Chronic Heart Failure
Conditions
Keywords
exercise training, chronic heart failure, parasympathetic, autonomic nervous system, cardiorespiratory fitness, cardiac rehabilitation
Brief summary
Purpose: Exaggerated sympathetic nervous system (SNS) activity associated with low heart rate variability (HRV) is considered as a trigger of cardiac arrhythmias and sudden death. Regular exercise training is efficient to improve autonomic balance. In 2013, the investigators published that a single session of an optimized short-high intensity interval exercise with passive recovery (HIIT) protocol was efficient in chronic heart failure (CHF) patients for enhancing vagal tone and to decrease arrhythmias in the 24-h post exercise period when compared to a single session of moderate intensity continuous exercise (MICT). Nevertheless the effects of HIIT training performed on several weeks have never yet been studied on the parameters described by Coumel's triangle (the arrhythmogenic substrate, the trigger factor as premature ventricular contraction and the modulation factors of which the most common is the autonomic nervous system). The aim of this study was to verify the superiority of HIIT to enhance parasympathetic activity, cardiorespiratory fitness and cardiac function when compared to MICT in a short and intense cardiac rehabilitation program.
Detailed description
Before and after the Rehabilitation Program (RP), all patients underwent a 24-hour ECG recording, an echocardiography, a cardiopulmonary exercise test. The RP consisted of 2 types of exercise training according to the randomization: 1. a short-high intensity interval exercise with passive recovery 2. a classical moderate and continuous exercise training at 60% of peak power output The RP lasted 4 weeks.
Interventions
BEHAVIORALexercise training in heart failure with HIIT
to compare MICT vs HIIT 5 days/week during 4 weeks in a Cardiovascular Centre.
Sponsors
Institut National de la Santé Et de la Recherche Médicale, France
University Hospital, Toulouse
Clinique Pasteur
Cardiovascular and Pulmonary Rehabilitation Center of Saint Orens
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Investigator, Outcomes Assessor)
Masking description
heart rate variability analyses and echocardiography were performed by investigators blind to randomization
Intervention model description
subjects were randomly assigned to one of the two groups: 1. high intensity interval training 2. moderate intensity and continuous training Block size = 4, allocation ratio 1:1
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* stable chronic heart failure with NYHA functional class from I to III * stable left ventricular ejection fraction (LVEF) \< 45% over at least 6 months * stable optimal medical therapy including a beta-blocker and an angiotensin-converting enzyme inhibitor or angiotensin receptor blockers for at least 6 weeks * ability to perform a maximal cardiopulmonary exercise test * admitted to the Rehabilitation Centre for a comprehensive Cardiovascular Rehabilitation Program
Exclusion criteria
* any relative or absolute contraindications to exercise training according to current recommendations * fixed-rate pacemaker with heart rate limits set lower than exercise training target * major cardiovascular event or procedure within the 3 months preceding enrolment * chronic atrial fibrillation * heart failure secondary to significant uncorrected primary valve disease (except for mitral regurgitation secondary to left ventricular dysfunction) * heart failure secondary to congenital heart disease or obstructive cardiomyopathy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| High Frequency power in normalized units (HFnu%) | Change from baseline through study completion, an average of 4 weeks (measured during the night period for stationary signal) | based on Heart Rate Variability, the power spectral density of the HF (0.15-0.40 Hz, ms2.Hz-1) bands were calculated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| First ventilatory threshold (VT1) (ml.min.kg) | Change from baseline through study completion, an average of 4 weeks | VO2 at VT1 was measured with Cardiopulmonary Exercise Test. |
| Heart Rate Recovery (beats per minute, bpm) | Change from baseline through study completion, an average of 4 weeks | Heart Rate Recovery (with passive recovery) at 1, 2 and 3 minutes after peak exercise (in beats per minute, bpm) |
| maximal oxygen consumption (VO2peak ml.min.kg) | Change from baseline through study completion, an average of 4 weeks | VO2 at peak exercise was measured with Cardiopulmonary Exercise Test. |
| premature ventricular contraction, (n/24h) | Change from baseline through study completion, an average of 4 weeks | Ectopic ventricular beats were classified as isolated premature contractions, bigeminy, and salves. |
| NT-pro-BNP, (ng/L) | Change from baseline through study completion, an average of 4 weeks | blood sample analysis |
| Left Ventricular Ejection Fraction (LVEF, %) | Change from baseline through study completion, an average of 4 weeks | LV volumes and ejection fraction were calculated from apical recordings by modified biplane Simpson's method. |
Outcome results
None listed