Improvements in Heart Rate Recovery Among Women After Cardiac Rehabilitation Completion

Abstract

Background Heart rate recovery (HRR) after exercise cessation is thought to reflect the rate of reestablishment of parasympathetic tone. Relatively little research has focused on improved HRR in women after completing cardiac rehabilitation (CR) exercise training. Objective We examined the influence of exercise training on HRR in women completing a traditional CR program and in women completing a CR program tailored for women. Methods A 2-group randomized clinical trial compared HRR between 99 women completing a traditional 12-week CR program and 137 women completing a tailored CR program. Immediately upon completion of a symptom-limited graded exercise test, HRR was measured at 1 through 6 minutes. Results Compared with baseline, improvement in 1-minute HRR (HRR1) was similar (P = 0.777) between the tailored (mean [SD], 17.5 [11] to 19.1 [12]) and the traditional CR program (15.7 [9.0] to 16.9 [9.5]). The amount of change in the 2-minute HRR (HRR2) for the tailored (30 [13] to 32.8 [14.6]) and traditional programs (28.3 [12.8] to 31.2 [13.7]) also was not different (P = 0.391). Similar results were observed for HRR at 3 through 6 minutes. Given these comparable improvements of the 2 programs, in the full cohort, the factors independently predictive of post-CR HRR1, in rank order, were baseline HRR1 (part correlation, 0.35; P < 0.001); peak exercise capacity, estimated as metabolic equivalents (METs; 0.24, P < 0.001); anxiety (−0.17, P = 0.001); and age (−0.13, P = 0.016). The factors independently associated with post-CR HRR2 were baseline HRR2 (0.44, P < 0.001), peak METs (0.21, P < 0.001), and insulin use (−0.10, P = 0.041). Conclusions One to 6 minutes after exercise cessation, HRR was significantly improved among the women completing both CR programs. The modifiable factors positively associated with HRR1 included peak METs and lower anxiety, whereas HRR2 was associated with insulin administration and peak METs. Additional research on HRR after exercise training in women is warranted.

Optimal Gender-Specific Strategies for the Secondary Prevention of Heart Disease in Women

“…Two out of three studies had clearly defined primary outcomes, such as adherence to secondary prevention guidelines 25 , and program adherence 26 . Secondary outcomes included statistically significant improvements in metabolic syndrome measures and inflammatory biomarkers 29 , depression 30,31 , anxiety 31 health perception 32 , heart rate recovery 28 , quality of life 31,33,34 , exercise capacity 35 , functional capacity 26 , CR model adherence, satisfaction and preferences 36 , heart health behaviours 31 , social support 31 (refer to Characteristics of Included Studies in Supplementary Table S2).…”

“…Usual care or comparison groups were clearly defined in all three studies. They included encouragement to attend CR and exercise three times per week 25 ; or a mixed gender exercise training program 26,28 .…”

Exercise Intensity in Patients with Cardiovascular Diseases: Systematic Review with Meta-Analysis

“…Exercise intensity appears to influence the number of cardioprotective benefits achieved from aerobic exercise [ 15 , 16 ]. The current consensus recommends that exercise intensity prescribed for patients with CVD should be approximately 60% of the maximal heart rate (MHR), 50% of the heart rate reserve (HRR), or 12–13 on the Borg scale.…”

“…Additionally, high-intensity protocols (85–100% of VO 2 peak) appear to be of particular interest to scientists, considering their application in patients with CVD based on the effects on the cardiorespiratory and muscle systems [ 7 ]. High-intensity protocols elicit a greater training stimulus than moderate continuous exercise in improving maximal aerobic capacity [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. In addition, high-intensity exercise appears to improve the limiting factors of VO 2 peak, and VO 2 peak itself has been found to be more effective in improving cardiovascular risk factors than moderate-intensity exercise [ 17 , 19 ].…”

“…Training sessions based on moderate-intensity continuous exercise have shown improvements in HRR after eight weeks [ 20 ] and after 12 weeks [ 21 , 22 ]. Moderate- to high-intensity continuous exercise (6 and 12 MET, corresponding to 21 and 42 mL-kg −1 -min −1 of VO 2 peak) has also been shown to reduce all-cause mortality in healthy individuals, independent of activity duration [ 7 ], and reduce the risk of heart disease [ 15 ], supporting the need to further investigate the potential health effects of protocols based on higher intensities. Therefore, during the last two decades, several studies have demonstrated that high-intensity exercise protocols induce more beneficial cardiovascular adaptations in patients with mild-to-severe heart disease when compared to moderate-intensity exercise protocols [ 8 , 17 , 18 , 19 ].…”