The importance of cardiopulmonary exercise test in determining training zones in cardiac rehabilitation and the time course of cardiopulmonary adaptations to high-intensity interval training training in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction patients

    Authors

    Keywords

    cardiopulmonary test to exhaustion, functional capacity, exercise prescription, high-intensity interval training, myocardial infarction

    DOI

    https://doi.org/10.15836/ccar2022.257

    Full Text

    **Introduction**: Functional capacity, also termed maximal oxygen consumption (VO2max), or aerobic fitness, has been shown to be an independent risk factor for all-cause and cardiovascular disease mortality. The cardiopulmonary exercise test (CPET) is the golden standard for assessing the functional capacity of the patient and it is becoming the integral part of the growing number of recommendations and guidelines. (1, 2) While high-intensity interval training (HIIT) would seem to be more effective than other types of training in improving cardiac performance and function (3), the time course of functional adaptations to this training in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction patients is still unknown. Therefore, the aim was to assess the progressive cardiopulmonary improvements throughout the process of 12 weeks of individually-prescribed HIIT training. **Patients and Methods:** 16 STEMI and NSTEMI patients (age 58 ± 10 years; VO2max 19 ± 5.3 ml min-1 kg-1) underwent 12 weeks of supervised cycling HIIT (4x4 min at 85-95% of HRmax) 3 times per week. Functional capacity (VO2max) and all cardiopulmonary parameters ware assessed by means of the incremental cardiopulmonary test to exhaustion (CPET) every 4 throughout the training program. Individual training zones were prescribed and adjusted according to the parameters obtained in CPET. **Results:** Peak VO2 increased significantly by 8% (19.2 ± 5.1 vs 20.8 ± 5.0 mil min-1 kg-1, P=.002) across the group already after 4 weeks of training. In the same timepoint, anaerobic threshold (AT) and respiratory compensation point (RCP) significantly improved by 15% (12.4 ± 3.1 vs 14.3 ± 3.0 mil min-1 kg-1, P<.001) and 19% (15.5 ± 4.2 vs 18.6 ± 4.3 mil min-1 kg-1, P<.001), respectively. The absolute improvement in VO2peak at the end of the 12-week training was 32% (19.2 ± 5.1 vs 25.5 ± 4.9 mil min-1 kg-1, P<.001) **Conclusion:** 4 weeks of HIIT are enough to induce significant functional adaptations like VO2max, VO2 at AT and RCP in STEMI and NSTEMI patients provided that patients are trained at the same in terms of volume, but at individually tailored intensity. Moreover, across 12 weeks of training, HIIT has proven to be effective training method in increasing functional capacity as well as exercise tolerance in STEMI and NSTEMI patients.

    Literature

    1. Guazzi M, Arena R, Halle M, Piepoli MF, Myers J, Lavie CJ. 2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations. Circulation. 2016 June 14;133(24):e694–711. https://doi.org/10.1161/CIR.0000000000000406
    2. Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, et al. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2022 February 19;29(1):230–45. https://doi.org/10.1093/eurjpc/zwab007
    3. D’Andrea A, Carbone A, Ilardi F, Pacileo M, Savarese C, Sperlongano S, et al. Effects of High Intensity Interval Training Rehabilitation Protocol after an Acute Coronary Syndrome on Myocardial Work and Atrial Strain. Medicina (Kaunas). 2022 March 21;58(3):453. https://doi.org/10.3390/medicina58030453
    Cardiologia Croatica
    Back to search

    The importance of cardiopulmonary exercise test in determining training zones in cardiac rehabilitation and the time course of cardiopulmonary adaptations to high-intensity interval training training in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction patients

    Extended Abstract
    Issue9-10
    Published
    Pages257
    PDF via DOIhttps://doi.org/10.15836/ccar2022.257
    cardiopulmonary test to exhaustion
    functional capacity
    exercise prescription
    high-intensity interval training
    myocardial infarction

