- Email: [email protected]
Reply: High Intensity Interval versus Moderate Intensity Continuous Training in Patients with Coronary Artery Disease
LETTER TO THE EDITOR
Heart, Lung and Circulation (2017) 26, 528–529 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2017.01.006
Reply: High Intensity Interval versus Moderate Intensity Continuous Training in Patients with Coronary Artery Disease To the Editor We wish to thank Dr Cochrane for expressing an interest in our analysis of high intensity interval training (HIIT) versus moderate intensity continuous training (MICT) in patients with coronary artery disease (CAD) [1]. Our study [2] aimed to examine the relative merits of HIIT and MICT in these patients. We concluded that neither HIIT nor MICT has demonstrated clear superiority over the other, particularly in terms of patients’ long-term prognosis. We suggested that this was due to a lack of evidence in this domain, which is reflected by the current guidelines on secondary prevention, where level B and C evidence remain the sole basis for all current recommendations in this regard [3]. We reinforced this notion by indicating the need for large scale studies with mechanisms for long term follow-up, as similar studies (with follow-up up to 16 years) performed in healthy individuals have favoured vigorous over moderate intensity exercise in the prevention of CAD and improvement of the subjects’ risk factor profiles [4]. Further, HIIT has also been shown to have superior efficacy in improving vascular function in patients with a range of pre-existing cardiometabolic disorders [5]. While HIIT undertaken in isolation may prove to be unsustainable over time for some, patients’ compliance with various exercise programs has not been thoroughly and comprehensively studied, nor have the factors that influence it. Logically, exercise regimens that are achievable with respect to patients’ age and underlying fitness are most likely to be continued. Indeed, instead of pitting one form of exercise against another, our study was really designed to differentiate and characterise them so that they can be tailored to the needs and physiological attributes of our patients in order to enhance their long-term adherence to the exercise programs. Finally, maximal aerobic capacity, often termed VO2max, remains a reasonable clinical and study endpoint in our
opinion, as it has been shown to correlate directly with patients’ overall and cardiac mortality in those with established coronary artery disease [6,7]. We feel therefore the continued use of VO2max should be encouraged. Kevin Liou, MPH, FRACP a,b,* Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia b Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia a
Andrew Keech, PhD School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia Jennifer Yu, FRACP a,b Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia b Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia a
Jennifer Fildes, RN, CNC Cardiac Rehabilitation Unit, Prince of Wales Hospital, Sydney, NSW, Australia Sze-Yuan Ooi, MD, FRACP a,b Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia b Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia a
*
Corresponding author at: Eastern Heart Clinic, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia. Tel.: + 61 2 93820700; fax: +61 2 93820799. Email: [email protected] (K. Smith Jr.). Received 17 November 2016
Crown Copyright © 2017 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.
529
Letter to the Editor
References [1] Cochrane A. Letter to the Editor regarding the manuscript by Liou K. et al., Heart Lung Circ 2016; 25: 166-174 [4_TD$IF]3Cochrane. Andrew Heart, Lung Circ 2016;0(0). [2] Liou K, Ho S, Fildes J, Ooi SY. High Intensity Interval versus Moderate Intensity Continuous Training in Patients with Coronary Artery Disease: A Meta-analysis of Physiological and Clinical Parameters. Heart Lung Circ 2016;25:166–74. [3] Smith Jr SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart
[4]
[5]
[6]
[7]
Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol 2011;58:2432–46. Swain DP, Franklin BA. Comparison of Cardioprotective Benefits of Vigorous Versus Moderate Intensity Aerobic Exercise. Am J Cardiol 2006;97:141–7. Ramos JS, Dalleck LC, Tjonna AE, Beetham KS, Coombes JS. The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review and meta-analysis. Sports Med 2015;45:679–92. Kavanagh T, Mertens DJ, Hamm LF, Beyene J, Kennedy J, Corey P, et al. Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation. J Am Coll Cardiol 2003;42:2139–43. Vanhees L, Fagard R, Thijs L, Staessen J, Amery A. Prognostic significance of peak exercise capacity in patients with coronary artery disease. J Am Coll Cardiol 1994;23:358–63.
