The effects of high-intensity interval training, Nordic walking and moderate-to-vigorous intensity continuous training on functional capacity, depression and quality of life in patients with coronary artery disease enrolled in cardiac rehabilitation: A randomized controlled trial (CRX study),Progress in Cardiovascular Diseases

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The effects of high-intensity interval training, Nordic walking and moderate-to-vigorous intensity continuous training on functional capacity, depression and quality of life in patients with coronary artery disease enrolled in cardiac rehabilitation: A randomized controlled trial (CRX study)
Progress in Cardiovascular Diseases ( IF 9.1 ) Pub Date : 2021-07-07 , DOI: 10.1016/j.pcad.2021.07.002
Jennifer L Reed ₁ , Tasuku Terada ₂ , Lisa M Cotie ₃ , Heather E Tulloch ₄ , Frans H Leenen ₅ , Matheus Mistura ₂ , Harleen Hans ₂ , Hong-Wei Wang ₆ , Sol Vidal-Almela ₇ , Robert D Reid ₄ , Andrew L Pipe ₄

Affiliation

Exercise Physiology and Cardiovascular Health Lab, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
Exercise Physiology and Cardiovascular Health Lab, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; School of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
School of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Brain and Heart Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
Brain and Heart Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
Exercise Physiology and Cardiovascular Health Lab, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada; Institut du savoir Montfort, Hôpital Montfort, Ottawa, Canada.

Background

Coronary artery disease (CAD) patients undergoing revascularization procedures often experience ongoing, diminished functional capacity, high rates of depression and markedly low quality of life (QoL). In CAD patients, studies have demonstrated that high-intensity interval training (HIIT) is superior to traditional moderate-to-vigorous intensity continuous training (MICT) for improving functional capacity, whereas no differences between Nordic walking (NW) and MICT have been observed. Mental health is equally as important as physical health, yet few studies have examined the impact of HIIT and NW on depression and QoL. The purpose of this randomized controlled trial (RCT) was to compare the effects of 12 weeks of HIIT, NW and MICT on functional capacity in CAD patients. The effects on depression severity, brain-derived neurotrophic factor (BDNF) and QoL were also examined.

Methods

CAD patients who underwent coronary revascularization procedures were randomly assigned to: (1) HIIT (4 × 4-min of high-intensity work periods at 85%–95% peak heart rate [HR]), (2) NW (resting HR [RHR] + 20–40 bpm), or (3) MICT (RHR + 20–40 bpm) twice weekly for 12 weeks. Functional capacity (six-min walk test [6MWT]), depression (Beck Depression Inventory-II [BDI-II]), BDNF (from a blood sample), and general (Short-Form 36 [SF-36]) and disease-specific (HeartQoL) QoL were measured at baseline and follow-up. Linear mixed-effects models for repeated measures were used to test the effects of time, group and time × group interactions.

Results

N = 135 CAD patients (aged 61 ± 7 years; male: 85%) participated. A significant time × group interaction (p = 0.042) showed greater increases in 6MWT distance (m) for NW (77.2 ± 60.9) than HIIT (51.4 ± 47.8) and MICT (48.3 ± 47.3). BDI-II significantly improved (HIIT: −1.4 ± 3.7, NW: −1.6 ± 4.0, MICT: −2.3 ± 6.0 points, main effect of time: p < 0.001) whereas BDNF concentrations did not change (HIIT: -2.5 ± 9.6, NW: -0.4 ± 7.7, MICT: −1.2 ± 6.4 ng/mL, main effect of time: p > 0.05). Significant improvements in SF-36 and HeartQoL values were observed (main effects of time: p < 0.05). HIIT, NW and MICT participants attended 17.7 ± 7.5, 18.3 ± 8.0 and 16.1 ± 7.3 of the 24 exercise sessions, respectively (p = 0.387).

Conclusions

All exercise programmes (HIIT, NW, MICT) were well attended, safe and beneficial in improving physical and mental health for CAD patients. NW was, however, statistically and clinically superior in increasing functional capacity, a predictor of future cardiovascular events.

中文翻译：

高强度间歇训练、越野行走和中高强度持续训练对参加心脏康复治疗的冠状动脉疾病患者的功能能力、抑郁和生活质量的影响：一项随机对照试验（CRX 研究）

背景

接受血运重建手术的冠状动脉疾病 (CAD) 患者经常经历持续的、功能能力下降、抑郁率高和生活质量 (QoL) 显着降低。在 CAD 患者中，研究表明高强度间歇训练 (HIIT) 在提高功能能力方面优于传统的中高强度持续训练 (MICT)，而北欧式步行 (NW) 和 MICT 之间没有观察到差异. 心理健康与身体健康同样重要，但很少有研究检查 HIIT 和 NW 对抑郁症和生活质量的影响。这项随机对照试验 (RCT) 的目的是比较 12 周的 HIIT、NW 和 MICT 对 CAD 患者功能能力的影响。对抑郁症严重程度的影响，

方法

接受冠状动脉血运重建手术的 CAD 患者被随机分配到：(1) HIIT（4 × 4 分钟的高强度工作期，峰值心率 [HR] 为 85%–95%），(2) NW（静息心率 [HR] RHR] + 20–40 bpm)，或 (3) MICT (RHR + 20–40 bpm) 每周两次，持续 12 周。功能能力（六分钟步行测试 [6MWT]）、抑郁症（贝克抑郁量表-II [BDI-II]）、BDNF（来自血液样本）和一般（Short-Form 36 [SF-36]）和疾病在基线和随访时测量特定 (HeartQoL) QoL。重复测量的线性混合效应模型用于测试时间、组和时间×组交互的影响。

结果

N = 135 名 CAD 患者（年龄 61 ± 7 岁；男性：85%）参与。显着的时间 × 组交互 ( p = 0.042) 显示，NW (77.2 ± 60.9) 的 6MWT 距离 (m) 比 HIIT (51.4 ± 47.8) 和 MICT (48.3 ± 47.3) 增加更大。BDI-II 显着改善（HIIT：-1.4 ± 3.7，NW：-1.6 ± 4.0，MICT：-2.3 ± 6.0 分，时间主效应：p < 0.001）而 BDNF 浓度没有变化（HIIT：-2.5 ± 9.6 ，NW：-0.4 ± 7.7，MICT：-1.2 ± 6.4 ng/mL，时间的主效应：p > 0.05）。观察到 SF-36 和 HeartQoL 值的显着改善（时间的主要影响：p < 0.05）。HIIT、NW 和 MICT 参与者分别参加了 24 次锻炼中的 17.7 ± 7.5、18.3 ± 8.0 和 16.1 ± 7.3 ( p= 0.387）。