Exercise-based Cardiac Rehabilitation in Coronary Disease: Training Impulse or Modalities?

Abstract

To compare the effects of 2 short programs with similar training load (TL), based on combined aerobic – resistance training (CT) or aerobic training (AT) on cardiorespiratory responses, 32 patients with coronary heart disease (CHD: 63.8±8.0y, 1.73±0.06 m, 84.8±15.9 kg, Left Ventricular Ejection Fraction: 0.53±0.8) performed 4 weeks of exercise rehabilitation based on CT (n=16) or AT (n=16). Maximal tolerated power (MTP), peak values of oxygen uptake (VO_2peak) and heart rate (HR_peak), anaerobic threshold (VT1) were determined during an incremental cycling exercise test before and after training periods. TL, quantified using the session rating of perceived exertion, did not differ between both modalities (CT: 4 438±572 vs. AT: 4 346±592 AU, p=0.300). Improvements in VO_2peak were larger after CT (+36.4±24.7% of pre-training VO_2peak, i. e., +4.4±2.3 mL.min⁻¹.kg⁻¹, n=14) than observed after AT (+20.1±9.1% of pre-training VO_2peak, i. e., +2.6±1.0 mL.min⁻¹.kg⁻¹, n=12) (p=0.014). Additionally, CT significantly improved power (54.6±23.8 vs. 75.1±21.2 watts, p=0.001) and VO₂ associated at VT1 (VO₂: 9.8±2.5 vs. 12.6±2.9 mL.min⁻¹.kg⁻¹, p=0.001). This might be taken into account when prescribing exercise rehabilitation for CHD patients with different initial clinical limitations.

Key words

rating exertion perception - training load - heart disease - VO_2peak - exercise capacity