Heart, Lung and Circulation (2017) 26, 528–529 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2017.01.006
Reply: High Intensity Interval versus Moderate Intensity Continuous Training in Patients with Coronary Artery Disease To the Editor We wish to thank Dr Cochrane for expressing an interest in our analysis of high intensity interval training (HIIT) versus moderate intensity continuous training (MICT) in patients with coronary artery disease (CAD) [1]. Our study [2] aimed to examine the relative merits of HIIT and MICT in these patients. We concluded that neither HIIT nor MICT has demonstrated clear superiority over the other, particularly in terms of patients’ long-term prognosis. We suggested that this was due to a lack of evidence in this domain, which is reflected by the current guidelines on secondary prevention, where level B and C evidence remain the sole basis for all current recommendations in this regard [3]. We reinforced this notion by indicating the need for large scale studies with mechanisms for long term follow-up, as similar studies (with follow-up up to 16 years) performed in healthy individuals have favoured vigorous over moderate intensity exercise in the prevention of CAD and improvement of the subjects’ risk factor profiles [4]. Further, HIIT has also been shown to have superior efficacy in improving vascular function in patients with a range of pre-existing cardiometabolic disorders [5]. While HIIT undertaken in isolation may prove to be unsustainable over time for some, patients’ compliance with various exercise programs has not been thoroughly and comprehensively studied, nor have the factors that influence it. Logically, exercise regimens that are achievable with respect to patients’ age and underlying fitness are most likely to be continued. Indeed, instead of pitting one form of exercise against another, our study was really designed to differentiate and characterise them so that they can be tailored to the needs and physiological attributes of our patients in order to enhance their long-term adherence to the exercise programs. Finally, maximal aerobic capacity, often termed VO2max, remains a reasonable clinical and study endpoint in our
opinion, as it has been shown to correlate directly with patients’ overall and cardiac mortality in those with established coronary artery disease [6,7]. We feel therefore the continued use of VO2max should be encouraged. Kevin Liou, MPH, FRACP a,b,* Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia b Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia a
Andrew Keech, PhD School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia Jennifer Yu, FRACP a,b Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia b Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia a
Jennifer Fildes, RN, CNC Cardiac Rehabilitation Unit, Prince of Wales Hospital, Sydney, NSW, Australia Sze-Yuan Ooi, MD, FRACP a,b Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia b Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia a
*
Corresponding author at: Eastern Heart Clinic, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia. Tel.: + 61 2 93820700; fax: +61 2 93820799. Email: [email protected] (K. Smith Jr.). Received 17 November 2016
Crown Copyright © 2017 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.
529
Letter to the Editor
References [1] Cochrane A. Letter to the Editor regarding the manuscript by Liou K. et al., Heart Lung Circ 2016; 25: 166-174 [4_TD$IF]3Cochrane. Andrew Heart, Lung Circ 2016;0(0). [2] Liou K, Ho S, Fildes J, Ooi SY. High Intensity Interval versus Moderate Intensity Continuous Training in Patients with Coronary Artery Disease: A Meta-analysis of Physiological and Clinical Parameters. Heart Lung Circ 2016;25:166–74. [3] Smith Jr SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart
[4]
[5]
[6]
[7]
Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol 2011;58:2432–46. Swain DP, Franklin BA. Comparison of Cardioprotective Benefits of Vigorous Versus Moderate Intensity Aerobic Exercise. Am J Cardiol 2006;97:141–7. Ramos JS, Dalleck LC, Tjonna AE, Beetham KS, Coombes JS. The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: a systematic review and meta-analysis. Sports Med 2015;45:679–92. Kavanagh T, Mertens DJ, Hamm LF, Beyene J, Kennedy J, Corey P, et al. Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation. J Am Coll Cardiol 2003;42:2139–43. Vanhees L, Fagard R, Thijs L, Staessen J, Amery A. Prognostic significance of peak exercise capacity in patients with coronary artery disease. J Am Coll Cardiol 1994;23:358–63.