High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation: a systematic review and meta-analysis

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Abstract

Background

Aerobic capacity has been shown to be inversely proportionate to cardiovascular mortality and morbidity and there is growing evidence that high-intensity interval training (HIIT) appears to be more effective than moderate-intensity continuous training (MICT) in improving cardiorespiratory fitness within the cardiac population. Previously published systematic reviews in cardiovascular disease have neither investigated the effect that the number of weeks of intervention has on cardiorespiratory fitness changes, nor have adverse events been collated.

Objective

We aimed to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) within the cardiac population that investigated cardiorespiratory fitness changes resulting from HIIT versus MICT and to collate adverse events.

Methods

A critical narrative synthesis and meta-analysis was conducted after systematically searching relevant databases up to July 2017. We searched for RCTs that compared cardiorespiratory fitness changes resulting from HIIT versus MICT interventions within the cardiac population.

Results

Seventeen studies, involving 953 participants (465 for HIIT and 488 for MICT) were included in the analysis. HIIT was significantly superior to MICT in improving cardiorespiratory fitness overall (SMD 0.34 mL/kg/min; 95% confidence interval [CI; 0.2–0.48]; p<0.00001; I ²=28%). There were no deaths or cardiac events requiring hospitalization reported in any study during training. Overall, there were more adverse events reported as a result of the MICT (n=14) intervention than the HIIT intervention (n=9). However, some adverse events (n=5) were not classified by intervention group.

Conclusion

HIIT is superior to MICT in improving cardiorespiratory fitness in participants of cardiac rehabilitation (CR). Improvements in cardiorespiratory fitness are significant for CR programs of >6-week duration. Programs of 7–12 weeks’ duration resulted in the largest improvements in cardiorespiratory fitness for patients with coronary artery disease. HIIT appears to be as safe as MICT for CR participants.

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Most cited references 37

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The nuts and bolts of PROSPERO: an international prospective register of systematic reviews

Alison Booth, Mike Clarke, Gordon Dooley … (2012)

Background Following publication of the PRISMA statement, the UK Centre for Reviews and Dissemination (CRD) at the University of York in England began to develop an international prospective register of systematic reviews with health-related outcomes. The objectives were to reduce unplanned duplication of reviews and provide transparency in the review process, with the aim of minimizing reporting bias. Methods An international advisory group was formed and a consultation undertaken to establish the key items necessary for inclusion in the register and to gather views on various aspects of functionality. This article describes the development of the register, now called PROSPERO, and the process of registration. Results PROSPERO offers free registration and free public access to a unique prospective register of systematic reviews across all areas of health from all around the world. The dedicated web-based interface is electronically searchable and available to all prospective registrants. At the moment, inclusion in PROSPERO is restricted to systematic reviews of the effects of interventions and strategies to prevent, diagnose, treat, and monitor health conditions, for which there is a health-related outcome. Ideally, registration should take place before the researchers have started formal screening against inclusion criteria but reviews are eligible as long as they have not progressed beyond the point of completing data extraction. The required dataset captures the key attributes of review design as well as the administrative details necessary for registration. Submitted registration forms are checked against the scope for inclusion in PROSPERO and for clarity of content before being made publicly available on the register, rejected, or returned to the applicant for clarification. The public records include an audit trail of major changes to planned methods, details of when the review has been completed, and links to resulting publications when provided by the authors. Conclusions There has been international support and an enthusiastic response to the principle of prospective registration of protocols for systematic reviews and to the development of PROSPERO. In October 2011, PROSPERO contained 200 records of systematic reviews being undertaken in 26 countries around the world on a diverse range of interventions.

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The potential for high-intensity interval training to reduce cardiometabolic disease risk.

Kevin R. Short, Susan Sisson, Harald H. Kessler (2012)

