High-Intensity Interval Training in Patients with Heart Failure with Reduced Ejection Fraction

Øyvind Ellingsen; Martin Halle; Viviane Conraads; Asbjørn Støylen; Håvard Dalen; Charles Delagardelle; Alf Inge Larsen; Torstein Hole; Alessandro Mezzani; Emeline M. Van Craenenbroeck; Vibeke Videm; Paul Beckers; Jeffrey W. Christle; Ephraim Winzer; Norman Mangner; Felix Woitek; Robert Höllriegel; Axel Pressler; Tea Monk-Hansen; Martin Snoer; Patrick Feiereisen; Torstein Valborgland; John Kjekshus; Rainer Hambrecht; Stephan Gielen; Trine Karlsen; Eva Prescott; Axel Linke

doi:10.1161/CIRCULATIONAHA.116.022924

High-Intensity Interval Training in Patients with Heart Failure with Reduced Ejection Fraction

Øyvind Ellingsen^*, Martin Halle, Viviane Conraads, Asbjørn Støylen, Håvard Dalen, Charles Delagardelle, Alf Inge Larsen, Torstein Hole, Alessandro Mezzani, Emeline M. Van Craenenbroeck, Vibeke Videm, Paul Beckers, Jeffrey W. Christle, Ephraim Winzer, Norman Mangner, Felix Woitek, Robert Höllriegel, Axel Pressler, Tea Monk-Hansen, Martin SnoerPatrick Feiereisen, Torstein Valborgland, John Kjekshus, Rainer Hambrecht, Stephan Gielen, Trine Karlsen, Eva Prescott, Axel Linke

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin

162 Citationer (Scopus)

60 Downloads (Pure)

Abstract

Background: Small studies have suggested that high-intensity interval training (HIIT) is superior to moderate continuous training (MCT) in reversing cardiac remodeling and increasing aerobic capacity in patients with heart failure with reduced ejection fraction. The present multicenter trial compared 12 weeks of supervised interventions of HIIT, MCT, or a recommendation of regular exercise (RRE). Methods: Two hundred sixty-one patients with left ventricular ejection fraction ≤35% and New York Heart Association class II to III were randomly assigned to HIIT at 90% to 95% of maximal heart rate, MCT at 60% to 70% of maximal heart rate, or RRE. Thereafter, patients were encouraged to continue exercising on their own. Clinical assessments were performed at baseline, after the intervention, and at follow-up after 52 weeks. Primary end point was a between-group comparison of change in left ventricular end-diastolic diameter from baseline to 12 weeks. Results: Groups did not differ in age (median, 60 years), sex (19% women), ischemic pathogenesis (59%), or medication. Change in left ventricular end-diastolic diameter from baseline to 12 weeks was not different between HIIT and MCT (P=0.45); left ventricular end-diastolic diameter changes compared with RRE were -2.8 mm (-5.2 to -0.4 mm; P=0.02) in HIIT and -1.2 mm (-3.6 to 1.2 mm; P=0.34) in MCT. There was also no difference between HIIT and MCT in peak oxygen uptake (P=0.70), but both were superior to RRE. However, none of these changes was maintained at follow-up after 52 weeks. Serious adverse events were not statistically different during supervised intervention or at follow-up at 52 weeks (HIIT, 39%; MCT, 25%; RRE, 34%; P=0.16). Training records showed that 51% of patients exercised below prescribed target during supervised HIIT and 80% above target in MCT. Conclusions: HIIT was not superior to MCT in changing left ventricular remodeling or aerobic capacity, and its feasibility remains unresolved in patients with heart failure.

Originalsprog	Engelsk
Tidsskrift	Circulation
Vol/bind	135
Udgave nummer	9
Sider (fra-til)	839-849
Antal sider	11
ISSN	0009-7322
DOI	https://doi.org/10.1161/CIRCULATIONAHA.116.022924
Status	Udgivet - feb. 2017

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10.1161/CIRCULATIONAHA.116.022924Licens: CC BY-NC-ND

839.fullForlagets udgivne version, 2,25 MBLicens: CC BY-NC-ND

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Ellingsen, Ø., Halle, M., Conraads, V., Støylen, A., Dalen, H., Delagardelle, C., Larsen, A. I., Hole, T., Mezzani, A., Van Craenenbroeck, E. M., Videm, V., Beckers, P., Christle, J. W., Winzer, E., Mangner, N., Woitek, F., Höllriegel, R., Pressler, A., Monk-Hansen, T., ... Linke, A. (2017). High-Intensity Interval Training in Patients with Heart Failure with Reduced Ejection Fraction. Circulation, 135(9), 839-849. https://doi.org/10.1161/CIRCULATIONAHA.116.022924

