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

Abstract

Objectives. Evaluate the effects of a 6-month High Intensity Interval Training (HIIT) program on (1) functional capacity and health-related quality of life, (2) multiple blood biomarkers, (3) echocardiographic parameters, and (4) exercise performance, in patients in cardiac resynchronization therapy (CRT) stratified by the presence of atrial fibrillation (AF), targeting the following questions: (1) Does CRT provide similar benefits in patients in AF and sinus rhythm (SR)?; and (2) Does HIIT provides similar benefits in patients in AF and SR? Design. Estimates were available at baseline and 6 months after CRT implantation in 37 patients with heart failure. Patients were randomized after CRT to a 24-week HIIT group or to a usual care group (CON). In this sub-analysis, HIIT (AF ¼ 7; SR ¼ 11) and CON (AF ¼ 9; SR ¼ 10) were stratified by the presence of AF. Results. Patients in AF benefitted to a lesser degree from CRT in functional status than patients in SR (23.8-46.0%). However, HIIT induced superior improvements in patients in AF compared to CON (23.9-61.0%). Decreases in TNF-a (8.5-42.9%), BNP (15.3-34.6%) and left ventricular mass (9.6-26.2%) were only observed in patients in SR, whereas increases in peak oxygen uptake were only observed in patients in . HIIT improved exercise capacity (8.8-59.4%) in patients in SR. Conclusions. Patients in AF or SR undergoing CRT demonstrated distinct benefits from device implantation and from HIIT as an adjunctive therapeutic strategy. This suggests that both mainstay and adjunctive therapeutics may need to be managed differently in patients in AF and SR. ARTICLE HISTORY

The role of exercise training on cardiovascular peptides in patients with heart failure: A systematic review and meta-analysis

“…Of those 84 papers, 28 full-text articles met the inclusion criteria and 56 full-text articles were excluded with reasons as follows: (1) three articles with “letters to the editor”, (2) sixteen articles without control group, (3) four articles with hormone therapy in exercise group, (4) two articles with combined dietary supplementation plus exercise interventions in HF patients, (5) two articles were measured serum levels of BNP and NT-proBNP in obese hypertension patients and athletes, (6) six articles with measured serum levels of BNP and NT-proBNP at baseline, (7) ten articles without reporting BNP and NT-proBNP values in HF patients, (8) four articles without any exercise training interventions in HF patients, (9) seven article with acute exercise training interventions in HF patients, and (10) two articles did not have specific and enough information in exercise training intervention and BNP and NT-proBNP values in patients with HF, and no additional information was provided after contacting the corresponding author. Nine articles included two arms of exercise training intervention ( Abolahrari-Shirazi et al, 2018 ; Aksoy et al, 2015 ; Delagardelle et al, 2008 ; Giallauria et al, 2006-a ; Fu et al, 2013 ; Kawauchi et al, 2017 ; Melo et al, 2019 ; Sandri et al, 2012 ; Wisløff et al, 2007 ). A total of 28 articles (37 intervention arms), 26 aerobic intervention arms, 3 resistance intervention arms, and 8 concurrent intervention arms were included.…”

“…Types of exercise interventions including aerobic ( Abolahrari-Shirazi et al, 2018 ; Ahmad et al, 2014 ; Aksoy et al, 2015 ; Conraads et al, 2007 ; Eleuteri et al, 2013 ; Fu et al, 2013 ; Giallauria et al, 2006-a ; Giallauria et al, 2006-b ; Giallauria et al, 2008 ; Kobayashi et al, 2003 ; Maria-Sarullo et al, 2006 ; Masterson-Creber et al, 2015 ; Melo et al, 2019 ; Nilsson et al, 2010 ; Passino et al, 2006 ; Radi et al, 2017 ; Sandri et al, 2012 ; Wisløff et al, 2007 ; Yeh et al, 2004 ; Yeh et al, 2011 ), resistance ( Karavidas et al, 2008 ; Kawauchi et al, 2017 ), and concurrent ( Abolahrari-Shirazi et al, 2018 ; Adamopoulos et al, 2014 ; Conraads et al, 2004 ; Delagardelle et al, 2008 ; Marco et al, 2013 ; Prescott et al, 2009 ; Van Berendoncks et al, 2010 ) were studies included in our meta-analysis. The intensity ranges for the aerobic exercise interventions were performed from 40% VO2peak ( Abolahrari-Shirazi et al, 2018 ), 60% HRmax reserve ( Ahmad et al, 2014 ; Masterson-Creber et al, 2015 ), increased heart rate up to 20 bpm above resting ( Radi et al, 2017 ) and 15–18 on the Borg scale ( Nilsson et al, 2010 ) to 70% HRmax reserve ( Masterson-Creber et al, 2015 ), 80% VO2peak ( Fu et al, 2013 ; Prescott et al, 2009 ), 90% of the ventilator threshold level ( Conraads et al, 2004 ; Conraads et al, 2007 ; Eleuteri et al, 2013 ; Kobayashi et al, 2003 ; van Berendoncks et al, 2010 ) and as well as 90–95% HRmax ( Melo et al, 2019 ; Wisløff et al, 2007 ), with the most common exercise intensity 60–75% VO2peak ( Delagardelle et al, 2008 ; Fu et al, 2013 ; Giallauria et al, 2006-b , ...…”

