Cardiovascular responses to high-intensity stair climbing in individuals with coronary artery disease.

Exercise-based cardiac rehabilitation leads to improvements in cardiovascular function in individuals with coronary artery disease. The cardiac effects of coronary artery disease (CAD) can be quantified using clinical echocardiographic measures, such as ejection fraction (EF). Measures of cardiovascular function typically only used in research settings can provide additional information and maybe more sensitive indices to assess changes after exercise-based cardiac rehabilitation. These additional measures include endothelial function (measured by flow-mediated dilation), left ventricular twist, myocardial performance index, and global longitudinal strain. To investigate the cardiovascular response to 12 week of either traditional moderate-intensity (TRAD) or stair climbing-based high-intensity interval (STAIR) exercise-based cardiac rehabilitation using both clinical and additional measures of cardiovascular function in individuals with CAD. Measurements were made at baseline (BL) and after supervised (4wk) and unsupervised (12 week) of training. This study was registered as a clinical trial at clinicaltrials.gov (NCT03235674). Participants were randomized into either TRAD (n = 9, 8M/1F) and STAIR (n = 9, 8M/1F). There was a training-associated increase in one component of left ventricular twist: Cardiac apical rotation (TRAD: BL: 5.6 ± 3.3º, 4 week: 8.0 ± 3.9º, 12 week: 6.2 ± 5.1º and STAIR: BL: 5.1 ± 3.6º, 4 week: 7.4 ± 3.9º, 12 week: 7.8 ± 2.8º, p (time) = 0.03, η2  = 0.20; main effect) and post-hoc analysis revealed a difference between BL and 4 week (p = 0.02). There were no changes in any other clinical or additional measures of cardiovascular function. The small increase in cardiac apical rotation observed after 4 weeks of training may indicate an early change in cardiac function. A larger overall training stimulus may be needed to elicit other cardiovascular function changes.

Brief Vigorous Stair Climbing Effectively Improves Cardiorespiratory Fitness in Patients With Coronary Artery Disease: A Randomized Trial.

Background: Cardiac rehabilitation exercise reduces the risk of secondary cardiovascular disease. Interval training is a time-efficient alternative to traditional cardiac rehabilitation exercise and stair climbing is an accessible means. We aimed to assess the effectiveness of a high-intensity interval stair climbing intervention on improving cardiorespiratory fitness ( V ˙ O 2 peak ) compared to standard cardiac rehabilitation care. Methods: Twenty participants with coronary artery disease (61 ± 7 years, 18 males, two females) were randomly assigned to either traditional moderate-intensity exercise (TRAD) or high-intensity interval stair climbing (STAIR). V ˙ O 2 peak was assessed at baseline, following 4 weeks of six supervised exercise sessions and after 8 weeks of ~24 unsupervised exercise sessions. TRAD involved a minimum of 30 min at 60-80%HRpeak, and STAIR consisted of three bouts of six flights of 12 stairs at a self-selected vigorous intensity (~90 s/bout) separated by recovery periods of walking (~90 s). This study was registered as a clinical trial at clinicaltrials.gov (NCT03235674). Results: Two participants could not complete the trial due to the time commitment of the testing visits, leaving n = 9 in each group who completed the interventions without any adverse events. V ˙ O 2 peak increased after supervised and unsupervised training in comparison to baseline for both TRAD [baseline: 22.9 ± 2.5, 4 weeks (supervised): 25.3 ± 4.4, and 12 weeks (unsupervised): 26.5 ± 4.8 mL/kg/min] and STAIR [baseline: 21.4 ± 4.5, 4 weeks (supervised): 23.4 ± 5.6, and 12 weeks (unsupervised): 25 ± 6.2 mL/kg/min; p (time) = 0.03]. During the first 4 weeks of training (supervised) the STAIR vs. TRAD group had a higher %HRpeak (101 ± 1 vs. 89 ± 1%; p ≤ 0.001), across a shorter total exercise time (7.1 ± 0.1 vs. 36.7 ± 1.1 min; p = 0.009). During the subsequent 8 weeks of unsupervised training, %HRpeak was not different (87 ± 8 vs. 96 ± 8%; p = 0.055, mean ± SD) between groups, however, the STAIR group continued to exercise for less time per session (10.0 ± 3.2 vs. 24.2 ± 17.0 min; p = 0.036). Conclusions: Both brief, vigorous stair climbing, and traditional moderate-intensity exercise are effective in increasing V ˙ O 2 peak , in cardiac rehabilitation exercise programmes.

Low-volume, high-intensity interval training in patients with CAD.

PURPOSE: Isocaloric interval exercise training programs have been shown to elicit improvements in numerous physiological indices in patients with CAD. Low-volume high-intensity interval exercise training (HIT) is effective in healthy populations; however, its effectiveness in cardiac rehabilitation has not been established. This study compared the effects of 12-wk of HIT and higher-volume moderate-intensity endurance exercise (END) on brachial artery flow-mediated dilation (FMD) and cardiorespiratory fitness (VO2 peak) in patients with CAD. METHODS: Twenty-two patients with documented CAD were randomized into HIT (n = 11) or END (n = 11) based on pretraining FMD. Both groups attended two supervised sessions per week for 12 wk. END performed 30-50 min of continuous cycling at 58% peak power output (PPO), whereas HIT performed ten 1-min intervals at 89% PPO separated by 1-min intervals at 10% PPO per session. RESULTS: Relative FMD was increased posttraining (END, 4.4% ± 2.6% vs 5.9% ± 3.6%; HIT, 4.6% ± 3.6% vs 6.1% ± 3.4%, P ≤ 0.001 pre- vs posttraining) with no differences between groups. A training effect was also observed for relative VO2 peak (END, 18.7 ± 5.7 vs 22.3 ± 6.1 mL · kg(-1) · min(-1); HIT, 19.8 ± 3.7 vs 24.5 ± 4.5 mL · kg(-1) · min(-1), P < 0.001 for pre- vs posttraining), with no group differences. CONCLUSIONS: Low-volume HIT provides an alternative to the current, more time-intensive prescription for cardiac rehabilitation. HIT elicited similar improvements in fitness and FMD as END, despite differences in exercise duration and intensity.