High-intensity interval training vs. moderate-intensity continuous exercise training in heart failure with preserved ejection fraction: a pilot study

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a major cause of morbidity and mortality. Exercise training is an established adjuvant therapy in heart failure; however, the effects of high-intensity interval training (HIIT) in HFpEF are unknown. We compared the effects of HIIT vs. moderate-intensity aerobic continuous training (MI-ACT) on peak oxygen uptake (V̇o₂peak), left ventricular diastolic dysfunction, and endothelial function in patients with HFpEF. Nineteen patients with HFpEF (age 70 ± 8.3 yr) were randomized to either HIIT (4 × 4 min at 85-90% peak heart rate, with 3 min active recovery) or MI-ACT (30 min at 70% peak heart rate). Fifteen patients completed exercise training (HIIT: n = 9; MI-ACT: n = 6). Patients trained 3 days/wk for 4 wk. Before and after training patients underwent a treadmill test for V̇o₂peak determination, 2D-echocardiography for assessment of left ventricular diastolic dysfunction, and brachial artery flow-mediated dilation (FMD) for assessment of endothelial function. HIIT improved V̇o₂peak (pre = 19.2 ± 5.2 ml·kg(-1)·min(-1); post = 21.0 ± 5.2 ml·kg(-1)·min(-1); P = 0.04) and left ventricular diastolic dysfunction grade (pre = 2.1 ± 0.3; post = 1.3 ± 0.7; P = 0.02), but FMD was unchanged (pre = 6.9 ± 3.7%; post = 7.0 ± 4.2%). No changes were observed following MI-ACT. A trend for reduced left atrial volume index was observed following HIIT compared with MI-ACT (-3.3 ± 6.6 vs. +5.8 ± 10.7 ml/m(2); P = 0.06). In HFpEF patients 4 wk of HIIT significantly improved V̇o₂peak and left ventricular diastolic dysfunction. HIIT may provide a more robust stimulus than MI-ACT for early exercise training adaptations in HFpEF.

The effect of exercise training on biventricular myocardial strain in heart failure with preserved ejection fraction

“…3 High‐intensity interval training resulted in significant improvements in RV‐GLS (pre = −18.4 ± 3.2% vs. post = −21.4 ± 1.7%; P  = 0.02; d  = 0.95; Table 2). No significant between‐group differences were noted for RV‐GLS ( P  > 0.2) although moderate between‐group effect sizes were noted ( d b  = 0.60; Table 2).…”

“…We have previously demonstrated improvements in LV diastolic function following high‐intensity interval training (HIIT) 3. However, recently published data with regard to acute and chronic effects of high‐intensity interval exercise are mixed with some data suggesting worsening of strain characteristics in otherwise healthy individuals4, 5 and no adverse changes in individuals with heart failure and reduced ejection fraction 6, 7.…”

High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in the Prevention/Management of Cardiovascular Disease

“…23 More recently, however, high-intensity interval training (HIIT) has raised considerable interest in the clinical context as a potential alternative to MICT for reducing the risk of CVD as well as improving the health and wellbeing outcomes of those affected. [26][27][28][29][30][31][32][33][34] It may be thought that the higher intensity of exercise as with HIIT may increase the risk of an acute cardiovascular event in comparison to MICT. However, HIIT applied in the settings discussed in this paper has been shown to be low risk and is adapted to maintain safety (See safety issues/clinical perspectives section).…”

“…A growing body of research suggests that HIIT has the capacity to induce changes in numerous physiological and health-related markers to a similar or even superior extent to MICT. [35][36][37] As such, the use of HIIT has also been shown to be very beneficial for CVD cohorts, with particular relevance to improving numerous risk factors in cardiovascular disease cohorts, including cardiorespiratory fitness (VO2peak), [26][27][28][29] endothelial function, 30,31 left ventricular 32,33 and overall myocardial function, 34 and specific blood pressure dynamics, 34 to a similar, if not superior magnitude to MICT. What is perhaps most intriguing about these findings is that the volume of exercise and time spent training has generally been significantly lower with HIIT relative to MICT.…”

High-Intensity Interval Training Beneficial Effects in Diet-Induced Obesity in Mice: Adipose Tissue, Liver Structure, and Pancreatic Islets

“…HIIT significantly increases cardiorespiratory fitness by almost double that of MICT in patients with lifestyle-induced chronic diseases (Weston et al, 2014). In addition, HIIT may provide a more robust stimulus than MCT for early exercise training adaptations in patients with heart failure and preserved ejection fraction (Angadi et al, 2014), and HIIT significantly reduces body mass, blood pressure and oxidative stress in menopause (Pimenta et al, 2015).…”