Does exercise prescription based on estimated heart rate training zones exceed the ventilatory anaerobic threshold in patients with coronary heart disease undergoing usual-care cardiovascular rehabilitation? A United Kingdom perspective

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Abstract

In the United Kingdom (UK), exercise intensity is prescribed from a fixed percentage range (% heart rate reserve (%HRR)) in cardiac rehabilitation programmes. We aimed to determine the accuracy of this approach by comparing it with an objective, threshold-based approach incorporating the accurate determination of ventilatory anaerobic threshold (VAT). We also aimed to investigate the role of baseline cardiorespiratory fitness status and exercise testing mode dependency (cycle vs. treadmill ergometer) on these relationships.

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High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis.

Kassia S Weston, Ulrik Wisløff, Jeff Coombes (2014)

Cardiorespiratory fitness (CRF) is a strong determinant of morbidity and mortality. In athletes and the general population, it is established that high-intensity interval training (HIIT) is superior to moderate-intensity continuous training (MICT) in improving CRF. This is a systematic review and meta-analysis to quantify the efficacy and safety of HIIT compared to MICT in individuals with chronic cardiometabolic lifestyle diseases. The included studies were required to have a population sample of chronic disease, where poor lifestyle is considered as a main contributor to the disease. The procedural quality of the studies was assessed by use of a modified Physiotherapy Evidence Base Database (PEDro) scale. A meta-analysis compared the mean difference (MD) of preintervention versus postintervention CRF (VO2peak) between HIIT and MICT. 10 studies with 273 patients were included in the meta-analysis. Participants had coronary artery disease, heart failure, hypertension, metabolic syndrome and obesity. There was a significantly higher increase in the VO2peak after HIIT compared to MICT (MD 3.03 mL/kg/min, 95% CI 2.00 to 4.07), equivalent to 9.1%. HIIT significantly increases CRF by almost double that of MICT in patients with lifestyle-induced chronic diseases. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Is a threshold-based model a superior method to the relative percent concept for establishing individual exercise intensity? a randomized controlled trial

Ali E. Wolpern, Dara J. Burgos, Jeffrey Janot … (2015)

Background Exercise intensity is arguably the most critical component of the exercise prescription model. It has been suggested that a threshold based model for establishing exercise intensity might better identify the lowest effective training stimulus for all individuals with varying fitness levels; however, experimental evidence is lacking. The purpose of this study was to compare the effectiveness of two exercise training programs for improving cardiorespiratory fitness: threshold based model vs. relative percent concept (i.e., % heart rate reserve – HRR). Methods Apparently healthy, but sedentary men and women (n = 42) were randomized to a non-exercise control group or one of two exercise training groups. Exercise training was performed 30 min/day on 5 days/week for 12weeks according to one of two exercise intensity regimens: 1) a relative percent method was used in which intensity was prescribed according to percentages of heart rate reserve (HRR group), or 2) a threshold based method (ACE-3ZM) was used in which intensity was prescribed according to the first ventilatory threshold (VT1) and second ventilatory threshold (VT2). Results Thirty-six men and women completed the study. After 12weeks, VO2max increased significantly (p 5.9 %) and were categorized as responders. Alternatively, exercise training in the ACE-3ZM group elicited a positive improvement in relative VO2max (Δ > 5.9 %) in 100 % (12/12) of the individuals. Conclusions A threshold based exercise intensity prescription: 1). elicited significantly (p < 0.05) greater improvements in VO2max, and 2). attenuated the individual variation in VO2max training responses when compared to relative percent exercise training. These novel findings are encouraging and provide important preliminary data for the design of individualized exercise prescriptions that will enhance training efficacy and limit training unresponsiveness. Trial registration ClinicalTrials.gov Identifier: ID NCT02351713 Registered 30 January 2015.

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The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology.

Massimo F. Piepoli, Luc Vanhees, Karin Coninx … (2017)

Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in exercise implementation in common cardiovascular diseases.

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Author and article information

Journal

Title: European Journal of Preventive Cardiology

Abbreviated Title: Eur J Prev Cardiolog

Publisher: SAGE Publications

ISSN (Print): 2047-4873

ISSN (Electronic): 2047-4881

Publication date Created: May 22 2019

Publication date (Electronic): May 22 2019

Page: 204748731985271

Affiliations

[1 ]Academic Vascular Surgical Unit Hull York Medical School, Hull, UK

[2 ]Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK

[3 ]Atrium Health, Centre for Exercise and Health, Coventry, UK

[4 ]School of Sport & Wellbeing, University of Central Lancashire, Preston, UK

[5 ]School of Sport and Health Sciences, University of Hull, UK

Article

DOI: 10.1177/2047487319852711

PubMed ID: 31116574

SO-VID: 0ca74134-8d50-4115-a2b2-60fbfb3d00f3

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http://journals.sagepub.com/page/policies/text-and-data-mining-license

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Does exercise prescription based on estimated heart rate training zones exceed the ventilatory anaerobic threshold in patients with coronary heart disease undergoing usual-care cardiovascular rehabilitation? A United Kingdom perspective

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Most cited references 25

High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysis.

Is a threshold-based model a superior method to the relative percent concept for establishing individual exercise intensity? a randomized controlled trial

The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology.

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