rehabilitation is an important consideration because an improvement in peak oxygen uptake requires an adequate physiological stimulus to invoke positive physiological adaptation. We conclude by critically reviewing the latest evidence regarding exercise dose for cardiac patients including the role of traditional and more contemporary training interventions including high intensity interval training.

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“…Applying estimates of VO 2peak to determine CRF change may over-estimate the efficacy of CR and lead to a different interpretation of study findings. [ 23 ] There are very few centres in the UK which have adopted maximal cardiopulmonary exercise testing as routine for evaluating clinical populations and prescribing individualised exercise training loads. The outcomes of the CARE CR trial, which used criterion exercise testing methods to evaluate the effectiveness of a UK CR programme recently showed that in 70 patients with coronary heart disease, there was no changes in directly determined at any time point following an 8-week CR programme.…”

Section: Discussionmentioning

confidence: 99%

Characterising the application of the “progressive overload” principle of exercise training within cardiac rehabilitation: A United Kingdom-based community programme

et al. 2020

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Background Recent concerns have cast doubt over the effectiveness of cardiac rehabilitation [CR] programmes for improving cardiorespiratory fitness [CRF] in patients with a history of cardiac disease in the United Kingdom [UK]. We aimed to characterise the weekly progression of exercise training dose over an 8-week Phase III CR programme as we felt this may be partly responsible for the lack of improvement in CRF reported in previous studies. Design Observational study. Methods We evaluated a community-based Phase III CR programme in the UK. During each training session, patients wore an Apple Watch and the weekly progression of exercise training dose/load was quantified. The analysis was based on 332 individual training sessions. Exercise intensity [% heart rate reserve] during the cardiovascular [CV] exercise training component [%HRR-CV], CV training duration; estimated changes in cardiorespiratory fitness [change in estimated metabolic equivalents (METs)]; session rating of perceived exertion [sRPE], sRPE training load [sRPE-TL], and exercise training impulse [TRIMP] were evaluated. Results Thirty cardiac patients [83% male; age [SD] 67.0 [10.0] years; body mass index [SD] 28.3 [4.6] kg�m-2 ] were recruited to an 8-week programme [16 sessions in total]. Bayesian repeated-measures ANOVA indicated anecdotal evidence for the alternative hypothesis for changes in %HRR-CV (BF 10 = 0.61), sRPE (BF 10 = 1.1), and change in estimated METs (BF 10 = 1.2) during CR. Conversely, Bayesian repeated-measures ANOVA showed

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Estimated peak functional capacity: an accurate method for assessing change in peak oxygen consumption after cardiac rehabilitation?

Cited by 13 publications

References 38 publications

Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study

Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study

Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure

Characterising the application of the “progressive overload” principle of exercise training within cardiac rehabilitation: A United Kingdom-based community programme

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