Effects of High-Intensity Interval vs. Moderate-Intensity Continuous Training on Cardiac Rehabilitation in Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis.

Tian Yue,Hui Liu,Fengxue Qi,Yan Wang,Zhaowei Kong

doi:10.3389/fcvm.2022.845225

Abstract

BackgroundStudies have shown that high-intensity interval training (HIIT) is superior to moderate-intensity continuous training (MICT) for increasing peak oxygen uptake (VO2peak) and reducing cardiovascular disease (CVD) and mortality. To our knowledge, previously published systematic reviews have neither compared different HIIT models with MICT nor investigated intervention frequencies of HIIT vs. MICT for purposes of improving cardiorespiratory fitness in patients with CVD.ObjectiveThe purpose of this meta-analysis was to compare the effects of different training models, intervention frequencies and weeks of HIIT vs. MICT on changes in cardiorespiratory fitness during cardiac rehabilitation (CR).MethodsA systematic search was carried out for research articles on randomized controlled trials (RCTs) indexed in the PubMed, Cochrane Library, Web of Science, Embase and Scopus databases for the period up to December 2021. We searched for RCTs that compared the effect of HIIT vs. MICT on cardiorespiratory fitness in patients with CVD.ResultsTwenty-two studies with 949 participants (HIIT: 476, MICT: 473) met the inclusion criteria. Sensitivity analysis revealed that HIIT increased VO2peak more than MICT (MD = 1.35). In the training models and durations, there was a greater increase in VO2peak with medium-interval HIIT (MD = 4.02) and more than 12 weeks duration (MD = 2.35) than with MICT. There were significant improvements in VO2peak with a HIIT frequency of 3 times/week (MD = 1.28). Overall, one minor cardiovascular and four non-cardiovascular adverse events were reported in the HIIT group, while six non-cardiovascular adverse events were reported in the MICT group.ConclusionHIIT is safe and appears to be more effective than MICT for improving cardiorespiratory fitness in patients with CVD. Medium-interval HIIT 3 times/week for more than 12 weeks resulted in the largest improvement in cardiorespiratory fitness during CR.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021245810, identifier: CRD42021245810.

Highlights

Cardiovascular disease (CVD) is responsible for more deaths than any other illness worldwide, and the past decade has witnessed a 12.5% increase in deaths, accounting for 1/3 of the global total [1]
Fourteen articles were excluded because of single-session intervention (n = 1), the lack of baseline data (n = 1), the study combined with gymnastics and underwater sports (n = 1), no cardiac rehabilitation (n = 2), without compared high-intensity interval training (HIIT) with moderate-intensity continuous training (MICT) (n = 5), no clarified a specific intervention (n = 1) and no measured the VO2peak (n = 3)
Our study found that one minor cardiovascular adverse event and four non-cardiovascular adverse events were reported in the HIIT group

Summary

Introduction

Cardiovascular disease (CVD) is responsible for more deaths than any other illness worldwide, and the past decade has witnessed a 12.5% increase in deaths, accounting for 1/3 of the global total [1]. Cardiac rehabilitation (CR) is a promising therapeutic approach to secondary prevention of CVD [3]. It includes health education, lifestyle changes, socialpsychological support, and supervised exercise [4]. Peak oxygen uptake (VO2peak), as the gold standard for evaluating cardiorespiratory fitness, has been identified as an important predictor of CVD and all-cause mortality [11]. Some studies have shown that CVD all-cause mortality decreases by 8–17% when individual cardiorespiratory fitness increases by one metabolic equivalent [12, 13]. Studies have shown that high-intensity interval training (HIIT) is superior to moderate-intensity continuous training (MICT) for increasing peak oxygen uptake (VO2peak) and reducing cardiovascular disease (CVD) and mortality. Previously published systematic reviews have neither compared different HIIT models with MICT nor investigated intervention frequencies of HIIT vs. MICT for purposes of improving cardiorespiratory fitness in patients with CVD

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