Ellingsen, Ø, Halle, M, Conraads, V, Støylen, A, Dalen, H, Delagardelle, C, Larsen, AI, Hole, T, Mezzani, A, Van Craenenbroeck, EM, Videm, V, Beckers, P, Christle, JW, Winzer, E, Mangner, N, Woitek, F, Höllriegel, R, Pressler, A, Monk-Hansen, T, Snoer, M, Feiereisen, P, Valborgland, T, Kjekshus, J, Hambrecht, R, Gielen, S, Karlsen, T, Prescott, E & Linke, A 2017, 'High-Intensity Interval Training in Patients with Heart Failure with Reduced Ejection Fraction', Circulation, bind 135, nr. 9, s. 839-849. https://doi.org/10.1161/CIRCULATIONAHA.116.022924

@article{6e525ad988c347cb8ebf860a52071a15,

title = "High-Intensity Interval Training in Patients with Heart Failure with Reduced Ejection Fraction",

abstract = "Background: Small studies have suggested that high-intensity interval training (HIIT) is superior to moderate continuous training (MCT) in reversing cardiac remodeling and increasing aerobic capacity in patients with heart failure with reduced ejection fraction. The present multicenter trial compared 12 weeks of supervised interventions of HIIT, MCT, or a recommendation of regular exercise (RRE). Methods: Two hundred sixty-one patients with left ventricular ejection fraction ≤35% and New York Heart Association class II to III were randomly assigned to HIIT at 90% to 95% of maximal heart rate, MCT at 60% to 70% of maximal heart rate, or RRE. Thereafter, patients were encouraged to continue exercising on their own. Clinical assessments were performed at baseline, after the intervention, and at follow-up after 52 weeks. Primary end point was a between-group comparison of change in left ventricular end-diastolic diameter from baseline to 12 weeks. Results: Groups did not differ in age (median, 60 years), sex (19% women), ischemic pathogenesis (59%), or medication. Change in left ventricular end-diastolic diameter from baseline to 12 weeks was not different between HIIT and MCT (P=0.45); left ventricular end-diastolic diameter changes compared with RRE were -2.8 mm (-5.2 to -0.4 mm; P=0.02) in HIIT and -1.2 mm (-3.6 to 1.2 mm; P=0.34) in MCT. There was also no difference between HIIT and MCT in peak oxygen uptake (P=0.70), but both were superior to RRE. However, none of these changes was maintained at follow-up after 52 weeks. Serious adverse events were not statistically different during supervised intervention or at follow-up at 52 weeks (HIIT, 39%; MCT, 25%; RRE, 34%; P=0.16). Training records showed that 51% of patients exercised below prescribed target during supervised HIIT and 80% above target in MCT. Conclusions: HIIT was not superior to MCT in changing left ventricular remodeling or aerobic capacity, and its feasibility remains unresolved in patients with heart failure.",

keywords = "exercise, heart failure",

author = "{\O}yvind Ellingsen and Martin Halle and Viviane Conraads and Asbj{\o}rn St{\o}ylen and H{\aa}vard Dalen and Charles Delagardelle and Larsen, {Alf Inge} and Torstein Hole and Alessandro Mezzani and {Van Craenenbroeck}, {Emeline M.} and Vibeke Videm and Paul Beckers and Christle, {Jeffrey W.} and Ephraim Winzer and Norman Mangner and Felix Woitek and Robert H{\"o}llriegel and Axel Pressler and Tea Monk-Hansen and Martin Snoer and Patrick Feiereisen and Torstein Valborgland and John Kjekshus and Rainer Hambrecht and Stephan Gielen and Trine Karlsen and Eva Prescott and Axel Linke",

year = "2017",

month = feb,

doi = "10.1161/CIRCULATIONAHA.116.022924",

language = "English",

volume = "135",

pages = "839--849",

journal = "Circulation",

issn = "0009-7322",

publisher = "AHA/ASA",

number = "9",

}

TY - JOUR

T1 - High-Intensity Interval Training in Patients with Heart Failure with Reduced Ejection Fraction

AU - Ellingsen, Øyvind

AU - Halle, Martin

AU - Conraads, Viviane

AU - Støylen, Asbjørn

AU - Dalen, Håvard

AU - Delagardelle, Charles

AU - Larsen, Alf Inge

AU - Hole, Torstein

AU - Mezzani, Alessandro

AU - Van Craenenbroeck, Emeline M.

AU - Videm, Vibeke

AU - Beckers, Paul

AU - Christle, Jeffrey W.

