Patrick Feiereisen

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

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. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00917046.

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

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. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00917046.

Isokinetic versus One-Repetition Maximum Strength Assessment in Chronic Heart Failure

PURPOSE Reduction in exercise capacity in patients with chronic heart failure (CHF) has been partially attributed to decreased muscle strength. Training studies reported important variations in strength increases during rehabilitation, ranging between 5% and 70% and depending on the measurement technique: isokinetic dynamometry or the one-repetition maximum (1RM) methods. Therefore, the question arises if both techniques assess the changes in muscle strength in a comparable way. METHODS Thirty patients with CHF, New York Heart Association class II-III, with mean baseline VO2peak of 14.8 +/-3.0 mL x kg(-1) x min(-1) and mean baseline left ventricular ejection fraction of 23.5% T 5.5%, were assessed for knee extensor and knee flexor strength before and after 40 training sessions by isokinetic dynamometry and 1RM method. These two strength measurement techniques were compared using the Bland and Altman method for agreement. RESULTS Knee extensor muscle strength increased by 7.4% and knee flexor strength increased by 18.7% if measured by isokinetic testing. With the 1RM method, knee extensor and flexor strength increased by 36% and 100%, respectively. Both techniques were not in agreement for muscle strength assessment; improvements were more important with the 1RM method. Furthermore, statistical analysis showed that the 1RM technique was overestimating strength increases in comparison with isokinetic evaluation, especially for higher strength levels. CONCLUSIONS In the follow-up of exercise training programs in patients with CHF, isokinetic measurements should be preferentially used to limit bias between measurements at different times.

Reverse remodelling through exercise training is more pronounced in non-ischemic heart failure

PurposeMost training studies in patients with chronic heart failure (CHF) do not consider CHF aetiology in the interpretation of the results. About 60% of the patients in those studies have ischemic CHF (IHF) and 40% non-ischemic CHF (NHF). Recently, we conducted a randomized controlled trial to study three different training modalities in 60 patients with severe CHF, with a similar distribution of IHF and NHF patients. In the present post hoc analysis we compared the differences in training results between ischemic and non-ischemic patients.MethodsLeft ventricular ejection fraction (EF), end diastolic volume (EDV), end systolic volume (ESV), measured with radionuclide ventriculography (RNV) and echocardiography, NT-pro BNP, peak oxygen uptake (peak

The importance of increasing exercise capacity during cardiac rehabilitation in heart failure: Optimising training to optimise prognosis:

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Objective effects of a 6 months' endurance and strength training program in outpatients with congestive heart failure

), working capacity and muscular volume were analyzed before and after training in 45 patients training for 40 sessions, 3 times per week. Fifteen patients served as control group. The outcome was analyzed considering the aetiology of CHF, either ischemic or non-ischemic.ResultsThere were no significant differences in improvements of peak

25 ans de sport pour Cardiaques a Luxembourg. Développement d'un modèle de rééducation durable.

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