“…The duration of exercise intervention protocols was varied from 1 month (4 weeks) ( Marco et al, 2013 ; Radi et al, 2017 ) to 12 months ( Masterson-Creber et al, 2015 ), with the most common period of 3 months (12 weeks) ( Adamopoulos et al, 2014 ; Ahmad et al, 2014 ; Eleuteri et al, 2013 ; Fu et al, 2013 ; Giallauria et al, 2006-a ; Giallauria et al, 2006-b ; Kobayashi et al, 2003 ; Maria-Sarullo et al, 2006 ; Wisløff et al, 2007 ; Yeh et al, 2004 ; Yeh et al, 2011 ). The duration of 6 weeks ( Karavidas et al, 2008 ), 7 weeks ( Abolahrari-Shirazi et al, 2018 ), 8 weeks ( Kawauchi et al, 2017 ; Prescott et al, 2009 ), 10 weeks ( Aksoy et al, 2015 ), 4 months ( Conraads et al, 2004 ; Delagardelle et al, 2008 ; Nilsson et al, 2010 ; Sandri et al, 2012 ; Van Berendoncks et al, 2010 ), 5 months ( Conraads et al, 2007 ), 6 months ( Giallauria et al, 2008 ; Melo et al, 2019 ), and 9 months ( Passino et al, 2006 ) were used in other studies. The exercise frequency was performed from 2 ( Melo et al, 2019 ; Nilsson et al, 2010 ; Prescott et al, 2009 ; Yeh et al, 2004 , 2011 ) to 7 ( Kawauchi et al, 2017 ; Marco et al, 2013 ) day/week, with the most common exercise frequency of 3 day/week ( Abolahrari-Shirazi et al, 2018 ; Adamopoulos et al, 2014 ; Ahmad et al, 2014 ; Aksoy et al, 2015 ; Conraads et al, 2004 ; Conraads et al, 2007 ; Delagardelle et al, 2008 ; Fu et al, 2013 ; Giallauria et al, 2006-a ; Giallauria et al, 2006-b ; Giallauria et al, 2008 ; Kobayashi et al, 2003 ; Maria-Sarullo et al, 2006 ; ...…”

“…It seems that an optimal reduction in serum levels of BNP and NT-proBNP may contribute to the beneficial role of exercise intervention on myocardial stretch function and cardio-metabolic risks in patients with HF ( Abolahrari-Shirazi et al, 2018 ; Adamopoulos et al, 2014 ; Conraads et al, 2004 ; Giallauria et al, 2006-a ; Giallauria et al, 2008 ; Maria-Sarullo et al, 2006 ; Masterson-Creber et al, 2015 ; Wisløff et al, 2007 ; Fu et al, 2013 ; Yeh et al, 2004 ), irrespective of overweight/obese status. A number of studies have reported that aerobic exercise intervention ( Fu et al, 2013 ; Yeh et al, 2004 ; Abolahrari-Shirazi et al, 2018 ; Giallauria et al, 2006-a ; Giallauria et al, 2008 ; Maria-Sarullo et al, 2006 ; Masterson-Creber et al, 2015 ; Melo et al, 2019 ; Wisløff et al, 2007 ) and as well as concurrent or combined aerobic and resistance interventions ( Abolahrari-Shirazi et al, 2018 ; Adamopoulos et al, 2014 ; Conraads et al, 2004 ) can reduce serum levels of BNP and NT-proBNP in patients with HF compared to the control group, while other studies have reported no change ( Karavidas et al, 2008 ; Kawauchi et al, 2017 ; Kobayashi et al, 2003 ; Yeh et al, 2011 ; Ahmad et al, 2014 ; Aksoy et al, 2015 ; Eleuteri et al, 2013 ; Giallauria et al, 2006-b ; Marco et al, 2013 ; Nilsson et al, 2010 ; Prescott et al, 2009 ; Sandri et al, 2012 ; Van Berendoncks et al, 2010 ). In this regard, there is the systematic review and meta-analysis-based evidence supporting a favorable effect in serum levels of BNP ( Smart and Steele, 2010 ; Smart et al, 2012 ) and NT-proBNP ( Smart and Steele, 2010 ; Smart et al, 2012 ; Pearson et al, 2018 ) in patients with HF.…”

Efficacy and Safety of Exercise Rehabilitation for Heart Failure Patients With Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis

“…Xavier et al reported patients in AF or sinus rhythm (SR)with a CRT device shown distinct benefits from CRT implantation and from exercise rehabilitation as an adjunctive treatment. This suggests that both mainstay and adjunctive therapy may need to be managed differently in patients with AF and SR (Melo et al, 2019). Further research is needed in the follow-up.…”