A Comparison of different intensity exercise training in ...
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Nacho Moreno-Suarez,PhD-candidate in Exercise PhysiologySchool of Physiotherapy & Exercise Sciences, Curtin University
Associate Professor Andrew MaioranaCurtin University;Advanced heart failure & cardiac transplant Service & Allied Health Department, FSH
A Comparison of different intensity exercise training in Patients with Left Ventricular Assist Devices
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Background
• Left ventricular assist device (LVAD). • Electro-mechanical pump implanted into the
left ventricle to augment cardiac output.
• A treatment option for patients with advanced heart failure (HF).Bridge-to-transplantDestination therapy
• Associated with:↑ Survival↑ Exercise capacity↑ Quality of life
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Background VO2peak remains reduced
• As low as 50% of age-predicted values 1,2
• Lower than heart-transplanted patients 3
Very few studies have evaluated the efficacy of exercise training in patients with LVADs.
Currently there are no specific exercise prescription guidelines for this patient population.
1. Simon, J Heart Lung Transplant. 2005.2. Allen, J Heart Lung Transplant. 2010.3. Slaughter, N Engl J Med. 2009.
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High intensity training in heart failure without LVAD
• High-intensity interval training (HIIT) was safe for patients with HF (but no LVAD).• May be superior compared with traditional moderate-intensity-continuous training (MICT)4
No study has tested HIIT in patients with LVADs!4. Gomes-Neto et al., Int J Cardiol. 2018
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Objective
To evaluate the safety and efficacy of 12-week exercise training program of HIIT vs. MICT (usual care) in
patients with LVADs
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Methods
• Ethical and site-specific approvals were granted• ANZCTR Registration (ACTRN12616001596493)
HIIT MICT
LVAD implantation
Routine Rehabilitation >6 weeks
Baseline Assessments
Randomisation
Follow up at 12 weeks
Study design
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Methods: AssessmentsPrimary Outcome
• Cardiopulmonary Exercise Testing VO2peak using Modified Naughton
protocol on treadmill
Secondary Outcomes
Functional Capacity 6-minute walk test (6MWT).
Vascular Endothelial Function Flow-mediated dilation (FMD%) of brachial artery
Resting Peak diameter
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Exercise Training Interventions
• 12-week Exercise Program• 3 sessions per week
• All sessions commence and concluded with 5-min aerobic exercise and stretching
• Identical Resistance Exercise• Consistent with best-practice for
cardiac rehabilitation
• Aerobic Exercise (Randomised)• MICT (50-60% VO2 reserve)• HIIT (80-90% VO2 reserve, 4x4
minutes)
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Aerobic Exercise Protocol
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4-mininterval
3-min active recovery
5-min warm up
MICT(usual care)
28-min steady-state intensity
HIIT
5-min warm up
Time (minutes)
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Methods: Statistical Analyses
• At baseline, comparison between groups was carried out using independent Student t-test or Mann-Whitney U-test.
• To compare the effects of exercise training:• Linear mixed models (LMM) with random subject effects.
• All analyses were 2-tailed & p < 0.05 considered significant.
• Data was analysed in Stata 14 software.
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Assessed for eligibility (n = 28)
Excluded (n = 7)- Did not meet inclusion criteria (n = 2)- Received cardiac transplant (n=2)- Declined to participate (n = 3)
Completed (n = 8)
Lost to follow-up (n = 3)- Received cardiac transplantation (n=2)- Discontinued intervention (n=1)
HIIT intervention (n = 11)
Lost to follow-up (n = 2)- Received cardiac transplantation (n=2)
MICT intervention (n = 10)
Completed (n = 8)
Allocation
Analysis
Follow-Up
Randomised (n = 21)
Enrollment
Results: CONSORT
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Results: Baseline characteristics
Characteristic HIIT group (n=11) MICT group (n=10) p-value
Age (years) 57.7 ± 13.1 55.6 ± 14.2 0.736
Weight (kg) 83.6 ± 14.9 82.6 ± 13.0 0.908
BMI (kg/m2) 27.3 ± 4.2 29.0 ± 4.4 0.376
Female sex (%) 27% 50% 0.290
Time since LVAD implantation (days) 91 [59 - 362] 125 [60 - 447] 0.885
No significant differences at baseline
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Results: Safety of Exercise
There were no serious adverse events during testing, or during the intervention period in either group.
One participant experienced supraventricular tachycardia during a MICT session.
• Event was not severe enough to interrupt continuation in the trial
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Results: VO2peak
Mean difference between groups (HIIT - MICT) = 1.9 mL·kg-1·min-1
(95%CI: 0.3 to 4.2)
MICT ↑ 1.0 mL·kg-1·min-1
(95%CI: -0.9 to 2.7)HIIT ↑ 2.9 mL·kg-1·min-1
(95%CI: 1.4 to 4.0)
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Results: 6-Minute Walk Test
Mean between-group difference = 27 m (95%CI: -18 to 73)
HIIT group ↑ 90 m (95%CI: 41 to 138)
MICT group ↑ 63 m (95%CI: 36 to 88)
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No between group mean difference =-0.8% (95%CI: -2.4 to -0.9)
HIIT ↑ 0.7% (95%CI: -1.0 to 2.5)
Results: FMD (%)
MICT ↑ 1.6% (95%CI: 0.2 to 3.1)
Baseline
Follow-up
N.S
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Conclusion & Clinical Implications
• HIIT appears to be safe and well-tolerated among patients with LVADs.
• HIIT improved cardiorespiratory fitness more than MICT. MICT traditional approach in exercise rehabilitation.
• Preliminary findings support the prescription of HIIT in clinically stable patients with LVADs.
• But warrant validation in larger trials & across a broader range of physiologic and clinical outcomes.
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Acknowledgements
Co-investigators: Ms Anna Scheer Dr Kaitlyn Lam Dr Robert Larbalestier Dr Lawrence Dembo A/Prof Andrew Maiorana
The Advanced Heart Failure & Cardiac Transplant Service team at FSH
The patients
Sponsors
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Questions?
Thanks for your attention!