Feasibility of high‐intensity interval training in patients with left ventricular assist devices: a pilot study

Abstract

Aims Patients with left ventricular assist device (LVAD) suffer from persistent exercise limitation despite improvement of their heart failure syndrome. Exercise training (ET) programmes to improve aerobic capacity have shown modest efficacy. High‐intensity interval training (HIIT), as an alternative to moderate continuous training, has not been systematically tested in this population. We examine the feasibility of a short, personalized HIIT programme in patients with LVAD and describe its effects on aerobic capacity and left ventricular remodelling. Methods and results Patients on durable LVAD support were prospectively enrolled in a 15‐session, 5 week HIIT programme. Turndown echocardiogram, Kansas City Cardiomyopathy Questionnaire, and cardiopulmonary exercise test were performed before and after HIIT. Training workloads for each subject were based on pretraining peak cardiopulmonary exercise test work rate (W). Percentage of prescribed training workload completed and adverse events were recorded for each subject. Fifteen subjects were enrolled [10 men, age = 51 (29–71) years, HeartMate II = 12, HeartMate 3 = 3, and time on LVAD = 18 (3–64) months]. Twelve completed post‐training testing. HIIT was well tolerated, and 90% (inter‐quartile range: 78, 99%) of the prescribed workload (W) was completed with no major adverse events. Improvements were seen in aV̇O2 at ventilatory threshold [7.1 (6.5, 9.1) to 8.5 (7.7, 9.3) mL/kg/min, P = 0.04], work rate at ventilatory threshold [44 (14, 54) to 55 (21, 66) W, P = 0.05], and left ventricular end‐diastolic volume [168 (144, 216) to 159 (124, 212) mL, n = 7, P = 0.02]. HIIT had no effect on maximal oxygen consumption (V̇O2peak) or Kansas City Cardiomyopathy Questionnaire score. Conclusions Cardiopulmonary exercise test‐guided HIIT is feasible and can improve submaximal aerobic capacity in stable patients with chronic LVAD support. Further studies are needed on its effects on the myocardium and its potential role in cardiac rehabilitation programmes.

Exercise oscillatory ventilation in patients with advanced heart failure with and without left ventricular assist device

“…Counteracting the natural decline of VO 2peak with age by adequate physical activity positively modifies the cardiovascular risk profile 30 . Although most exercise studies with LVAD patients prescribed aerobic activities and demonstrated patient safety, 31 short‐term improvement of VO 2peak by applying more intense exercise has also been demonstrated 32,33 . However, it may be argued that especially LVAD/EOV+ may be put at risk for pulmonary congestion in case of more intense and longer bouts of exercise, such as the “Norwegian model” with a 4x4min interval up to 90% of maximal heart rate 34,35 .…”

Rethinking Rehabilitation

“…68 Exercise training in this population has shown to be beneficial for both improvements in exercise capacity and patient-reported health outcomes (Table 4). [68][69][70][71][72][73][74][75] However, despite this, and despite the fact that the Centers for Medicare & Medicaid Services now covers CR in patients on LVAD support under HF, only 42% of eligible patients in this population utilize CR. 76…”

“…35 In this population, HIIT has shown promise with some preliminary data. 73,84 However, more research is needed on the safety of HIIT in this population and should only be considered in select patients, based upon factors such as age, balance, and overall functional abilities.…”

Vascular Inflammation as a Therapeutic Target in COVID-19 “Long Haulers”: HIITing the Spot?

“…Hence, a recent, admittedly small retrospective study of 28 discharged COVID-19 survivors reported that rehabilitation triggered by HIIT, with endurance training at the maximum tolerated exercise load was both safe and feasible (49). To this end HIIT has successfully been implemented as a rehabilitation strategy in other "high risk" populations, as demonstrated in larger studies on patients at risk or with prevalent ischaemic heart disease, heart failure, chronic obstructive pulmonary disease, cystic fibrosis, and asthma with effects on parameters such as cardiorespiratory fitness (VO 2 peak) and exercise capacity with few reports of severe adverse events, even in patients with left ventricular assist devices (36,41,(50)(51)(52)(53)(54)(55)(56)(57)(58)(59). The rate of cardiovascular complications has been reported of 1 per 23,182 h of high-intensity exercise (51) and later studies have confirmed that HIIT is safe in patients with cardiovascular disease (53).…”