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

Abstract

Aims 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. Methods 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. Results 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 VO 2 (HIIT = 8.64%, CON = 4.85%) and percent-predicted VO 2 (HIIT = 10.57%, CON = 4.26%) in both groups, were observed in the intention-to-treat analysis. Conclusion 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.clini caltr ials.gov. Unique identifier: NCT02413151. Keywords Exercise capacity • Chronic heart failure • Reduced ejection fraction • Exercise training Abbreviations CHF Chronic heart failure CON Control CPET Cardiopulmonary exercise testing duration CRT Cardiac resynchronization therapy Communicated by Keith Phillip George.

Effects of exercise-based cardiac rehabilitation delivery modes on exercise capacity and health-related quality of life in heart failure: a systematic review and network meta-analysis

“…Aerobic (n=84) and aerobic +resistance (n=27) were the most common training modes, followed by flexibility (n=9), resistance (n=8), aerobic +resistance + flexibility (n=7), aerobic +flexibility (n=2) and resistance +flexibility (n=2). Characteristics of included RCTs28–166 are summarised in online supplemental file 1.…”

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

“…The additive role of exercise training superimposed onto CRT in increasing functional capacity and improving cardiovascular prognosis -since up to one-third of patients are initially non-responder to CRT and may gain from exercise -is still unclear, due to conflicting evidence. 86,87 When prescribing exercise in CRT patients, wound evaluation in terms of both skin and heart muscle wire insertion has to be preliminary performed, and, in case, information regarding adverse events during device implantation should be collected. Chronic dynamic and resistance exercises prevents the side-effects of immunosuppressive therapy Exercise intensity relies more on perceived exertion than on a specific HR (due to denervation of the heart).…”

A Post hoc analysis on rhythm and high intensity interval training in cardiac resynchronization therapy

“…However, this is not an universal finding. Our group has shown recently that 6 months of HIIT in patients in CRT did not further improve indices of functional capacity, health-related quality of life, and left ventricular structure and function, compared to CRT alone [11]. HIIT led to further improvements in exercise performance, but it remains unclear whether patients with and without regular, organized atrial activity derive the same benefits from HIIT, as it is known that atrioventricular timing may influence the response to CRT [3,5].…”

“…HIIT led to further improvements in exercise performance, but it remains unclear whether patients with and without regular, organized atrial activity derive the same benefits from HIIT, as it is known that atrioventricular timing may influence the response to CRT [3,5]. Here, we report the results of a post hoc analysis of the previous randomized control trial [11], with a focus on whether patients in AF enrolled in HIIT also improve primary predictors of mortality and morbidity [12] as well as other predictors of relatively poor outcome [13] in chronic heart failure. Thus, the aim of this post hoc analysis was to evaluate the effects of a 6-month HIIT program on selected estimates of (1) functional capacity and health-related quality of life, (2) multiple blood biomarkers, (3) echocardiographic parameters, and (4) exercise performance, in patients stratified by the presence of AF with the intention of answering the following questions: (1) Does CRT provide similar benefits in patients in AF and SR?…”