High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes (HIIT or MISS UK): study protocol for a multicentre randomised controlled trial and economic evaluation

Abstract

IntroductionCurrent international guidelines for cardiac rehabilitation (CR) advocate moderate-intensity exercise training (MISS, moderate-intensity steady state). This recommendation predates significant advances in medical therapy for coronary heart disease (CHD) and may not be the most appropriate strategy for the ‘modern’ patient with CHD. High-intensity interval training (HIIT) appears to be a safe and effective alternative, resulting in greater improvements in peak oxygen uptake (VO2 peak). To date, HIIT trials have predominantly been proof-of-concept studies in the laboratory setting and conducted outside the UK. The purpose of this multicentre randomised controlled trial is to compare the effects of HIIT and MISS training in patients with CHD attending UK CR programmes.Methods and analysisThis pragmatic study will randomly allocate 510 patients with CHD to 8 weeks of twice weekly HIIT or MISS training at 3 centres in the UK. HIIT will consist of 10 high-intensity (85–90% peak power output (PPO)) and 10 low-intensity (20–25% PPO) intervals, each lasting 1 min. MISS training will follow usual care recommendations, adhering to currently accepted UK guidelines (ie, >20 min continuous exercise at 40–70% heart rate reserve). Outcome measures will be assessed at baseline, 8 weeks and 12 months. The primary outcome for the trial will be change in VO2 peak as determined by maximal cardiopulmonary exercise testing. Secondary measures will assess physiological, psychosocial and economic outcomes.Ethics and disseminationThe study protocol V.1.0, dated 1 February 2016, was approved by the NHS Health Research Authority, East Midlands—Leicester South Research Ethics Committee (16/EM/0079). Recruitment will start in August 2016 and will be completed in June 2018. Results will be published in peer-reviewed journals, presented at national and international scientific meetings and are expected to inform future national guidelines for exercise training in UK CR.Trial registration numberNCT02784873; pre-results.

The effects of low-volume high-intensity interval training and circuit training on maximal oxygen uptake

“…Comparable improvements in V O 2max and the AT have been shown following low-volume HIIT, with increases in maximum oxygen pulse ( V O 2 /HR) also observed [16,18,19]. However, there is limited evidence directly comparing both training methods across a range of CRF markers, as such it is unknown which approach is most beneficial [20,21].…”

Is exercise-based cardiac rehabilitation effective? A systematic review and meta-analysis to re-examine the evidence

“…In the era of contemporary medical management, higher intensity exercise protocols might be appropriate and effective. 62 …”

High INtensity Interval Training In pATiEnts with intermittent claudication (INITIATE): protocol for a multicentre, proof-of-concept, prospective interventional study

“…This study will adapt a pragmatic and flexible HIIT protocol, based on a similar protocol currently being investigated in those with coronary artery disease. 33 Patients will attend three HIIT sessions per week for a period of 6 weeks, totalling 18 sessions. If participants miss sessions, the intervention period can be extended for up to two additional weeks to allow these sessions to be completed.…”