Aerobic Fitness for Heart Problems

Overseen By Patrick Savage, Research Coordinator

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: University of Vermont Medical Center

Disqualifiers: Active malignancy, Unwilling to comply, Submaximal performance, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 16 weeks

114 Participants Needed

Trial Summary

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment HIIT and MICT for heart problems?

Research shows that high-intensity interval training (HIIT) can improve heart health by increasing cardiorespiratory fitness and quality of life in patients with heart conditions, such as coronary artery disease. Studies suggest that HIIT may be more effective than moderate-intensity continuous training (MICT) in enhancing exercise capacity and reducing cardiovascular risks. ^{1 2 3 4 5}

Is aerobic fitness training, like HIIT and MICT, safe for people with heart problems?

Research shows that high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) are generally safe for people with heart problems, with a low rate of major adverse events. In a study of 1117 participants, only one major cardiovascular event occurred during HIIT, equating to 1 event per 17,083 training sessions. ^{2 6 7 8 9}

How does the treatment HIIT differ from other treatments for heart problems?

HIIT (high-intensity interval training) is unique because it can improve aerobic capacity and cardiovascular health more effectively and in less time than traditional moderate-intensity continuous training (MICT). It offers similar benefits for heart health, body composition, and quality of life, making it a time-efficient alternative for cardiac rehabilitation. ^{1 3 10 11 12}

What is the purpose of this trial?

Hospitalization and treatment for cardiovascular disease is one of the main contributors to disability in older adults. Moderate intensity continuous aerobic and resistance training have been the cornerstone of cardiac rehabilitation (CR) for decades to remediate hospital-acquired functional deficits, but some groups receive less or minimal functional benefit from this training. The proposed studies seek to optimize recovery of aerobic fitness and physical function among older cardiac patients using a novel high intensity training regimen with the long-term goal of reducing subsequent disability and improving clinical outcomes.

Research Team

Sherrie Khadanga MD, Principal Investigator, MD

Principal Investigator

University of Vermont Medical Center

Eligibility Criteria

This trial is for adults over 65 who can walk and are in cardiac rehab after a heart attack or heart procedure. They must be willing to follow the exercise plan they're given, and not have active cancer (except certain skin or low-grade prostate cancers) or poor performance on an initial exercise test.

Inclusion Criteria

I can walk on my own.

I am in a heart rehab program after a heart attack or heart procedure.

I am older than 65.

Exclusion Criteria

Have a submaximal performance on entry exercise tolerance test, defined as respiratory exchange ratio <1.0

I have cancer that is not low-grade prostate or non-melanoma skin cancer.

Unwilling to comply with the exercise prescription they may be assigned to

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo either high intensity interval training (HIIT+HIRT) or moderate intensity continuous training (MICT+MIRT) to improve aerobic fitness and physical function

16 weeks

Regular visits for exercise sessions

Follow-up

Participants are monitored for maintenance of fitness and other health outcomes after the intervention

26 weeks

Treatment Details

Interventions

• HIIT
• MICT

Trial Overview The study tests whether high intensity interval training (HIIT) or moderate intensity continuous training (MICT) is better at improving fitness and physical function in older adults recovering from heart issues, with the aim of reducing disability and enhancing clinical outcomes.

Participant Groups

Group I: Usual Care Group Experimental Treatment 1 Intervention

Patients who recently experienced a myocardial infarction (MI) or percutaneous intervention (PCI; angioplasty, stent placement or valve replacement) and enroll in Phase 2 Cardiac Rehabilitation (CR) may be randomized to Moderate intensity training

Group II: Intervention Group Experimental Treatment 1 Intervention

Patients who recently experienced a myocardial infarction (MI) or percutaneous intervention (PCI; angioplasty, stent placement or valve replacement) and enroll in Phase 2 Cardiac Rehabilitation (CR) may be randomized to High intensity training

Who Is Running the Clinical Trial?

University of Vermont Medical Center

Lead Sponsor

Trials

46

Recruited

25,900+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Findings from Research

High-intensity interval training (HIIT) significantly improves exercise capacity (peak VO2) in patients with coronary artery disease (CAD), especially in training sessions lasting less than eight weeks, compared to moderate-intensity continuous training (MICT).

HIIT also enhances important prognostic markers such as the anaerobic threshold (AT) and left ventricular ejection fraction (LVEF) in patients with CAD and heart failure (HF), indicating its potential benefits for heart health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of High-Intensity Interval Training on Exercise Capacity and Prognosis in Heart Failure and Coronary Artery Disease: A Systematic Review and Meta-Analysis. Wang, C., Xing, J., Zhao, B., et al.[2022]

In a study of 81 heart disease patients with very high cardiovascular risk, both moderate and high-intensity interval training (MIIT and HIIT) were found to be safe, with no adverse outcomes reported during the training.

While there were no statistically significant differences in overall exercise improvements between the training types, the HIIT group showed a trend towards greater improvements in exercise tolerance, suggesting it may be more effective than continuous moderate intensity training (MICT).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and improvement in exercise tolerance with interval training vs moderate-intensity continuous training in heart disease patient of very high cardiovascular risk. Pineda-García, AD., Lara-Vargas, JA., Ku-González, A., et al.[2022]

Higher-intensity interval training (HIIT) was safely integrated into a standard cardiac rehabilitation program for 39 patients, with no hospitalizations reported during or after exercise, indicating its safety for patients with stable coronary heart disease.