    Authors

    Dijana Travica Samsa*ORCIDSpecial Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism "Thalassotherapia Opatija", Opatija, Croatia
    Kristina SkročeORCIDThe Faculty of Medicine - University of Rijeka, Rijeka, Croatia
    Viktor IvanišORCIDSpecial Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism "Thalassotherapia Opatija", Opatija, Croatia
    Koraljka KneževićORCIDSpecial Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism "Thalassotherapia Opatija", Opatija, Croatia
    Danijel PremušORCIDSpecial Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism "Thalassotherapia Opatija", Opatija, Croatia
    Irena Kužet MiokovićORCIDSpecial Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism "Thalassotherapia Opatija", Opatija, Croatia
    Marina NjegovanORCIDSpecial Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism "Thalassotherapia Opatija", Opatija, Croatia
    Viktor PeršićORCIDSpecial Hospital for Medical Rehabilitation of the Heart and Lung Diseases and Rheumatism "Thalassotherapia Opatija", Opatija, Croatia

    *Correspondence email: dijana.travica@gmail.com

    Full Text

    Introduction: Functional capacity, also termed maximal oxygen consumption (VO2max), or aerobic fitness, has been shown to be an independent risk factor for all-cause and cardiovascular disease mortality. The cardiopulmonary exercise test (CPET) is the golden standard for assessing the functional capacity of the patient and it is becoming the integral part of the growing number of recommendations and guidelines. (1, 2) While high-intensity interval training (HIIT) would seem to be more effective than other types of training in improving cardiac performance and function (3), the time course of functional adaptations to this training in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction patients is still unknown. Therefore, the aim was to assess the progressive cardiopulmonary improvements throughout the process of 12 weeks of individually-prescribed HIIT training.

    Patients and Methods: 16 STEMI and NSTEMI patients (age 58 ± 10 years; VO2max 19 ± 5.3 ml min-1 kg-1) underwent 12 weeks of supervised cycling HIIT (4x4 min at 85-95% of HRmax) 3 times per week. Functional capacity (VO2max) and all cardiopulmonary parameters ware assessed by means of the incremental cardiopulmonary test to exhaustion (CPET) every 4 throughout the training program. Individual training zones were prescribed and adjusted according to the parameters obtained in CPET.

    Results: Peak VO2 increased significantly by 8% (19.2 ± 5.1 vs 20.8 ± 5.0 mil min-1 kg-1, P=.002) across the group already after 4 weeks of training. In the same timepoint, anaerobic threshold (AT) and respiratory compensation point (RCP) significantly improved by 15% (12.4 ± 3.1 vs 14.3 ± 3.0 mil min-1 kg-1, P<.001) and 19% (15.5 ± 4.2 vs 18.6 ± 4.3 mil min-1 kg-1, P<.001), respectively. The absolute improvement in VO2peak at the end of the 12-week training was 32% (19.2 ± 5.1 vs 25.5 ± 4.9 mil min-1 kg-1, P<.001)

    Conclusion: 4 weeks of HIIT are enough to induce significant functional adaptations like VO2max, VO2 at AT and RCP in STEMI and NSTEMI patients provided that patients are trained at the same in terms of volume, but at individually tailored intensity. Moreover, across 12 weeks of training, HIIT has proven to be effective training method in increasing functional capacity as well as exercise tolerance in STEMI and NSTEMI patients.

    Literature

    1. 1.
      Guazzi M, Arena R, Halle M, Piepoli MF, Myers J, Lavie CJ. 2016 Focused Update: Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations. Circulation. 2016 June 14;133(24):e694–711.DOI
    2. 2.
      Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, et al. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2022 February 19;29(1):230–45.DOI
    3. 3.
      D’Andrea A, Carbone A, Ilardi F, Pacileo M, Savarese C, Sperlongano S, et al. Effects of High Intensity Interval Training Rehabilitation Protocol after an Acute Coronary Syndrome on Myocardial Work and Atrial Strain. Medicina (Kaunas). 2022 March 21;58(3):453.DOI