• References

• 1 Adams J, Cline MJ, Hubbard M, McCullough T, Hartman J. A new paradigm for post-cardiac event resistance exercise guidelines. Am J Cardiol 2006; 97: 281-286
• 2 American College of Sports Medicine. American College of Sports Medicine’s guidelines for exercise testing and prescription. 8^th ed. Philadelphia: Lippincott Williams and Wilkins; 2009: 219
• 3 American College of Sports Medicine. American College of Sports Medicine’s guidelines for exercise testing and prescription. 9^th ed. Philadelphia: Lippincott Williams and Wilkins; 2013: 124
• 4 Arthur HM, Gunn E, Thorpe KE, Ginis KM, Mataseje L, McCartney N, McKelvie RS. Effect of aerobic vs combined aerobic-strength training on 1-year, post-cardiac rehabilitation outcomes in women after a cardiac event. J Rehabil Med 2007; 39: 730-735
• 5 Beaver WL, Wasserman K, Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 1986; 60: 2020-2027
• 6 Belardinelli R, Georgiou D, Cianci G, Purcaro A. 10-year exercise training in chronic heart failure: a randomized controlled trial. J Am Coll Cardiol 2012; 60: 1521-1528
• 7 Campbell NC, Ritchie LD, Thain J, Deans HG, Rawles JM, Squair JL. Secondary prevention in coronary heart disease: a randomised trial of nurse led clinics in primary care. Heart 1998; 80: 447-452
• 8 Candotti CT, Loss JF, Bagatini D, Soares DP, da Rocha EK, de Oliveira AR, Guimarães AC. Cocontraction and economy of triathletes and cyclists at different cadences during cycling motion. J Electromyogr Kinesiol 2009; 19: 915-921
• 9 Chevalier L, Lacoste C, Douard H, Labbé L, Bordier P, Broustet JP. Segmental rehabilitation in cardiac failure: short and long-term results. Arch Mal Coeur Vaiss 1996; 89: 819-824
• 10 Cohen J. A power primer. Psychological Bulletin 1992; 112: 155-159
• 11 Egan AD, Winchester JB, Foster C, McGuigan MR. Using session RPE to monitor different methods of resistance exercise. J Sports Sci Med 2006; 5: 289-295
• 12 Foster C, Florhaug JA, Franklin J, Gottschall L, Hrovatin LA, Parker S, Doleshal P, Dodge C. A new approach to monitoring exercise training. J Strength Cond Res 2001; 15: 109-115
• 13 Gayda M, Choquet D, Ahmaidi S. Effects of exercise training modality on skeletal muscle fatigue in men with coronary heart disease. J Electromyogr Kinesiol 2009; 19: e32-e39
• 14 Georgiou D, Chen Y, Appadoo S, Belardinelli R, Greene R, Parides MK, Glied S. Cost-effectiveness analysis of long-term moderate exercise training in chronic heart failure. Am J Cardiol 2001; 87: 984-988
• 15 Gosselin N, Lambert K, Poulain M, Martin A, Préfaut C, Varray A. Endurance training improves skeletal muscle electrical activity in active COPD patients. Muscle Nerve 2003; 28: 744-753
• 16 Hansen D, Eijnde BO, Roelants M, Broekmans T, Rummens JL, Hensen K, Daniels A, Van Erum M, Bonné K, Reyckers I, Alders T, Berger J, Dendale P. Clinical benefits of the addition of lower extremity low-intensity resistance muscle training to early aerobic endurance training intervention in patients with coronary artery disease: a randomized controlled trial. J Rehabil Med 2011; 43: 800-807
• 17 Harriss DJ, Atkinson G. Ethical standards in sport and exercise science research: 2016 update. Int J Sports Med 2015; 36: 1121-1124
• 18 Heran BS, Chen JM, Ebrahim S, Moxham T, Oldridge N, Rees K, Thompson DR, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011; 7: CD001800
• 19 Iellamo F, Legramante JM, Massaro M, Raimondi G, Galante A. Effects of a residential exercise training on baroreflex sensitivity and heart rate variability in patients with coronary artery disease: A randomized, controlled study. Circulation 2000; 102: 2588-2592
• 20 Jetté M, Sidney K, Blümchen G. Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity. Clin Cardiol 1990; 13: 555-565
• 21 Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2001; 1: CD001800
• 22 Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 2009; 301: 2024-2035
• 23 Leprêtre PM, Vogel T, Bréchat PH, Dufour S, Richard R, Kaltenbach G, Berthel M, Lonsdorfer J. Impact of short-term aerobic interval training on maximal exercise in sedentary aged subjects. Int J Clin Pract 2009; 63: 1472-1478
• 24 Liu S, Manson JE. Dietary carbohydrates, physical inactivity, obesity, and the ‘metabolic syndrome’ as predictors of coronary heart disease. Curr Opin Lipidol 2001; 12: 395-404
• 25 Marzolini S, Oh PI, Brooks D. Effect of combined aerobic and resistance training versus aerobic training alone in individuals with coronary artery disease: a meta-analysis. Eur J Prev Cardiol 2012; 19: 81-94
• 26 Marzolini S, Oh PI, Thomas SG, Goodman JM. Aerobic and resistance training in coronary disease: single versus multiple sets. Med Sci Sports Exerc 2008; 40: 1557-1564
• 27 Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002; 346: 793-801
• 28 Naci H, Ioannidis JP. Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study. BMJ 2013; 347: f5577
• 29 Pavy B, Iliou MC, Vergès-Patois B, Brion R, Monpère C, Carré F, Aeberhard P, Argouach C, Borgne A, Consoli S, Corone S, Fischbach M, Fourcade L, Lecerf JM, Mounier-Vehier C, Paillard F, Pierre B, Swynghedauw B, Theodose Y, Thomas D, Claudot F, Cohen-Solal A, Douard H, Marcadet D. Exercise, Rehabilitation Sport Group (GERS), French Society of Cardiology. French Society of Cardiology guidelines for cardiac rehabilitation in adults. Arch Cardiovasc Dis 2012; 105: 309-328
• 30 Pierson LM, Herbert WG, Norton HJ, Kiebzak GM, Griffith P, Fedor JM, Ramp WK, Cook JW. Effects of combined aerobic and resistance training versus aerobic training alone in cardiac rehabilitation. J Cardiopulm Rehabil 2001; 21: 101-110
• 31 Sala V, Petrucci L, Monteleone S, Dall’angelo A, Miracca S, Conte T, Carlisi E, Ricotti S, D’Armini AM, Dalla Toffola E. Oxygen saturation and heart rate monitoring during a single session of early rehabilitation after cardiac surgery. Eur J Phys Rehabil Med 2016; 52: 12-19
• 32 Santa-Clara H, Fernhall B, Mendes M, Sardinha LB. Effect of a 1 year combined aerobic- and weight-training exercise programme on aerobic capacity and ventilatory threshold in patients suffering from coronary artery disease. Eur J Appl Physiol 2002; 87: 568-575
• 33 Scherr J, Wolfarth B, Christle JW, Pressler A, Wagenpfeil S, Halle M. Associations between Borg’s rating of perceived exertion and physiological measures of exercise intensity. Eur J Appl Physiol 2013; 113: 147-155
• 34 Sun XG, Hansen JE, Stringer WW. Oxygen uptake efficiency plateau best predicts early death in heart failure. Chest 2002; 141: 1284-1294
• 35 Tang LH, Zwisler AD, Taylor RS, Doherty P, Zangger G, Berg SK, Langberg H. Self-rating level of perceived exertion for guiding exercise intensity during a 12-week cardiac rehabilitation programme and the influence of heart rate reducing medication. J Sci Med Sport 2015 pii: S1440-2440(15)00176-0. [Epub ahead of print]
• 36 Valkeinen H, Aaltonen S, Kujala UM. Effects of exercise training on oxygen uptake in coronary heart disease: a systematic review and meta-analysis. Scand J Med Sci Sports 2010; 20: 545-555
• 37 Vona M, Codeluppi GM, Iannino T, Ferrari E, Bogousslavsky J, von Segesser LK. Effects of different types of exercise training followed by detraining on endothelium-dependent dilation in patients with recent myocardial infarction. Circulation 2009; 119: 1601-1608
• 38 Zoll J, Steiner R, Meyer K, Vogt M, Hoppeler H, Flück M. Gene expression in skeletal muscle of coronary artery disease patients after concentric and eccentric endurance training. Eur J Appl Physiol 2006; 96: 413-422