In the US, 34% of adults currently meet the criteria for the metabolic syndrome defined by elevated waist circumference, plasma triglycerides (TG), fasting glucose and/or blood pressure, and decreased high-density lipoprotein cholesterol (HDL-C). While these cardiometabolic risk factors can be treated with medication, lifestyle modification is strongly recommended as a first-line approach. The purpose of this review is to focus on the effect of physical activity interventions and, specifically, on the potential benefits of incorporating higher intensity exercise. Several recent studies have suggested that compared with continuous moderate exercise (CME), high-intensity interval training (HIT) may result in a superior or equal improvement in fitness and cardiovascular health. HIT is comprised of brief periods of high-intensity exercise interposed with recovery periods at a lower intensity. The premise of using HIT in both healthy and clinical populations is that the vigorous activity segments promote greater adaptations via increased cellular stress, yet their short length, and the ensuing recovery intervals, allow even untrained individuals to work harder than would otherwise be possible at steady-state intensity. In this review, we examine the impact of HIT on cardiometabolic risk factors, anthropometric measures of obesity and cardiovascular fitness in both healthy and clinical populations with cardiovascular and metabolic disease. The effects of HIT versus CME on health outcomes were compared in 14 of the 24 studies featuring HIT. Exercise programmes ranged from 2 weeks to 6 months. All 17 studies that measured aerobic fitness and all seven studies that measured insulin sensitivity showed significant improvement in response to HIT, although these changes did not always exceed responses to CME comparison groups. A minimum duration of 12 weeks was necessary to demonstrate improvement in fasting glucose in four of seven studies (57%). A minimum duration of 8 weeks of HIT was necessary to demonstrate improvement in HDL-C in three of ten studies (30%). No studies reported that HIT resulted in improvement of total cholesterol, low-density lipoprotein cholesterol (LDL-C), or TG. At least 12 weeks of HIT was required for reduction in blood pressure to emerge in five studies of participants not already being treated for hypertension. A minimum duration of 12 weeks was necessary to see consistent improvement in the six studies that examined anthropometric measures of obesity in overweight/obese individuals. In the 13 studies with a matched-exercise-volume CME group, improvement in aerobic fitness in response to HIT was equal to (5 studies), or greater than (8 studies) in response to CME. Additionally, HIT has been shown to be safe and effective in patients with a range of cardiac and metabolic dysfunction. In conclusion, HIT appears to promote superior improvements in aerobic fitness and similar improvements in some cardiometabolic risk factors in comparison to CME, when performed by healthy subjects or clinical patients for at least 8-12 weeks. Future studies need to address compliance and efficacy of HIT in the real world with a variety of populations.

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A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus?

Kym Price, Brett Gordon, Stephen Bird … (2016)

Cardiac rehabilitation is an important component in the continuum of care for individuals with cardiovascular disease, providing a multidisciplinary education and exercise programme to improve morbidity and mortality risk. Internationally, cardiac rehabilitation programmes are implemented through various models. This review compared cardiac rehabilitation guidelines in order to identify any differences and/or consensus in exercise testing, prescription and monitoring.

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Author and article information

Journal

Journal ID (nlm-ta): Open Access J Sports Med

Journal ID (iso-abbrev): Open Access J Sports Med

Journal ID (publisher-id): Open Access Journal of Sports Medicine

Title: Open Access Journal of Sports Medicine

Publisher: Dove Medical Press

ISSN (Electronic): 1179-1543

Publication date Collection: 2018

Publication date (Electronic): 26 January 2018

Volume: 9

Pages: 1-17

Affiliations

[1 ]Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia

[2 ]Exercise Health and Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia

[3 ]Water Based Research Unit, Bond University, Gold Coast, QLD, Australia

[4 ]School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia

[5 ]Cardiology Department, Gold Coast University Hospital, Gold Coast, QLD, Australia

[6 ]Griffith University, Gold Coast, QLD, Australia

[7 ]Macquarie University, Sydney, NSW, Australia

[8 ]Centre for Applied Health Economics, School of Medicine, Griffith University, Logan, QLD, Australia

Author notes

Correspondence: Amanda L Hannan, Faculty of Health Sciences & Medicine, Bond University, 2 Promethean Way, Robina, Gold Coast, QLD 4226, Australia, Tel +61 4 1551 0772, Fax +61 7 5595 1652, Email mhannan@ 123456bond.edu.au

Article

Publisher ID: oajsm-9-001

DOI: 10.2147/OAJSM.S150596

PMC ID: 5790162

PubMed ID: 29416382

SO-VID: 636ec7a7-a15d-4c36-a17e-2925e76eeb38

License:

The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation: a systematic review and meta-analysis

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Objective

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Cardiovascular Innovations and Applications

Most cited references 37

The nuts and bolts of PROSPERO: an international prospective register of systematic reviews

The potential for high-intensity interval training to reduce cardiometabolic disease risk.

A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus?

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