Key result
Warm-up ischemia before exercise training is linked to a ~28% longer ischemic threshold in stable angina.
Why the study?
It is unknown whether ischemia-inducing training is superior to training below the ischemic threshold in patients with stable angina.
Does warm-up ischemia prior to exercise training improve physical capacity and attenuate myocardial ischemia in patients with stable angina?
Observational (n=30)
Single-blind
No
Does warm-up ischemia prior to exercise training improve physical capacity and attenuate myocardial ischemia in patients with stable angina?
p-value: p=<0.05
Warm-up ischemia prior to exercise training appears necessary to attenuate myocardial ischemia in patients with stable angina, challenging the paradigm of strictly sub-ischemic training.
Warm-up ischemia may enhance exercise training effects on ischemia markers in stable angina; hypothesis-generating and should not yet change practice.
INTRODUCTION: It is still unknown whether ischemia‑inducing training in patients with stable angina is superior to the training conducted below the ischemic threshold (IT) according to the current guidelines. OBJECTIVES: The aim of the study was to assess the influence of warm‑up ischemia prior to training on the effects of training conducted either at or below the IT in patients with stable angina. PATIENTS AND METHODS: Thirty male patients aged 56 ±8 years, after myocardial infarction, with stable angina and positive exercise test (ET1) were divided into 2 groups: group A included 18 patients with the warm‑up effect, group B - 12 patients without this effect. All patients followed an 8‑week interval training program (TP). The intensity of training was planned to reach the heart rate at the IT. Successive ETs were performed immediately after the TP (ET2), at day 3 (ET3), day 10 (ET4), and at 1 month (ET5). RESULTS: After the TP, there was a statistically significant improvement in group A in all analyzed variables except maximum ST depression (max STD). Maximal workload increased by 28%, walking distance by 24%, duration by 20%, and time to 1‑mm STD by 28%. Max STD reduction amounted to 14% (P =0.13). The beneficial effect of training on exercise‑induced ischemia was maintained for up to 10 days (ET4) and on physical capacity for up to 1 month (ET5). In group B, the TP did not affect time to 1‑mm STD, but physical capacity improved significantly and was maintained for up to 1 month (ET5). CONCLUSIONS: The warm‑up effect appears to be necessary to attenuate myocardial ischemia after training.
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Korzeniowska‐Kubacka et al. (2012) conducted an observational in Stable angina (n=30). Warm-up ischemia (warm-up effect) vs. No warm-up ischemia was evaluated on Increase in time to 1-mm ST-segment depression (STD) after 8-week training program (p=<0.05). The presence of warm-up ischemia prior to an 8-week exercise training program increased the time to 1-mm ST-segment depression by 28% in male patients with stable angina, an effect not seen in those without initial warm-up ischemia.
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