A comparison of high versus low dose of exercise training in exercise-based cardiac rehabilitation: a randomized controlled trial with 12-months follow-up

Objective: To assess if a higher dose of exercise training in exercise-based cardiac rehabilitation could affect improvements in aerobic capacity and muscle strength. Design: Assessor-blinded randomized controlled trial with 12-months follow-up. Setting: Aarhus University Hospital, Aarhus, Denmark. Subjects: A total of 164 cardiac patients referred to exercise-based cardiac rehabilitation were recruited. Interventions: Patients were randomized to 1-hour exercise sessions either three times weekly for 12 weeks (36 sessions, high-dose group) or twice weekly for 8 weeks (16 sessions, low-dose group). The same standardized exercise and intensity protocol including aerobic and muscle strength training was used in all participants. Main measures: Primary outcome was changes in VO 2peak . Secondary outcomes were changes in maximal workload, muscle strength and power. Measures were obtained at baseline, after termination of the rehabilitation programme and at follow-up after 6 and 12 months. Results: After the end of intervention, statistically significant between-group differences were seen in favour of the high-dose group in all outcomes: VO 2peak 2.6 (mL kg −1 min −1 ) (95% confidence interval (CI): 0.4–4.8), maximal workload 0.3 W kg −1 (95%CI: 0.02–0.5), isometric muscle strength 0.7 N m kg −1 (95%CI: 0.1–1.2) and muscle power 0.3 W kg −1 (95%CI: 0.04–0.6). After 12 months, a significant between-group difference only persisted in VO 2peak and maximal workload. Conclusion: A higher dose of exercise training had a small effect on all outcomes at termination of intervention. A long-term effect persisted in VO 2peak and maximal workload. Although the effect was small, it is an important finding because VO 2peak is the most important predictor of all-cause mortality in cardiac patients.