Impact of training intensity on cardiovascular responses in patients with coronary artery disease: extended systematic review and meta-analysis
DOI:
https://doi.org/10.47197/retos.v67.111325Keywords:
high intensity interval training, moderate intensity continuous training, exercise capacity, hs-CRP, lipid profilesAbstract
Introduction: intensity plays a major role for optimal benefits from exercise for coronary artery disease (CAD) patients. The superior effect between high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) is still uncertain.
Objective: To investigate the effect of different aerobic exercise intensities on exercise capacity, hs-CRP, and lipid profile among CAD patients.
Methodology: an extensive search was carried out in databases such as PubMed, Scopus, ClinicalKey and ScienceDirect (from the earliest data available to May 2024) for randomised controlled trials comparing HIIT and MICT among CAD patients. Mean differences and 95% confidence interval (CI) were calculated using random effect model in Revman version 5.4, a funnel plot was used for publication bias and heterogeneity was reported using I2 statistics.
Results: thirty-five studies were identified, which included 1879 CAD patients. HIIT resulted in a significant improvement in peak VO2 weighted mean difference (1.39 ml/kg/min, p <0.00001, 95% CI: 0.87 – 1.90, n = 1461, I2=0%) compared with MICT. Moreover, HIIT resulted in a significant improvement in total cholesterol (TC) weighted mean difference (-0.08, p = 0.03, 95% CI: -0.15 – -0.01, n = 738, I2=26%) compared with MICT. Both intensities improved in hs-CRP, LDL-C, HDL-C, and TG but there were no statistically significant differences.
Conclusions: this study confirmed that HIIT provides greater improvement in peak VO2 and may be an important part of an effective exercise program for CAD patients. More well-designed, randomised controlled trials are needed to establish the safety of HIIT via inflammatory markers.
References
Abdelhalem, A., Shabana, A., Onsy, A., & Gaafar, A. (2018). High intensity interval training exercise as a novel protocol for cardiac rehabilitation program in ischemic Egyptian patients with mild left ventricular dysfunction. The Egyptian Heart Journal, 70(4), 287-294. https://doi.org/10.1016/j.ehj.2018.07.008
Alfaddagh, A., Martin, S. S., Leucker, T. M., Michos, E. D., Blaha, M. J., Lowenstein, C. J., Jones, S. R., & Toth, P. P. (2020). Inflammation and cardiovascular disease: From mechanisms to therapeutics. American Journal of Preventive Cardiology, 4, 100130. https://doi.org/10.1016/j.ajpc.2020.100130
Arnold, S. V., Bhatt, D. L., Barsness, G. W., Beatty, A. L., Deedwania, P. C., Inzucchi, S. E., Kosiborod, M., Leiter, L. A., Lipska, K. J., & Newman, J. D. (2020). Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association. Circulation, 141(19), e779-e806. https://doi.org/10.1161/cir.0000000000000766
Baygutalp, F., Buzdağlı, Y., Ozan, M., Koz, M., Kılıç Baygutalp, N., & Atasever, G. (2021). Impacts of dif-ferent intensities of exercise on inflammation and hypoxia markers in low altitude. BioMed Cen-tral Sports Science, Medicine and Rehabilitation, 13, 1-9.
