Comparison Between HIIT and MICT on the Phase III of Cardiac Rehabilitation
Condition: Patients With Coronary Artery Disease
MeSH terms: Coronary Artery Disease
Study type: Interventional

Summary: 
      The increase in the prevalence of cardiovascular diseases (CVD), directly associated with the
      aging of the population, is a concern for public health in Portugal. Given the high
      prevalence of risk factors and the increasing number of cases of CD throughout Alentejo,
      where there is no cardiac rehabilitation (CR) coverage, there is an urgent need for the
      implementation of a CR program.

      CR has evolved over the past decades to multidisciplinary approaches focused on education,
      individualized training, modification of risk factors, and overall well-being of cardiac
      patients. Studies suggest that high intensity interval training (HIIT) allows greater patient
      benefits compared to moderate continuous training (MCT), reversal of DC and increased aerobic
      capacity in CR patients. This study intends to compare HIIT and MCT interventions
      investigating direct and indirect associations between informally performed physical activity
      (AF), sedentary behavior, cardiovascular fitness and quality of life (QoL) among patients
      enrolled in RC programs in phase III.
    

Detailed description: 
      According to WHO (1) cardiovascular diseases (CVD) are the number 1 cause of death globally:
      an estimated 17.5 million people died from CVD in 2012, representing 31% of all global
      deaths. In 2013 there were 1.9 million deaths resulting from CVD of the circulatory system in
      the EU-28, which was correspondent to 37.5 % of all deaths considerably higher than the
      second most prevalent cause of death, cancer.

      In Portugal, cardiovascular diseases lead to morbidity and mortality rates, which makes
      evident the importance in the Public Health scenario and the need to implement measures aimed
      at primary and secondary prevention. In 2004, cardiovascular diseases signify 39% of all
      causes of death, since then a reduction in these values has been recorded and, according to
      more recent data (2013), the values are around 29.5%.

      As these pathologies are associated, among other causes, with aging, the Alentejo emerges as
      one of the regions where the prevalence of these pathologies is greater. In fact, since
      Alentejo is the oldest region, it becomes an authentic Living Lab. In this way, this study
      intends to study the effects of different types of cardiac rehabilitation (CR) programs,
      emphasizing in particular the use of a high intensity interval program that we will compare
      with a traditional program.

      For the program will be recruited patients who have been admitted in the Cardiology Services
      at Espírito Santo Hospital in Évora. Participants of both sexes will be included, between 18
      and 80 years of age, meeting the criteria for low or moderate risk, class B for participation
      and exercise supervision, absence of signs/symptoms after cardiac surgery, with a left
      ventricular ejection fraction greater than 40%, according to the American Heart Association
      and the American Association of Cardiovascular and Pulmonary Rehabilitation.

      Those who meet the inclusion criteria will be evaluated in a clinical context in order to
      determine the capacity to integrate phase III of CR. This phase will last about 6 weeks, will
      be held at the Nursing School located at the Espírito Santo Hospital.

      The sessions will be supervised and will take place on a cycloergometer and treadmill, 3
      times a week for 6 consecutive weeks. If a session is lost, it will be recovered that week or
      the following week. Each session will be limited to three participants.

      The HIIT protocol will consist of four four-minute intervals at high intensity, stimulating
      85-95% of peak-FC followed by active recovery at 70% peak-FC for a total of 20 minutes. The
      MCT protocol consists of continuously exerting moderate intensity, causing a peak-FC 70-75%
      for 27.5 minutes to equal the energy expenditure of the HIIT protocol. Both protocols will
      include a warm-up of 10 minutes at low moderate intensity (50-70% of peak-FC) and a 3 to 5
      minute calm return period was performed at 50% of peak-FC.

      During the intervention, the workload, FC and the subjective effort perception scale (EPE -
      Borg) will be recorded throughout each session, every minute for the HIIT training and all
      other minutes for the MTC. During the intervention the load will be adjusted to obtain the
      target FC.

      After the exercise session, participants will complete 1 of 18 items of the Physical Activity
      and Pleasure Scale (PACES) on a weekly basis in which subjects rate their appreciation for
      the exercise of that week on a seven-point scale.

      In the same period, the usual medical recommendations for cardiac rehabilitation through
      exercise will be provided to the Control Groups (phase III).

      When subjects complete phase III CR, they will be given guidelines on exercise and nutrition.
      The intention is that participants after the program have adopted a healthy lifestyle, where
      the practice of physical exercise is a reality. The intention is also to verify if
      participation in one of the different exercise programs that have been implemented, in phase
      III of CR, can possibly provide better results both in maintaining good life habits and also
      in reducing the time in the sedentary activities, the "Active Couch Potato" phenomenon. More
      than solving a health problem at a certain stage of a subject's life, it is intended to
      consolidate healthy habits of life.

      In order to verify which type of program allows to modify the habits of life towards the
      increase of the practice of physical activity, as well as the maintenance of these habits, we
      will carry out a follow-up at 6 months and one year after the beginning of the intervention.
    

Intervention name(s): High Intensity Interval Training Program; Moderate Intensity Continuous Training Program
Intervention type(s): Other; Other
Intervention description(s): The HIIT group performed 4 × 4-minute high-intensity intervals at 85%-95% HRpeak followed by a 1-minute recovery interval at 40% HRpeak, predicted with a supervised graded exercise test on a treadmill with the Bruce protocol. The protocol will include a warm-up of 10 minutes at low moderate intensity (50-70% of HRpeak) and a 3 to 5 minute calm return period at 50% of the HRpeak.
The supervised sessions will take place on treadmill, 3 times a week for 6 consecutive weeks. If a session is lost, it will be recovered that week or the following week. Each session will be limited to three participants.; The MICT protocol (usual care) consisted of a continuous bout of moderate-intensity exercise to elicit 70-75% HRpeak, rating of perceived exertion 3 to 5 (fairly light to somewhat hard), for 27.5 minutes to equate the energy expenditure with the HIIT protocol. The protocol will include a warm-up of 10 minutes at low moderate intensity (50-70% of HRpeak) and a 3 to 5 minute calm return period at 50% of the HRpeak.
The supervised sessions will take place on treadmill, 3 times a week for 6 consecutive weeks. If a session is lost, it will be recovered that week or the following week. Each session will be limited to three participants.
Other intervention name(s): HIIT; MICT
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cardiac Rehabilitation; High Intensity Interval Training; Moderate Intensity Continuous Training; Secondary prevention; Cardiovascular Risk Factors; Exercise-based Rehabilitation