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The impact of high-intensity interval training in CAD patients

Comment by Dominique Hansen, Hasselt University, Diepenbeek, Belgium, EACPR member

The higher the better? Interval training intensity in coronary heart disease.
Moholdt et al.
e-pub ahead of print, Journal of Science and Medicine in Sport, 9 August 2013; doi: 10.1016/j.jsams.2013.07.007
Cardiovascular Rehabilitation

It is well established that exercise tolerance is of great importance in the primary and secondary prevention of coronary artery disease (CAD). A large number of studies indicate that a greater exercise tolerance, as quantified by peak oxygen uptake (VO2peak) or maximum oxygen uptake (VO2max), and /or an increase in VO2peak, is related to improved life expectancy. As a result, in the rehabilitation of CAD patients we often aim to implement exercise interventions with a significant impact on VO2peak.

During the last decade, a great focus has been put on the impact of exercise intensity in the rehabilitation of CAD. In this regard, the impact of high-intensity interval training has been studied more frequently.

Most studies seem to indicate that the implementation of high-intensity interval training is more effective to improve VO2peak, as opposed to isocaloric traditional continuous moderate-intensity exercise training in patients with CAD.

In a recent publication from Moholdt et al. it was found that within a cohort of revascularised CAD patients (n=112) without chronic heart failure who followed a high-intensity interval training program, the elicited exercise intensity within a relatively narrow range (between 85-95% of maximal heart rate) still correlated significantly with changes in VO2peak (r=0.019).

Those patients who exercised at higher intensities (>92% of maximal heart rate) during the high-intensity exercise bouts experienced greater improvements in VO2peak, as compared to those patients who exercise at lower intensities (<88% of maximal heart rate). The number of exercise sessions, age, and baseline VO2peak did not affect this result.

This study is the first to study the impact of different exercise intensity during high-intensity interval training and provides further support for the importance of exercise intensity on changes in VO2peak in CAD patients following rehabilitation programs.

According to the authors, however, more data are needed to verify the medical safety of high-intensity interval in CAD patients, especially in moderate-to-high risk patients. On the other hand, it is argued that this type of exercise training is well applicable in older and/or less fit patients as well, and seems related to good exercise therapy adherence.