Benetti, M., Araujo, C. L. P. d., & Santos, R. Z. d. (2010). Cardiorespiratory fitness and quality of life at different exercise intensities after myocardial infarction. Arquivos Brasileiros de Cardiologia, 95, 399-404. https://doi.org/10.1590/s0066-782x2010005000089
Cerqueira, É., Marinho, D. A., Neiva, H. P., & Lourenço, O. (2020). Inflammatory effects of high and moderate intensity exercise—a systematic review. Frontiers in Physiology, 10, 1550. https://doi.org/10.3389/fphys.2019.01550
Conraads, V. M., Pattyn, N., De Maeyer, C., Beckers, P. J., Coeckelberghs, E., Cornelissen, V. A., Denollet, J., Frederix, G., Goetschalckx, K., & Hoymans, V. Y. (2015). Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the SAINTEX-CAD study. International Journal of Cardiology, 179, 203-210. https://doi.org/10.1016/j.ijcard.2014.10.155
de Souza e Silva, C. G., Buginga, G. C., de Souza e Silva, E. A., Arena, R., Rouleau, C. R., Aggarwal, S., Wilton, S. B., Austford, L., Hauer, T., & Myers, J. (2022). Prediction of mortality in coronary artery dis-ease: role of machine learning and maximal exercise capacity. Mayo Clinic Proceedings, 97(8), 1472-1482. https://doi.org/https://doi.org/10.1016/j.mayocp.2022.01.016
Denegri, A., & Boriani, G. (2021). High sensitivity C-reactive protein (hsCRP) and its implications in car-diovascular outcomes. Current Pharmaceutical Design, 27(2), 263-275. https://doi.org/10.2174/1381612826666200717090334
Du, L., Zhang, X., Chen, K., Ren, X., Chen, S., & He, Q. (2021). Effect of high-intensity interval training on physical health in coronary artery disease patients: a meta-analysis of randomized controlled trials. Journal of Cardiovascular Development and Disease, 8(11), 158. https://doi.org/10.3390/jcdd8110158
Elboim-Gabyzon, M., Buxbaum, R., & Klein, R. (2021). The Effects of High-Intensity Interval Training (HIIT) on Fall Risk Factors in Healthy Older Adults: A Systematic Review. International Journal of Environment Researh and Public Health, 18(22). https://doi.org/10.3390/ijerph182211809
Eser, P., Trachsel, L. D., Marcin, T., Herzig, D., Freiburghaus, I., De Marchi, S., Zimmermann, A. J., Schmid, J.-P., & Wilhelm, M. (2022). Short-and long-term effects of high-intensity interval training vs. moderate-intensity continuous training on left ventricular remodeling in patients early after st-segment elevation myocardial infarction—The HIIT-EARLY randomized controlled trial. Fron-tiers in Cardiovascular Medicine, 9, 869501. https://doi.org/10.3389/fcvm.2022.869501
Ezzatvar, Y., Izquierdo, M., Nunez, J., Calatayud, J., Ramirez-Velez, R., & Garcia-Hermoso, A. (2021). Car-diorespiratory fitness measured with cardiopulmonary exercise testing and mortality in pa-tients with cardiovascular disease: A systematic review and meta-analysis. Journal of Sport and Health Science, 10(6), 609-619. https://doi.org/10.1016/j.jshs.2021.06.004
Franklin, B. A., Eijsvogels, T. M., Pandey, A., Quindry, J., & Toth, P. P. (2022). Physical activity, cardi-orespiratory fitness, and cardiovascular health: A clinical practice statement of the ASPC Part I: Bioenergetics, contemporary physical activity recommendations, benefits, risks, extreme exer-cise regimens, potential maladaptations. American Journal of Preventive Cardiology, 12. https://doi.org/10.1016/j.ajpc.2022.100424
Franklin, B. A., Thompson, P. D., Al-Zaiti, S. S., Albert, C. M., Hivert, M.-F., Levine, B. D., Lobelo, F., Madan, K., Sharrief, A. Z., & Eijsvogels, T. M. (2020). Exercise-related acute cardiovascular events and potential deleterious adaptations following long-term exercise training: Placing the risks into perspective–an update: a scientific statement from the American Heart Association. Circulation, 141(13), e705-e736. https://doi.org/10.1161/cir.0000000000000749
Garneau, L., Terada, T., Mistura, M., Mulvihill, E. E., Reed, J. L., & Aguer, C. (2023). Exercise training re-duces circulating cytokines in male patients with coronary artery disease and type 2 diabetes: A pilot study. Physiological Reports, 11(5), e15634. https://doi.org/10.14814/phy2.15634
Ghardashi-Afousi, A., Holisaz, M. T., Shirvani, H., & Pishgoo, B. (2018). The effects of low-volume high-intensity interval versus moderate intensity continuous training on heart rate variability, and hemodynamic and echocardiography indices in men after coronary artery bypass grafting: A randomized clinical trial study. ARYA Atherosclerosis, 14(6), 260. https://doi.org/10.22122/arya.v14i6.1781