AU - Winzer, Ephraim

AU - Mangner, Norman

AU - Woitek, Felix

AU - Höllriegel, Robert

AU - Pressler, Axel

AU - Monk-Hansen, Tea

AU - Snoer, Martin

AU - Feiereisen, Patrick

AU - Valborgland, Torstein

AU - Kjekshus, John

AU - Hambrecht, Rainer

AU - Gielen, Stephan

AU - Karlsen, Trine

AU - Prescott, Eva

AU - Linke, Axel

PY - 2017/2

Y1 - 2017/2

N2 - Background: Small studies have suggested that high-intensity interval training (HIIT) is superior to moderate continuous training (MCT) in reversing cardiac remodeling and increasing aerobic capacity in patients with heart failure with reduced ejection fraction. The present multicenter trial compared 12 weeks of supervised interventions of HIIT, MCT, or a recommendation of regular exercise (RRE). Methods: Two hundred sixty-one patients with left ventricular ejection fraction ≤35% and New York Heart Association class II to III were randomly assigned to HIIT at 90% to 95% of maximal heart rate, MCT at 60% to 70% of maximal heart rate, or RRE. Thereafter, patients were encouraged to continue exercising on their own. Clinical assessments were performed at baseline, after the intervention, and at follow-up after 52 weeks. Primary end point was a between-group comparison of change in left ventricular end-diastolic diameter from baseline to 12 weeks. Results: Groups did not differ in age (median, 60 years), sex (19% women), ischemic pathogenesis (59%), or medication. Change in left ventricular end-diastolic diameter from baseline to 12 weeks was not different between HIIT and MCT (P=0.45); left ventricular end-diastolic diameter changes compared with RRE were -2.8 mm (-5.2 to -0.4 mm; P=0.02) in HIIT and -1.2 mm (-3.6 to 1.2 mm; P=0.34) in MCT. There was also no difference between HIIT and MCT in peak oxygen uptake (P=0.70), but both were superior to RRE. However, none of these changes was maintained at follow-up after 52 weeks. Serious adverse events were not statistically different during supervised intervention or at follow-up at 52 weeks (HIIT, 39%; MCT, 25%; RRE, 34%; P=0.16). Training records showed that 51% of patients exercised below prescribed target during supervised HIIT and 80% above target in MCT. Conclusions: HIIT was not superior to MCT in changing left ventricular remodeling or aerobic capacity, and its feasibility remains unresolved in patients with heart failure.

AB - Background: Small studies have suggested that high-intensity interval training (HIIT) is superior to moderate continuous training (MCT) in reversing cardiac remodeling and increasing aerobic capacity in patients with heart failure with reduced ejection fraction. The present multicenter trial compared 12 weeks of supervised interventions of HIIT, MCT, or a recommendation of regular exercise (RRE). Methods: Two hundred sixty-one patients with left ventricular ejection fraction ≤35% and New York Heart Association class II to III were randomly assigned to HIIT at 90% to 95% of maximal heart rate, MCT at 60% to 70% of maximal heart rate, or RRE. Thereafter, patients were encouraged to continue exercising on their own. Clinical assessments were performed at baseline, after the intervention, and at follow-up after 52 weeks. Primary end point was a between-group comparison of change in left ventricular end-diastolic diameter from baseline to 12 weeks. Results: Groups did not differ in age (median, 60 years), sex (19% women), ischemic pathogenesis (59%), or medication. Change in left ventricular end-diastolic diameter from baseline to 12 weeks was not different between HIIT and MCT (P=0.45); left ventricular end-diastolic diameter changes compared with RRE were -2.8 mm (-5.2 to -0.4 mm; P=0.02) in HIIT and -1.2 mm (-3.6 to 1.2 mm; P=0.34) in MCT. There was also no difference between HIIT and MCT in peak oxygen uptake (P=0.70), but both were superior to RRE. However, none of these changes was maintained at follow-up after 52 weeks. Serious adverse events were not statistically different during supervised intervention or at follow-up at 52 weeks (HIIT, 39%; MCT, 25%; RRE, 34%; P=0.16). Training records showed that 51% of patients exercised below prescribed target during supervised HIIT and 80% above target in MCT. Conclusions: HIIT was not superior to MCT in changing left ventricular remodeling or aerobic capacity, and its feasibility remains unresolved in patients with heart failure.

KW - exercise

KW - heart failure

U2 - 10.1161/CIRCULATIONAHA.116.022924

DO - 10.1161/CIRCULATIONAHA.116.022924

M3 - Journal article

C2 - 28082387

AN - SCOPUS:85009822146

SN - 0009-7322

VL - 135

SP - 839

EP - 849

JO - Circulation

JF - Circulation

IS - 9

ER -

High-Intensity Interval Training in Patients with Heart Failure with Reduced Ejection Fraction

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