Different Endurance Training Protocols in Cardiac Patients

Study Overview
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Brief Summary
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It is the aim of our study to compare the effects of 6 and/or 2 years of either HIT (carried out at correctly assessed 85-95% of maximal heart rate), pyramid, or continuous endurance training, on changes of physical exercise capacity in cardiac patients.

Detailed Description
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The three exercise arms (isocaloric) are composed as follows: Endurance training: 31 min at 65-75% HRmax, making it a total of 25min; HIT: 4x4min intervals at 85-95% HRmax divided by 3x3min of active recovery at 60-70% HRmax, making it a total of 25 min; Pyramid: One pyramid consists of 8 one-minute blocks. Those are grouped starting with one block of 70-75% HRmax, followed by one block at 75-80% HRmax and another one at 80-85% HRmax. The top of the pyramid are 2 blocks of 85-90% HRmax. Intensity is lowered afterwards with one block of 80-85% HRmax, followed by one block at 75-80% HRmax and last one at 70-75% HRmax. Two more pyramids follow, each divided by 2min of active recovery at 65-70% HRmax, making it a total of 28min. All protocols are initiated by 5min of warm-up and end with 5min of cool-down, both at 60-70% HRmax. Primary Outcome: Individual maximum power output in watt (Pmax). Secondary Outcome: Change of power output in watt at lactate tresholds at 2 and 4mmol/l.

Official Title
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Effects of Different Endurance Training Protocols on Physical Performance in Cardiac Patients

Conditions
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Coronary Artery Disease

Intervention / Treatment
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* Other: Continuous Endurance Training
* Other: Pyramid Training
* Other: High-intensity interval training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: acute coronary syndrome (STEMI - NONSTEMI) aortocoronary bypass surgery percutaneous coronary intervention (PCI) state after stable coronary heart disease state after heart surgeries state after myo-, endo-, or pericarditis state after heart- or lung-transplantation state after heart failure state after pulmonary hypertension state after peripheral venous disease state after electrophysiological surgery state after implantation of an implantable cardioverter or difibrillator Patients at high risk Patients with cardiac dysrhythmias or sudden death Exclusion Criteria: unstable angina pectoris Heart failure (NYHA IV) acute myo-, endo-, or pericarditis or other infections pulmonary-arterial embolism or phlebothrombosis within 6 months hemodynamic instable dysrhythmias hypertrophic cardiomyopathy medical conditions which prevent patients from complying with the exercise program

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Continuous Endurance training<br>Endurance training with constant work load 31min at 65-75% maximal heart rate (HRmax) | Other: Pyramid Training<br>* One pyramid consists of 8 one-minute blocks. Those are grouped starting with one block of 70-75% HRmax, followed by one block at 75-80% HRmax and another one at 80-85% HRmax. The top of the pyramid are 2 blocks of 85-90% HRmax. Intensity is lowered afterwards with one block of 80-85% HRmax, followed by one block at 75-80% HRmax and last one at 70-75% HRmax. Two more pyramids follow, each divided by 2min of active recovery at 65-70% HRmax, making it a total of 28min.<br>Other: High-intensity interval training<br>* HIT: 4x4 min intervals at85-95% HRmax divided by 3x3min of active recovery at 60-70% HRmax, making it a total of 25min.<br>|
| Experimental: Pyramid Training<br>One pyramid consists of 8 one-minute blocks. Those are grouped starting with one block of 70-75% HRmax, followed by one block at 75-80% HRmax and another one at 80-85% HRmax. The top of the pyramid are 2 blocks of 85-90% HRmax. Intensity is lowered afterwards with one block of 80-85% HRmax, followed by one block at 75-80% HRmax and last one at 70-75% HRmax. Two more pyramids follow, each divided by 2min of active recovery at 65-70% HRmax, making it a total of 28min. | Other: Continuous Endurance Training<br>* Endurance training with constant work load 31min at 65-75% Hrmax<br>Other: High-intensity interval training<br>* HIT: 4x4 min intervals at85-95% HRmax divided by 3x3min of active recovery at 60-70% HRmax, making it a total of 25min.<br>|
| Experimental: High-intensity intervall training<br>HIT: 4x4 min intervals at85-95% HRmax divided by 3x3min of active recovery at 60-70% HRmax, making it a total of 25min. | Other: Continuous Endurance Training<br>* Endurance training with constant work load 31min at 65-75% Hrmax<br>Other: Pyramid Training<br>* One pyramid consists of 8 one-minute blocks. Those are grouped starting with one block of 70-75% HRmax, followed by one block at 75-80% HRmax and another one at 80-85% HRmax. The top of the pyramid are 2 blocks of 85-90% HRmax. Intensity is lowered afterwards with one block of 80-85% HRmax, followed by one block at 75-80% HRmax and last one at 70-75% HRmax. Two more pyramids follow, each divided by 2min of active recovery at 65-70% HRmax, making it a total of 28min.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Physical work capacity (PWC) | PWC will be measured by graded exercise testing on cycle ergometer. | 6 weeks or 36 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Heart rate | Heart rate will be measured by graded exercise testing on cycle ergometer. | 6 weeks or 36 weeks | 
| Blood pressure | Blood pressure will be measured by graded exercise testing on cycle ergometer. | 6 weeks or 36 weeks | 
| Lactate Thresholds | Lactate thresholds will be measured by graded exercise testing on cycle ergometer. | 6 weeks or 36 weeks | 
| Metabolical and cellular blood parameter | Blood will be taken before and after intervention | 6 weeks or 36 weeks | 
| BMI | BMI will be taken before and after intervention | 6 weeks or 36 weeks | 
| Gene expression | Gene expression will be taken before and after intervention | 6 weeks or 36 weeks | 
| Quality of Life | Quality of Life will be taken before and after intervention | 6 weeks or 36 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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High-Intensity Interval Training, Continuous Training, Pyramid Training, Physical Performance, Training Protocol, Cardiac Rehabilitation