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)
Section snippets
Alphabetical list of abbreviations
6MWT, six-min walk test BDI-II, Beck Depression Inventory-II BDNF, brain-derived neurotrophic factor BMI, body mass index CABG, coronary artery bypass graft surgery CAD, coronary artery disease CONSORT, consolidated standards of reporting trials CI, confidence interval CR, cardiac rehabilitation CV, coefficient of variation CVD, cardiovascular disease GXT, graded exercise test HIIT, high-intensity interval training HR, heart rate MCID, minimal clinically important difference MI, myocardial
Study design
This single-centre, parallel-group, RCT was conducted at the University of Ottawa Heart Institute (UOHI), a tertiary care cardiovascular institute. This study was registered with ClinicalTrials.gov (NCT02765568) and carried out in accordance with the consolidated standards of reporting trials (CONSORT) and template for intervention description and replication (TIDieR) checklist.19 The protocol was approved by the Ottawa Health Science Network Research Ethics Board (protocol #: 20160127-01H).
Recruitment
Functional capacity
Functional capacity was assessed using a 6MWT on a measured indoor track at baseline and follow-up.24 Patients were instructed to walk as far as possible for 6 min but not to run or jog. At 2, 3, and 4 min of the 6MWT, patients were provided with standardized encouragement and informed of the time remaining. Total walking distance was measured in meters. The measures were performed in duplicate; the average was used for statistical analyses. A suggested minimal clinically important difference
Results
Of the 1222 patients who were screened, 135 were eligible and consented to participate; a total of 43, 43 and 44 patients were randomized to HIIT, NW and MICT, respectively (see Fig. 1). Patients' demographics, anthropometrics, medical conditions and medications are presented in Table 1. Most patients were male and identified, on average, as being overweight or obese, and normotensive (many due to medical management). Most were taking statins, acetylsalicylic acid, β-blockers, anti-platelets,
Discussion
The physical and mental health benefits of traditional CR involving MICT are well established for patients with CAD.35 This RCT examined the efficacy of alternative exercise interventions (i.e. HIIT and NW) for improving functional capacity, depression severity, BDNF concentrations and QoL in patients with CAD who recently underwent coronary revascularization procedures. Contrary to our hypothesis, a significantly greater increase in functional capacity was achieved following NW when compared
Conclusion
The findings from this RCT reveal that NW facilitated greater improvements in functional capacity, an important predictor of future cardiovascular events,8 when compared to HIIT and MICT in patients with CAD. All exercise modalities produced significant, beneficial changes in functional capacity and improved depression severity and QoL. These offerings were well attended and safe. Depending on space, equipment, personnel (e.g. expertise, experience in NW instruction) and patient preference, CR
Sources of funding
This investigator initiated research was supported by the Innovations Fund of the Alternate Funding Plan for the Academic Health Sciences Centres of the Ministry of Ontario (PIs: Pipe, Reed) and Heart and Stroke Foundation of Canada (PI: Reid).
Declaration of Competing Interest
The authors declare they have no conflicts of interests.
Acknowledgments
We would like to thank the patients, CR staff and Anna Clarke, Christie Cole, Dr. Daniele Chirico, Kyle Scott, Brenna Czajkowski, Rachelle Beanlands, Janet Wilson, Aaron Brautigam and Yannick MacMillan for their contributions to this research.
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