What is the effect of aerobic exercise intensity on cardiorespiratory fitness in those undergoing cardiac rehabilitation? A systematic review with meta-analysis

Mitchell, Braden L; Lock, Merilyn; Davison, Kade; Parfitt, Gaynor; Buckley, John; Eston, Roger G.

doi:10.1136/bjsports-2018-099153

Cited by 38 publications

(35 citation statements)

References 65 publications

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“…19 This is may explain some of the heterogeneity of responses of cardiorespiratory fitness to CR in studies with similar exercise prescriptions. 46 Our data demonstrate that the application of an exercise prescription identical to that used in the RAMIT can result in a highly variable but generally low dose of exercise (figure 2). Furthermore, this intervention does not appear adequate to improve vascular health or habitual PA: key factors in secondary CVD prevention.…”

Section: Open Accessmentioning

confidence: 59%

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UK cardiac rehabilitation fit for purpose? A community-based observational cohort study

et al. 2020

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ObjectivesThis study aimed to characterise the exercise performed in UK cardiac rehabilitation (CR) and explore relationships between exercise dose and changes in physiological variables.DesignObservational cohort study.SettingOutpatient community-based CR in Leeds, UK. Rehabilitation sessions were provided twice per week for 6 weeks.ParticipantsSixty patients (45 male/15 female 33–86 years) were recruited following referral to local outpatient CR.Outcome measuresThe primary outcome was heart rate achieved during exercise sessions. Secondary outcomes were measured before and after CR and included incremental shuttle walk test (ISWT) distance and speed, blood pressure, brachial artery flow-mediated dilatation, carotid arterial stiffness and accelerometer-derived habitual physical activity behaviours.ResultsThe mean % of heart rate reserve patients exercised at was low and variable at the start of CR (42%±16 %) and did not progress by the middle (48%±17 %) or end (48%±16 %) of the programme. ISWT performance increased following CR (440±150 m vs 633±217 m, p<0.001); however, blood pressure, body weight, endothelial function, arterial stiffness and habitual physical activity behaviours were unchanged following 6 weeks of CR (p>0.05).ConclusionPatients in a UK CR cohort exercise at intensities that are variable but generally low. The exercise dose achieved using this CR format appears inadequate to impact markers of health. Attending CR had no effect on physical activity behaviours. Strategies to increase the dose of exercise patients achieve during CR and influence habitual physical activity behaviours may enhance the effectiveness of UK CR.

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Section: Open Accessmentioning

confidence: 59%

“… 19 This is may explain some of the heterogeneity of responses of cardiorespiratory fitness to CR in studies with similar exercise prescriptions. 46 …”

Section: Discussionmentioning

confidence: 99%

UK cardiac rehabilitation fit for purpose? A community-based observational cohort study

et al. 2020

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“…Improvements in fitness levels have been described in central-based CR programs and, more recently, in home-based settings. [ 27 , 28 ]…”

Section: Discussionmentioning

confidence: 99%

Effect of home-based high-intensity interval training using telerehabilitation among coronary heart disease patients

et al. 2020

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Introduction: Cardiovascular diseases are the world's most common causes of morbidity and mortality in the population, including Central Europe. Cardiac rehabilitation (CR) is an effective preventive approach that includes several core components. Physical training is identified as an integral and essential part of CR. Training can positively influence several cardiovascular risk factors in people diagnosed with coronary heart disease and prevent them from clinical events. Our study aims to research the method of high-intensity interval training (HIIT) in a home environment using telerehabilitation. We assume that the HIIT form of telerehabilitation, using a heart rate monitor as a tool for backing up training data, can improve cardiorespiratory fitness and lead to higher peak oxygen uptake than the traditional moderate-intensity continuous training (MICT). Methods: This study is designed as a monocentral randomized controlled trial at University Hospital Brno in the Czech Republic. After the coronary heart event, the suitable patients will be randomized (1:1 ratio) and separated into 2 groups: the experimental HIIT group and the control MICT group. Both groups undergo a 12-week telerehabilitation with a 1-year follow-up period. Study participants will be telemonitored during physical training in their home environment via a heart rate monitor and a web platform. Once a week, the patients will give their feedback and motivation by a telephone call. The primary outcome observed will be the effect of intervention expressed by changes in cardiorespiratory fitness. Secondary outcomes will be the health-related quality of life, anxiety, training adherence, body composition, safety, and satisfaction. Discussion: The HIIT is widely researched predominantly in a center-based supervised form. Our study differs from others by the use of telemedicine and smart technologies in home-based settings. Previous home-based cardiac telerehabilitation studies have focused primarily on MICT, which has demonstrated feasibility, and results have shown similar improvements as center-based CR. There is a presumption that HIIT may be superior to MICT. However, it can be complicated to self-dose the method in the home environment. Investigators expect that HIIT research will provide insight into the possibilities of telemedicine feasibility, effect, and limitations of coronary heart disease patients’ use at low to moderate cardiovascular risk.

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“…The need for clearer guidelines, however, may only be indicated if training intensity plays an important role for the improvement in exercise capacity. A recent meta-analysis found significantly greater, though not clinically meaningful, improvements in peak _ VO 2 with vigorous exercise interventions compared to interventions with lower intensities in a general CR population [7]. Despite the fact that guidelines recommend exercise above the VT 1 , low intensities may also have a beneficial effect on exercise capacity, especially in cardiac patients with a significantly reduced pre-training exercise capacity [4] and patients with chronic heart failure [8].…”

Section: Introductionmentioning

confidence: 99%

Training intensity and improvements in exercise capacity in elderly patients undergoing European cardiac rehabilitation – the EU-CaRE multicenter cohort study

et al. 2020

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Objectives Guidelines for exercise intensity prescription in Cardiac Rehabilitation (CR) are inconsistent and have recently been discussed controversially. We aimed (1) to compare training intensities between European CR centres and (2) to assess associations between training intensity and improvement in peak oxygen consumption (V˙O2) in elderly CR patients. Methods Peak V˙O2, heart rate and work rate (WR) at the first and second ventilatory thresholds were measured at start of CR. Training heart rate was measured during three sessions spread over the CR. Multivariate models were used to compare training characteristics between centres and to assess the effect of training intensity on change in peak V˙O2. Results Training intensity was measured in 1011 out of 1633 EU-CaRE patients in 7 of 8 centers and the first and secondary ventilatory threshold were identified in 1166 and 817 patients, respectively. The first and second ventilatory threshold were found at 44% (SD 16%) and 78% (SD 9%) of peak WR and 78% (SD 9%) and 89% (SD 5%) of peak heart rate, respectively. Training intensity and session duration varied significantly between centres but change in peak V˙O2 over CR did not. Training above the first individual threshold (β 0.62, 95% confidence interval [0.25–1.02]) and increase in training volume per hour (β 0.06, 95%CI [0.01–0.12]) were associated with a higher change in peak V˙O2. Conclusion While training intensity and volume varied greatly amongst current European CR programs, changes in peak V˙O2 were similar and the effect of training characteristics on these changes were small.

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What is the effect of aerobic exercise intensity on cardiorespiratory fitness in those undergoing cardiac rehabilitation? A systematic review with meta-analysis

Abstract: Prospero CRD42016035638.

Cited by 38 publications

References 65 publications

UK cardiac rehabilitation fit for purpose? A community-based observational cohort study

UK cardiac rehabilitation fit for purpose? A community-based observational cohort study

Effect of home-based high-intensity interval training using telerehabilitation among coronary heart disease patients

Training intensity and improvements in exercise capacity in elderly patients undergoing European cardiac rehabilitation – the EU-CaRE multicenter cohort study

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