High-intensity interval training is now recommended for cardiac rehabilitation and could bring additional benefits, experts say.
High-intensity interval training is safe and recommended for cardiac rehabilitation in most patients, according to a new position statement that spells out how to start and support patients on an exercise program.
The Australian position statement recommends moderate-to-vigorous physical activity on most days of the week for patients who have had a cardiac event, to reduce the risk of future events and improve quality of life.
Emerging evidence has shown that in some patients, high-intensity interval training will give more benefits than moderate-intensity continuous training, the experts said.
At the very least, half an hour of aerobic exercise three times a week was the minimum threshold to achieve cardiovascular benefits, the experts said in the position statement, published in Heart, Lung and Circulation and presented at the Cardiac Society of Australia and New Zealand conference in Adelaide this month.
Once a patient has had an aerobic exercise assessment, the experts suggested they progress slowly to moderate to high-intensity aerobic exercise on three or more days per week.
If patients were assessed as being able to do high-intensity interval training, they should do so on at least two sessions each week.
The authors suggested a commonly used HIIT model of a warm-up, followed by four four-minute intervals at 75%–90% peak heart rate, with three minutes of recovery in between each interval at around 60% peak heart rate, followed by a cool-down.
“Moderate-intensity continuous training (MICT) is beneficial and safe for all patients with coronary disease and is strongly recommended,” the authors wrote.
“More recently, high-intensity interval training (HIIT) has also been recommended and deemed safe by international authorities for various patients with stable cardiac disease and may provide superior outcomes compared to moderate-intensity continuous training.”
The authors recommended moderate-intensity continuous training for patients with low aerobic exercise capacity but could be moved to high-intensity sessions once aerobic exercise capacity improves.
“Select patients with stable coronary disease, and a good level of aerobic exercise capacity, may progress to high-intensity exercise after a brief period of moderate-intensity exercise training,” the authors wrote.
The authors also recommend two to three sessions of resistance training a week. Sessions should be at least 20 minutes, with 48 hours between sessions to enable muscles to recover.
This will help prevent or reverse sarcopenia after coronary artery bypass grafting and with older age, as well as metabolic, vascular, cognitive, frailty and mental health conditions, they said.
“Despite historical concerns regarding safety, resistance exercise is well tolerated by patients with cardiovascular conditions, with very few adverse cardiovascular events reported and acute haemodynamic changes comparable to aerobic exercise,” they wrote.
However, before starting patients on an exercise program, clinicians should consider contraindications such as progressive worsening of exercise tolerance, dyspnoea at rest or on exertion, unstable angina, recent embolism, thrombophlebitis, active pericarditis or myocarditis.
The authors said health professionals should identify patients’ individual exercise and physical activity needs, values and preferences and help them set realistic short- and medium-term goals.
“A patient-centred approach is important, and communication with patients should be non-judgemental and respectful,” they wrote.
“Shared decision making, where patients and their carers are actively involved in the care process, results in personalised interventions that are more likely to improve engagement, treatment adherence, and clinical outcomes.”