Gomes-Neto, M., Durães, A. R., Conceição, L. S. R., Saquetto, M. B., Alves, I. G., Smart, N. A., & Carvalho, V. O. (2024). Some types of exercise interventions are more effective than others in people with coronary heart disease: Systematic review and network meta-analysis. Journal of Physiothera-py. https://doi.org/10.1016/j.jphys.2024.02.018
Gonçalves, C., Raimundo, A., Abreu, A., Pais, J., & Bravo, J. (2024). Effects of high-intensity interval train-ing vs moderate-intensity continuous training on body composition and blood biomarkers in coronary artery disease patients: A randomized controlled trial. Reviews in Cardiovascular Medicine, 25(3), 102. https://doi.org/10.31083/j.rcm2503102
Hansen, D., Abreu, A., Ambrosetti, M., Cornelissen, V., Gevaert, A., Kemps, H., Laukkanen, J. A., Pedretti, R., Simonenko, M., & Wilhelm, M. (2022). Exercise intensity assessment and prescription in car-diovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. European Journal of Preventive Cardiology, 29(1), 230-245. https://doi.org/10.1093/eurjpc/zwab007
Harb, S. C., Bhat, P., Cremer, P. C., Wu, Y., Cremer, L. J., Berger, S., Cho, L., Menon, V., Gulati, M., & Jaber, W. A. (2020). Prognostic value of functional capacity in different exercise protocols. Journal of the American Heart Association, 9(13), e015986. https://doi.org/10.1161/JAHA.119.015986
Heber, S., Fischer, B., Sallaberger-Lehner, M., Hausharter, M., Ocenasek, H., Gleiss, A., Fischer, M. J., Pokan, R., Assinger, A., & Volf, I. (2020). Effects of high-intensity interval training on platelet function in cardiac rehabilitation: a randomised controlled trial. Heart, 106(1), 69-79. https://doi.org/10.1136/heartjnl-2019-315130
Ismail, H., McFarlane, J. R., Nojoumian, A. H., Dieberg, G., & Smart, N. A. (2013). Clinical outcomes and cardiovascular responses to different exercise training intensities in patients with heart failure: a systematic review and meta-analysis. Journal of the American Collage of Cardiology Heart Failure, 1(6), 514-522. https://doi.org/10.1016/j.jchf.2013.08.006
Kavanagh, T., Mertens, D. J., Hamm, L. F., Beyene, J., Kennedy, J., Corey, P., & Shephard, R. J. (2002). Pre-diction of long-term prognosis in 12 169 men referred for cardiac rehabilitation. Circulation, 106(6), 666-671. https://doi.org/10.1161/01.cir.0000024413.15949.ed
Keteyian, S. J., Brawner, C. A., Savage, P. D., Ehrman, J. K., Schairer, J., Divine, G., Aldred, H., Ophaug, K., & Ades, P. A. (2008). Peak aerobic capacity predicts prognosis in patients with coronary heart dis-ease. American Heart Journal, 156(2), 292-300. https://doi.org/10.1016/j.ahj.2008.03.017
Keteyian, S. J., Hibner, B. A., Bronsteen, K., Kerrigan, D., Aldred, H. A., Reasons, L. M., Saval, M. A., Brawn-er, C. A., Schairer, J. R., & Thompson, T. M. (2014). Greater improvement in cardiorespiratory fitness using higher-intensity interval training in the standard cardiac rehabilitation setting. Journal of Cardiopulmonary Rehabilitation and Prevention, 34(2), 98-105. DOI: 10.1097/HCR.0000000000000049
Kim, C., Choi, H. E., & Lim, M. H. (2015). Effect of high interval training in acute myocardial infarction patients with drug-eluting stent. American Journal of Physical Medicine & Rehabilitation, 94(10S), 879-886. DOI: 10.1097/PHM.0000000000000290
Lee, L. S., Tsai, M.-C., Brooks, D., & Oh, P. I. (2019). Randomised controlled trial in women with coro-nary artery disease investigating the effects of aerobic interval training versus moderate inten-sity continuous exercise in cardiac rehabilitation: CAT versus MICE study. British Medical Jour-nal Open Sport and Exercise Medicine, 5(1).
Libby, P. (2012). Inflammation in atherosclerosis. Arteriosclerosis, Thrombosis, and Vascular Biology, 32(9), 2045-2051. https://doi.org/10.1161/ATVBAHA.108.179705
Libby, P. (2021). Inflammation in atherosclerosis—no longer a theory. Clinical Chemistry, 67(1), 131-142. https://doi.org/10.1093/clinchem/hvaa275
Libby, P., Ridker, P. M., & Maseri, A. (2002). Inflammation and atherosclerosis. Circulation, 105(9), 1135-1143. https://doi.org/10.1161/hc0902.104353
McGregor, G., Powell, R., Begg, B., Birkett, S. T., Nichols, S., Ennis, S., McGuire, S., Prosser, J., Fiassam, O., & Hee, S. W. (2023). High-intensity interval training in cardiac rehabilitation (HIIT or MISS UK): A multi-centre randomised controlled trial. European Journal of Preventive Cardiology, (In-Press). https://doi.org/10.1093/eurjpc/zwad039
Mensah, G. A., Fuster, V., Murray, C. J., & Roth, G. A. (2023). Global burden of cardiovascular diseases and risks, 1990-2022. Journal of the American College of Cardiology, 82(25), 2350-2473.
