June 29, 2020Open Access

The feasibility of implementing high-intensity interval training in cardiac rehabilitation settings: a retrospective analysis

KWKimberley L. WayBaker Heart and Diabetes Institute SVSol Vidal‐AlmelaUniversidad de Granada MKMarja-Leena KeastUniversity of Ottawa

Structured PICO

Is high-intensity interval training feasible, safe, and well-received by patients in a cardiac rehabilitation setting?

Population

151 patients with cardiovascular disease (CVD) or CVD risk factors referred to an on-site cardiac rehabilitation program, mean age 57.4, 67% male, based in Canada (University of Ottawa Heart Institute). Key inclusion: baseline exercise level ≥4 METS, able to sustain at least 30 min of aerobic exercise, no contraindications for high-intensity exercise, and able to independently self-monitor.

Intervention

High-intensity interval training (HIIT) consisting of a 10-min warm-up (60-70% HRpeak), 4 x 4-min high-intensity intervals (85-95% HRpeak) interspersed with 3-min lower intensity intervals (60-70% HRpeak), and a 10-min cool-down. Administered twice weekly for 10 weeks.

Outcome

Feasibility of HIIT in a cardiac rehabilitation setting, assessed by exercise attendance, compliance to prescribed heart rate ranges, patient experience (perceived effort, difficulty, satisfaction), and safety.

High-intensity interval training is a feasible, safe, and well-received exercise paradigm for patients in a cardiac rehabilitation setting, though women may experience higher dropout rates than men.

Abstract

Abstract Background Cardiovascular disease is the leading cause of death worldwide. Notwithstanding the well-known benefits of cardiac rehabilitation (CR), adherence to CR remains low, particularly in women. High-intensity interval training (HIIT) has received specific attention as an emerging exercise-training paradigm that addresses frequently cited barriers to CR (i.e. lack of motivation/enjoyment and time, perceiving exercise regime as tiring/boring) and improves cardiovascular risk factors. Previous studies have examined the safety of HIIT in CR; there is little evidence on the feasibility of HIIT in CR. The aims of this study were to evaluate the feasibility of HIIT within a CR setting and examine the sex differences regarding the feasibility of such programming. Methods Patients attended an on-site HIIT CR program (10-min warm-up, 25 min of interspersed high-intensity HI - 4 min at 85–95% HRpeak and lower intensity LO - 3 min at 60–70% HRpeak intervals, 10-min cool-down) twice weekly for 10 weeks. Heart rate (HR) and the Borg rating of perceived exertion (RPE) scale (6–20 points) were recorded at each session. Feasibility was assessed by: 1 attendance and compliance: the number of sessions attended and the compliance to the prescribed HI and LO HR ranges; 2 the patient experience: patients’ perceived effort, program difficulty, if the program was challenging and satisfying; and, 3 safety. Descriptive statistics were used to report the means and their variations. Mann-Whitney U tests and Chi-square analyses were performed to examine sex-differences. Results A total of 151 patients (33% women, 57.5 ± 9.1 years) attended the HIIT program and completed 16 ± 5 classes with a low attrition rate (11.3%). Most patients met or exceeded the prescribed target HR for the HI (80%) and LO (84%) intervals, respectively. Patients reported a “somewhat hard” RPE for HI (14 ± 2 points) and “very light” for LO (10 ± 2 points) intervals. All patients were satisfied with the program and found it challenging. Most patients found HIIT to be difficult (7 ± 2 points, scale range 0–10 points), yet safe (97%). Three vasovagal episodes occurred and more women dropped-out of the program than men ( p < 0.01). Conclusions HIIT is a feasible, safe and well-received exercise paradigm in a CR setting.

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