High Intensity Exercise Training in Clinical Populations

Interval Training Do you use interval training?

Interval Training Do you use interval training? PAD?

Interval Training Do you use interval training? PAD? HF?

Interval Training Do you use interval training? PAD? HF? Deconditioned?

Interval training is about 2 things: Managing energy Building strength

Interval Training

Steady state exercise Interval training

Anaerobic Threshold

Steady state exercise Interval training

We’ve Come a Long Way Strict bedrest – prior to 1950 Arm chair method Levine Systematic aerobic exercise Hellerstein Marathon running for patients Kavanagh High intensity exercise training Smodlaka

VN Smodlaka: Interval Training in Rehabilitation Medicine Arch Phys Med Rehabil 54: , 1973 Work/Rest=30s/30s

Washington University School of Medicine Ehsani, Hagberg, Holloszy – month training study 10-12, young uncomplicated MI patients 3 months at 50-70% VO 2 max 9 months – intensity increased to 70-80% VO 2 max, interspersed with 2-3 intervals at 80-90% VO 2 max, each lasting 2-5 minutes in duration

Ehsani et al., 1981 Hagberg et al., 1983

Katharina Meyer, Ph.D. Krozingen, Germany Interval Training in post CABG patients and patients with CHF 1990’s

K Meyer et al.: Interval vs Continuous Exercise Training After CABGS: A Comparison of Training Induced Acute Reactions with Respect to the Effectiveness of the Exercise Methods Clin Cardiol 13: , 1990 Uncomplicated Post (3-4 wk) CABGS Patients 60s/60s INT W/kg W/kg 0.27—1.66 W/kg CONT 0.77 W/kg 0.95 W/kg 1.09 W/kg People got stronger!!!

Interval training is safe: No adverse events HIIT was well tolerated No significant arrythmias or abnormal blood pressure responses None of the patients developed serious ventricular arrythmias, had an MI, or cardiac arrest during the study

K Meyer et al. Comparison of left ventricular function during interval training vs steady-state exercise training in patients with chronic congestive heart failure Am J Cardiol 82: , 1998 INT vs CONT 16 min 30s/60s 50% of PPO during steep ramp test

Aerobic Interval Training Wisloff et al., Norway (2007) Uphill treadmill walking 10-minute warm-up at 50-60% HRmax 4, 4-minute intervals at 90-95% HRmax; separated by 3 minutes of active rest 3-minute cool-down at 50-70% HRmax Total exercise time of 38 minutes

Aerobic interval training compared to steady state exercise: Greater increase in aerobic capacity (46 vs. 14%) 35% increase in ejection fraction Lower ED and ES volumes 40% lower BNP levels Better endothelial dysfunction Improved QOL

Guiraud et al., Canada (2011) 10 min warm-up at 50% PPO 2 sets – 10 min each - 15 sec at 100% PPO - 15 sec passive recovery 4 min passive recovery between sets 5 min cool-down

How do you do it?

Mayo Clinic (Ray Squires) 5 min warm-up; RPE minutes steady-state exercise; RPE intervals – typically 30 sec/90 seconds; RPE (can start at sec with longer rest period; can build up to 60 sec/60 sec) 5 min cool-down Total exercise time - ~ 40 min

Are their patients who should not perform HIIT? Basically people who are unstable Those with orthopedic concerns

High Intensity Exercise Training Long history Good safety record Many ways to do it Improvement typically better than steady state exercise Patients seem to enjoy it

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Gibala et al., Canada (2007) 6-week study 4-6 “all-out” 30 second bouts, separated by 4 minutes of rest, 3 days per week minutes of cycling at 65% VO 2 max, 5 days per week Despite a 10 fold greater energy expenditure with the steady-state exercise (225 vs 2250 kjoules), changes in aerobic capacity were the same for both groups

Meyer et al.: Physical responses to different modes of interval exercise in patients with chronic heart failure—application to exercise training Eur Heart J 17: , 1996