Mikkelsen, N., Cadarso-Suárez, C., Lado-Baleato, O., Díaz-Louzao, C., Gil, C. P., Reeh, J., Rasmusen, H., & Prescott, E. (2020). Improvement in VO2 peak predicts readmissions for cardiovascular disease and mortality in patients undergoing cardiac rehabilitation. European Journal of Preventive Cardiology, 27(8), 811-819. https://doi.org/10.1177/2047487319887835
Möbius-Winkler, S., Uhlemann, M., Adams, V., Sandri, M., Erbs, S., Lenk, K., Mangner, N., Mueller, U., Ad-am, J., & Grunze, M. (2016). Coronary collateral growth induced by physical exercise: results of the impact of intensive exercise training on coronary collateral circulation in patients with sta-ble coronary artery disease (EXCITE) trial. Circulation, 133(15), 1438-1448. https://doi.org/10.1161/CIRCULATIONAHA.115.016442
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Group*, P. (2009). Preferred reporting items for sys-tematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine, 151(4), 264-269. DOI:10.1002/9781118715598
Moholdt, T., Aamot, I. L., Granøien, I., Gjerde, L., Myklebust, G., Walderhaug, L., Brattbakk, L., Hole, T., Graven, T., & Stølen, T. O. (2012). Aerobic interval training increases peak oxygen uptake more than usual care exercise training in myocardial infarction patients: a randomized controlled study. Clinical Rehabilitation, 26(1), 33-44. https://doi.org/10.1177/0269215511405229
Nathan, C., & Ding, A. (2010). Nonresolving inflammation. Cell, 140(6), 871-882.
Netto, J., Teren, A., Burkhardt, R., Willenberg, A., Beutner, F., Henger, S., Schuler, G., Thiele, H., Isermann, B., & Thiery, J. (2022). Biomarkers for non-invasive stratification of coronary artery disease and prognostic impact on long-term survival in patients with stable coronary heart disease. Nu-trients, 14(16), 3433. https://doi.org/10.3390/nu14163433
Novaković, M., Novak, T., Vižintin Cuderman, T., Krevel, B., Tasič, J., Rajkovič, U., Fras, Z., & Jug, B. (2022). Exercise capacity improvement after cardiac rehabilitation following myocardial in-farction and its association with long-term cardiovascular events. European Journal of Cardio-vascular Nursing, 21(1), 76-84. https://doi.org/10.1093/eurjcn/zvab015
Pathak, M., Dwivedi, S. N., Thakur, B., & Vishnubhatla, S. (2020). Methods of estimating the pooled effect size under meta-analysis: A comparative appraisal. Clinical Epidemiology and Global Health, 8(1), 105-112. https://doi.org/10.1016/j.cegh.2019.05.004
Pattyn, N., Beckers, P. J., Cornelissen, V. A., Coeckelberghs, E., De Maeyer, C., Frederix, G., Goetschalckx, K., Possemiers, N., Schepers, D., & Van Craenenbroeck, E. M. (2017). The effect of aerobic inter-val training and continuous training on exercise capacity and its determinants. Acta Cardiologi-ca, 72(3), 328-340. https://doi.org/10.1080/00015385.2017.1304712
Pattyn, N., Beulque, R., & Cornelissen, V. (2018). Aerobic interval vs. continuous training in patients with coronary artery disease or heart failure: an updated systematic review and meta-analysis with a focus on secondary outcomes. Sports Medicine, 48, 1189-1205.
Pearson, T. A., Mensah, G. A., Alexander, R. W., Anderson, J. L., Cannon III, R. O., Criqui, M., Fadl, Y. Y., Fortmann, S. P., Hong, Y., & Myers, G. L. (2003). Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare profes-sionals from the Centers for Disease Control and Prevention and the American Heart Associa-tion. Circulation, 107(3), 499-511. https://doi.org/10.1161/01.CIR.0000052939.59093.45
Pernick, Y. (2017). Moderate-to-high intensity aerobic interval training versus continuous aerobic training in real life, centre based, cardiac rehabilitation. Bangor University (United Kingdom).
