Short-Term Water- and Land-Based Exercise Training Comparably Improve Exercise Capacity and Vascular Function in Patients After a Recent Coronary Event: A Pilot Randomized Controlled Trial

Abstract

Background We hypothesized that a 2-week twice daily aquatic endurance plus calisthenics exercise training program: (i) increases aerobic exercise capacity (peak oxygen uptake/ O 2 peak), (ii) improves endothelium-dependent flow-mediated vasodilation (FMD), and (iii) reduces circulating markers of low-grade inflammation and hemostasis, as compared to land-based endurance plus calisthenics exercise training or no exercise in patients undergoing short-term residential cardiac rehabilitation after a recent coronary artery disease (CAD) event. Methods Patients with a recent myocardial infarction or revascularization procedure were randomized into two interventional groups and a control group. The interventional groups underwent supervised aerobic endurance plus calisthenics exercise training either in thermo-neutral water or on land at moderate intensity (60–80% of the peak heart rate achieved during symptom-limited graded exercise testing) for 30 min twice daily for 2 weeks (i.e., 24 sessions). The control group was deferred from supervised exercise training for the 2-week duration of the intervention, but was advised low-to-moderate intensity physical activity at home while waiting. At baseline and after the intervention period, all participants underwent estimation of aerobic exercise capacity, brachial artery flow-mediated dilatation (FMD, measured ultrasonographically at rest and during reactive hyperemia after 4.5 min of forearm cuff inflation), markers of cardiac dysfunction (NT-proBNP), inflammation (hsCRP, IL-6, IL-8, IL-10), cell adhesion (ICAM, P-selectin), and hemostasis (fibrinogen, D-dimer). Results A total of 89 patients (mean age 59.9 ± 8.2 years, 77.5% males, O 2 peak at baseline 14.8 ± 3.5 ml kg -1 min -1 ) completed the study. Both exercise modalities were safe (no significant adverse events recorded) and associated with a significant improvement in O 2 peak as compared to controls: age and baseline O 2 peak-adjusted end-of-study O 2 peak increased to 16.7 (95% CI 16.0–17.4) ml kg -1 min -1 with land-based training ( p < 0.001 for change from baseline) and to 18.6 (95% CI 17.9–19.3) ml kg -1 min -1 with water-based training ( p < 0.001 for change from baseline), but not in controls (14.9 ml kg -1 min -1 ; 95% CI 14.2–15.6; p = 0.775 for change from baseline). FMD also increased in both intervention groups (from 5.5 to 8.8%, p ...

The Association Between Cardiovascular Function, Measured as FMD and CVC, and Long-Term Aquatic Exercise in Older Adults (ACELA Study): A Cross-Sectional Study

“…These findings suggest that aquatic exercise could have similar CVD risk reduction benefits to land-based exercise in this population. Although this study is a cross-sectional study and outcomes were not measured over time, our findings are in agreement with work by others ( Sherlock et al, 2014 ; Cugusi et al, 2019 ; Vasić et al, 2019 ). This study provides support for the CVD risk-reduction role of aquatic exercise and highlights a potential next step, which would be developing a cohort study to measure changes in circulatory function over time.…”

“…Our study indicates that long-term, water-based exercise in older individuals can offer improvements in macrovascular function parameters, which are associated with CVD risk reduction, such as %FMD (Klonizakis et al, 2017). This happens in a manner similar to what is observed in the short-term, in clinical populations such as people with coronary heart disease (Vasić et al, 2019) and osteoarthritis (Alkatan et al, 2016). Our work extends the findings of other research groups on clinical (e.g., peripheral artery disease) (Park et al, 2019) and general (Sherlock et al, 2014;Reichert et al, 2018) populations, which have used alternative measures known to be related to CVD risk, such as arterial stiffness (assessed by Pulse Wave Velocity) (Sherlock et al, 2014) and blood pressure (Reichert et al, 2018), suggesting notable risk reductions, similar to that observed following land-based exercise (Di Francescomarino et al, 2009).…”

“…Most of the CVD-related studies conducted on the effects of aquatic exercise on older people, have been focused on people with coronary heart disease and heart failure ( Mourot et al, 2009 ; Cugusi et al, 2019 ; Vasić et al, 2019 ), with little work having been completed on the longer-term effects on a general, “older-but-healthy” population ( Igarashi and Nogami, 2018 ). This is an important knowledge gap, considering that a number of researchers debate the positive cardio-protective influence that aquatic exercise may have on our bodies ( Tanaka, 2009 ; Lazar et al, 2013 ).…”

“…Nevertheless, this is no surprise, looking closely to our findings: FMD, in which we observed the biggest differences between older people following aquatic exercise regimes and sedentary older adults, is known to be endothelium-dependent, NO-mediated. Considering that longer-term aquatic exercise is associated with a reduction in the markers of low-grade inflammation ( Alkatan et al, 2016 ), the most plausible mechanism behind the observed increase in NO bioavailability, is that this was achieved through a reversal of the inflammation affected endothelial dysfunction, possible in combination with hemodynamic changes triggered by long-term aquatic exercise ( Vasić et al, 2019 ). As we observed similar differences at microcirculatory level, the effect is most likely happening on a systemic manner, which is a novel finding worthy of further investigation (and confirmation) in future studies, exploring both micro- and macro-circulation.…”

Exercise-mediated adaptations in vascular function and structure: Beneficial effects in coronary artery disease

“…Patients with CAD following a 6-month aerobic exercise training program had higher peak response to acetylcholine when they performed high-frequency exercise compared with low frequency cardiac rehabilitation programs[ 130 ]. In addition, a 2-wk twice daily aquatic endurance plus calisthenics exercise training program in patients with a recent myocardial infarction or revascularization intervention improved both aerobic exercise capacity and vascular endothelial function[ 131 ]. Kollet et al [ 132 ] conducted a randomized pilot study and enrolled post-myocardial infarction patients undergoing PCI who performed a 30-min moderate-intensity aerobic training program.…”