High-Intensity Interval Training in Patients with Pulmonary Embolism: A Randomized Controlled Trial

Abstract

PurposeHigh-intensity interval training (HIIT) appears to be safe and effective in cardiovascular diseases. However, there is a paucity of data on the effect of HIIT for patients with acute pulmonary embolism (PE). The present randomized controlled trial (RCT) therefore examined the efficiency and safety of HIIT in patients with acute PE.MethodsIn single-center parallel open-label RCT, 24 patients (5 women) discharged recently with a diagnosis of intermediate–high-risk acute PE were randomized (1:1) to supervised HIIT (n = 12) or control (n = 12) group. The primary outcomes were exercise capacity evaluated in terms of the estimated maximal oxygen uptake (eV˙O2max), lung function (forced expiratory volume in 1 s [FEV1]), right ventricular (RV) function (RV/left ventricular diameter [LV] ratio), and health-related quality of life (HRQoL). Safety was the secondary outcome.ResultsEight weeks of HIIT improved eV˙O2max (+65%, P < 0.001), FEV1 (%) (+17%, P = 0.031), and RV/LV ratio diameter (−27%, P = 0.005), as well as HRQoL. All patients in the HIIT group tolerated exercise training without serious adverse events. The control group did not improve (P > 0.05) eV˙O2max, RV/LV ratio diameter, or HRQoL; however, FEV1 (%) was slightly reduced (−6%, P = 0.030).ConclusionsThe present RCT of a tailored center-based HIIT intervention provides preliminary evidence that this intervention could improve exercise capacity, lung function, RV function, and HRQoL without serious adverse events, which could provide marked clinical benefits after PE. Further larger multicenter randomized controlled studies are needed to confirm these promising findings.

Post-Pulmonary Embolism Syndrome and Functional Outcomes after Acute Pulmonary Embolism

“…Overall, multiple studies have shown that exercise training in patients with PPES is safe. [100][101][102][103][104][105][106][107] Rehabilitation can be effective to improve outcomes of patients with persistent symptoms several months after the acute PE. Randomized controlled trials with large sample sizes investigating the effectiveness of a rehabilitation course in patients with PPES are currently lacking.…”

“…A randomized controlled trial showed significant improvement of estimated VO 2max , RV/left ventricle ratio, and health-related QoL in the high-intensity interval training group after 8 weeks of training started shortly after PE diagnosis, while no improvement was found in the control group. 106 A Danish trial randomized 140 patients between an 8-week home-based exercise program with nurse consultations starting 2 to 3 weeks after PE diagnosis and a control group. The exercise program resulted in a greater improvement of incremental shuttle walk test and PE-specific QoL compared with the control group.…”

Right Ventricular Recovery: Early and Late Changes after Acute PE Diagnosis

“…5 High-intensity interval training in patients with intermediate-high risk PE showed promising results with a marked improvement in the RV/LV diameter ratio after 8 weeks but further larger randomized controlled trials will be needed to confirm these findings and assess long-term benefit. 70 Potential rehabilitative and medical interventions for prevention of post-PE impairment also remain to be studied. Much will depend on a better understanding of post PE impairment pathophysiology and the characteristics of patients at highest risk of developing this complication.…”

Long-Term Management of Pulmonary Embolism: A Review of Consequences, Treatment, and Rehabilitation

“…These symptoms and functional limitations can therefore be improved with a rehabilitation program that includes exercise. Several studies have investigated the safety and effect of initiating physical exercise after a pulmonary embolism, varying in the study design and interventions that were used [ 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 ]. The interventions included cardio exercise (running, biking, and fast walking) and these were initiated within a few weeks to several months after the pulmonary embolism was diagnosed, and some included exercise intervals with increased intensity of the program (e.g., bouts of high intensity for 2–3 min several times during each training session).…”