Schaefer, E. J., Tsunoda, F., Diffenderfer, M., Polisecki, E., Thai, N., & Asztalos, B. (2016). The measure-ment of lipids, lipoproteins, apolipoproteins, fatty acids, and sterols, and next generation se-quencing for the diagnosis and treatment of lipid disorders.
Silveira, L. S., Antunes, B. d. M. M., Minari, A. L. A., Dos Santos, R. V. T., Neto, J. C. R., & Lira, F. S. (2016). Macrophage polarization: implications on metabolic diseases and the role of exercise. Critical Reviews™ in Eukaryotic Gene Expression, 26(2).
Smart, N. A., Waldron, M., Ismail, H., Giallauria, F., Vigorito, C., Cornelissen, V., & Dieberg, G. (2015). Vali-dation of a new tool for the assessment of study quality and reporting in exercise training stud-ies: TESTEX. Joanna Briggs Institute Evidence Implementation, 13(1), 9-18. DOI: 10.1097/XEB.0000000000000020
Tagashira, S., Kurose, S., & Kimura, Y. (2021). Improvements in exercise tolerance with an exercise in-tensity above the anaerobic threshold in patients with acute myocardial infarction. Heart and vessels, 36(6), 766-774.
Taraldsen, M. D., Videm, V., Hegbom, K., Wiseth, R., & Madssen, E. (2021). Stent edge vascular response and in-stent geometry after aerobic exercise. Cardiovascular Intervention and Therapeutics, 36, 111-120.
Taylor, J. L., Bonikowske, A. R., & Olson, T. P. (2021). Optimizing outcomes in cardiac rehabilitation: the importance of exercise intensity. Frontiers in Cardiovascular Medicine, 8, 734278. https://doi.org/10.3389/fcvm.2021.734278
Taylor, J. L., Holland, D. J., Keating, S. E., Leveritt, M. D., Gomersall, S. R., Rowlands, A. V., Bailey, T. G., & Coombes, J. S. (2020). Short-term and long-term feasibility, safety, and efficacy of high-intensity interval training in cardiac rehabilitation: the FITR heart study randomized clinical trial. Journal of the American Medical Association Cardiology, 5(12), 1382-1389. doi:10.1001/jamacardio.2020.3511
Thompson, W. R., Sallis, R., Joy, E., Jaworski, C. A., Stuhr, R. M., & Trilk, J. L. (2020). Exercise is medicine. American Journal of Lifestyle Medicine, 14(5), 511-523. https://doi.org/10.1177/1559827620912192
Tschentscher, M., Eichinger, J., Egger, A., Droese, S., Schönfelder, M., & Niebauer, J. (2014). High-intensity interval training is not superior to other forms of endurance training during cardiac rehabilitation. European Journal of Preventive Cardiology, 23(1), 14-20. https://doi.org/10.1177/2047487314560100
Valentino, S. E., Dunford, E. C., Dubberley, J., Lonn, E. M., Gibala, M. J., Phillips, S. M., & MacDonald, M. J. (2022). Cardiovascular responses to high‐intensity stair climbing in individuals with coronary artery disease. Physiological Reports, 10(10), e15308. https://doi.org/10.14814/phy2.15308
Villelabeitia-Jaureguizar, K., Vicente-Campos, D., Senen, A. B., Jiménez, V. H., Bautista, L. R., Garrido-Lestache, M. E. B., & Chicharro, J. L. (2019). Mechanical efficiency of high versus moderate in-tensity aerobic exercise in coronary heart disease patients: A randomized clinical trial. Cardiol-ogy Journal, 26(2), 130-137. DOI: 10.5603/CJ.a2018.0052
Warburton, D. E. R., McKenzie, D. C., Haykowsky, M. J., Taylor, A., Shoemaker, P., Ignaszewski, A. P., & Chan, S. Y. (2005). Effectiveness of high-intensity interval training for the rehabilitation of pa-tients with coronary artery disease. American Journal of Cardiology, 95(9), 1080-1084. https://doi.org/10.1016/j.amjcard.2004.12.063
Wewege, M. A., Ahn, D., Yu, J., Liou, K., & Keech, A. (2018). High‐intensity interval training for patients with cardiovascular disease—is it safe? A systematic review. Journal of the American Heart As-sociation, 7(21), e009305. https://doi.org/10.1161/JAHA.118.009305
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