Effect of Different Endurance Training Protocols During Cardiac Rehabilitation on Quality of Life.

BACKGROUND: This study aimed to assess the effect of different types of endurance training during outpatient cardiac rehabilitation on patients' health-related quality of life (HRQL). METHODS: The MacNew Heart Disease HRQL questionnaire and the Hospital Anxiety and Depression Scale were used to assess changes in HRQL in 66 patients before and after 6 weeks of cardiac rehabilitation. Patients were randomized to 1 of 3 types of supervised endurance training: continuous endurance training, high-intensity interval training, and pyramid training. Two-way analysis of variance for repeated measure and chi-square test were used to analyze changes before and after rehabilitation. RESULTS: Attendance rate during the 6 weeks of exercise training was 99.2%. Physical work capacity increased from 136.1 to 165.5 watts (+22.9%; P < .001), and there were no statistical differences between training protocols. Fully completed questionnaires at both time points were available in 46 patients (73.9%; 61.3±11.6 years, 34 males, 12 females). Regardless of the type of supervised endurance training, there was significant improvement during rehabilitation in each of the categories of the MacNew questionnaire (ie, emotion, physical, social, global; all P < .05) and the Hospital Anxiety and Depression Scale (anxiety: P = .05; depression: P = .032), without significant differences between protocols. CONCLUSIONS: All 3 types of endurance training led to significant and well comparable increases in physical work capacity, which was associated with an increase in HRQL independent of the type of training. Our findings support further individualization of training regimes, which could possibly lead to better compliance during life-long home-based exercise training.

Supplemental Oxygen During High-Intensity Exercise Training in Nonhypoxemic Chronic Obstructive Pulmonary Disease.

BACKGROUND: Physical exercise training is an evidence-based treatment in chronic obstructive pulmonary disease, and patients' peak work rate is associated with reduced chronic obstructive pulmonary disease mortality. We assessed whether supplemental oxygen during exercise training in nonhypoxemic patients with chronic obstructive pulmonary disease might lead to superior training outcomes, including improved peak work rate. METHODS: This was a randomized, double-blind, controlled, crossover trial. Twenty-nine patients with chronic obstructive pulmonary disease (aged 63.5 ± 5.9 years; forced expiratory volume in 1 second percent predicted, 46.4 ± 8.6) completed 2 consecutive 6-week periods of endurance and strength training with progressive intensity, which was performed 3 times per week with supplemental oxygen or compressed medical air (flow via nasal cannula: 10 L/min). Each session of electrocardiography-controlled interval cycling lasted 31 minutes and consisted of a warm-up, 7 cycles of 1-minute intervals at 70% to 80% of peak work rate alternating with 2 minutes of active recovery, and final cooldown. Thereafter, patients completed 8 strength-training exercises of 1 set each with 8 to 15 repetitions to failure. Change in peak work rate was the primary study end point. RESULTS: The increase in peak work rate was more than twice as high when patients exercised with supplemental oxygen compared with medical air (0.16 ± 0.02 W/kg vs 0.07 ± 0.02 W/kg; P < .001), which was consistent with all other secondary study end points related to exercise capacity. The impact of oxygen on peak work rate was 39.1% of the overall training effect, whereas it had no influence on strength gain (P > .1 for all exercises). CONCLUSIONS: We report that supplemental oxygen in nonhypoxemic chronic obstructive pulmonary disease doubled the effect of endurance training but had no effect on strength gain.

High-intensity interval training is not superior to other forms of endurance training during cardiac rehabilitation.

BACKGROUND: High-intensity interval training has recently emerged as superior to continuous endurance training in cardiac rehabilitation upon other training regimes. Individually tailored continuous endurance training and pyramid training could induce comparable effects on peak work capacity as high intensity interval training. DESIGN: A prospective, randomized study. METHODS: Effects of the following isocaloric cycle ergometer protocols on peak work capacity have been assessed in patients with coronary artery disease (n = 60) during 6 weeks of outpatient cardiac rehabilitation, i.e. 18 supervised sessions of exercise training: (1) continuous endurance training (n = 20): 33 min at 65-85% peak heart rate; (2) high intensity interval training (n = 20): 4 × 4 min intervals at 85-95% peak heart rate, each followed by 3 min of active recovery at 60-70% peak heart rate; (3) pyramid training (n = 20): 3 × 8 min of stepwise load increase and subsequent decrease from 65-95-65% peak heart rate, supplemented by 2 min recovery at 60-70% peak heart rate between pyramids. All protocols were preceded by 5 min of warm-up and followed by 5 min cool-down at 60-70% peak heart rate. RESULTS: Attendance during exercise sessions was 99.2%. There were significant increases in peak work capacity of comparable magnitude in all three training groups (begin vs. end: continuous endurance training: 136.0 ± 49.6 W vs. 163.4 ± 60.8 W (21.1 ± 8.5%); high-intensity interval training: 141.0 ± 60.4 W vs. 171.1 ± 69.8 W (22.8 ± 6.6%); pyramid training: 128.7 ± 50.6 W vs. 158.5 ± 57.9 W (24.8 ± 10.8%); within groups all p < 0.001; between groups, p = not significant). CONCLUSION: Endurance training protocols assessed in this study all led to significant increases in peak work capacity of comparable magnitude. Our findings suggest that these protocols can be used interchangeably, which will lead to further individualization of exercise prescription and may therefore result in improved adherence to lifelong behavioural changes.

Health benefits of Nordic walking: a systematic review.

CONTEXT: Modern lifestyle, with its lack of everyday physical activity and exercise training, predisposes people to chronic diseases such as diabetes mellitus, obesity, hypertension, and coronary artery diseases. Brisk walking as a simple and safe form of exercise is undisputedly an effective measure to counteract sedentary lifestyle risks even in the most unfit and could lead to a reduction of the prevalence of chronic diseases in all populations. The purpose of this review is to systematically summarize, analyze, and interpret the health benefits of Nordic walking (walking with poles), and to compare it to brisk walking and jogging. EVIDENCE ACQUISITION: A systematic and comprehensive literature search was performed between November 2010 and May 2012. Data were analyzed between April 2011 and May 2012. EVIDENCE SYNTHESIS: Sixteen RCTs with a total of 1062 patients and 11 observational studies with 831 patients were identified. The current analysis revealed that with regard to short- and long-term effects on heart rate, oxygen consumption, quality of life, and other measures, Nordic walking is superior to brisk walking without poles and in some endpoints to jogging. CONCLUSIONS: Nordic walking exerts beneficial effects on resting heart rate, blood pressure, exercise capacity, maximal oxygen consumption, and quality of life in patients with various diseases and can thus be recommended to a wide range of people as primary and secondary prevention.