HIIT led to a significantly greater improvement in peak oxygen uptake (3.6 mL·kg⁻¹·min⁻¹) compared to moderate-intensity continuous training (1.7 mL·kg⁻¹·min⁻¹), demonstrating its efficacy in enhancing cardiorespiratory fitness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Greater improvement in cardiorespiratory fitness using higher-intensity interval training in the standard cardiac rehabilitation setting. Keteyian, SJ., Hibner, BA., Bronsteen, K., et al.[2022]

High-intensity interval training (HIIT) is as effective, if not more so, than traditional moderate-intensity continuous training (MICT) for patients with cardiovascular disease, based on a systematic review of 23 studies involving 1117 participants.

The safety profile of HIIT in cardiac rehabilitation is promising, with only one major cardiovascular adverse event reported per 17,083 training sessions, indicating that HIIT can be safely implemented in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High-Intensity Interval Training for Patients With Cardiovascular Disease-Is It Safe? A Systematic Review. Wewege, MA., Ahn, D., Yu, J., et al.[2021]

High-intensity, low-volume interval training (HIIT-low volume) and moderate-intensity continuous aerobic training (MICT) are both safe for adults with metabolic syndrome, with no serious adverse reactions reported during a 12-week supervised exercise program involving 60 participants.

While both training methods had similar rates of musculoskeletal events, HIIT-low volume was associated with a higher incidence of cardiovascular events, suggesting caution for individuals with specific health concerns, such as venous insufficiency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety of High-Intensity, Low-Volume Interval Training or Continuous Aerobic Training in Adults With Metabolic Syndrome. Gallo-Villegas, J., Restrepo, D., Pérez, L., et al.[2023]

High-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) both significantly reduce cardiovascular disease risk factors, including weight, BMI, body fat percentage, and total cholesterol, while also improving VO2max in adults with overweight and obesity.

HIIT is particularly effective in enhancing cardiopulmonary fitness compared to MICT, especially when HIIT intervals are 2 minutes or longer, while requiring less overall training time per session.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of HIIT and MICT on cardiovascular risk factors in adults with overweight and/or obesity: A meta-analysis. Su, L., Fu, J., Sun, S., et al.[2020]

A scoping review of 69 studies on high-intensity interval training (HIIT) in older adults found that HIIT protocols are generally well-tolerated and can provide significant health benefits, particularly in improving cardiorespiratory fitness.

Most research has focused on healthy older adults, highlighting a need for larger studies and more investigation into HIIT's effects on older adults with various health conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High-Intensity Interval Training in Older Adults: a Scoping Review. Marriott, CFS., Petrella, AFM., Marriott, ECS., et al.[2021]

A study involving 120 patients with chronic heart failure showed that the modified group-based high-intensity aerobic interval training (m-Ullevaal) significantly improved functional exercise capacity, left ventricular ejection fraction, perceived exertion, and quality of life compared to moderate-intensity continuous training (MICT) over a 12-week period.

The m-Ullevaal protocol demonstrated greater benefits than MICT, suggesting it should be considered as a preferred rehabilitation method for patients with chronic heart failure by physical and rehabilitation medicine physicians.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Group-based cardiac rehabilitation interventions. A challenge for physical and rehabilitation medicine physicians: a randomized controlled trial. Papathanasiou, JV., Petrov, I., Tokmakova, MP., et al.[2021]

High-intensity interval training (HIIT) can lead to equal or greater improvements in aerobic capacity compared to traditional moderate-intensity continuous training (MICT), while also positively affecting body composition, glucose metabolism, blood pressure, and quality of life.

HIIT offers a significant time advantage, allowing individuals to achieve the same energy expenditure in a shorter duration, making it a practical option for both healthy adults and those with cardiovascular diseases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Salutary effects of high-intensity interval training in persons with elevated cardiovascular risk. Fleg, JL.[2018]

References

1. England pubmed.ncbi.nlm.nih.gov

The Effects of High-Intensity Interval Training on Exercise Capacity and Prognosis in Heart Failure and Coronary Artery Disease: A Systematic Review and Meta-Analysis. [2022]

2. Mexico pubmed.ncbi.nlm.nih.gov

Safety and improvement in exercise tolerance with interval training vs moderate-intensity continuous training in heart disease patient of very high cardiovascular risk. [2022]

3. New Zealand pubmed.ncbi.nlm.nih.gov

High-intensity interval training versus moderate-intensity continuous training within cardiac rehabilitation: a systematic review and meta-analysis. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Feasibility and impact of whole-body high-intensity interval training in patients with stable coronary artery disease: a randomised controlled trial. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Greater improvement in cardiorespiratory fitness using higher-intensity interval training in the standard cardiac rehabilitation setting. [2022]

6. England pubmed.ncbi.nlm.nih.gov

High-Intensity Interval Training for Patients With Cardiovascular Disease-Is It Safe? A Systematic Review. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Safety of High-Intensity, Low-Volume Interval Training or Continuous Aerobic Training in Adults With Metabolic Syndrome. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Effects of HIIT and MICT on cardiovascular risk factors in adults with overweight and/or obesity: A meta-analysis. [2020]

9. Switzerland pubmed.ncbi.nlm.nih.gov

High-Intensity Interval Training in Older Adults: a Scoping Review. [2021]

10. Italy pubmed.ncbi.nlm.nih.gov

Group-based cardiac rehabilitation interventions. A challenge for physical and rehabilitation medicine physicians: a randomized controlled trial. [2021]

11. England pubmed.ncbi.nlm.nih.gov

Salutary effects of high-intensity interval training in persons with elevated cardiovascular risk. [2018]

12. England pubmed.ncbi.nlm.nih.gov

Which high-intensity interval training program is more effective in patients with coronary artery disease? [2023]