High-intensity interval training in patients with left ventricular assist devices: A pilot randomized controlled trial

Ignacio Moreno-Suarez; Anna Scheer; Kaitlyn Lam; Lawrence Dembo; Angela L Spence; Christopher Hayward; David M Kaye; Angela Leet; Louise M Fuller; Angela Jacques; Louise H Naylor; Daniel J Green; Andrew Maiorana

doi:10.1016/j.healun.2020.08.005

High-intensity interval training in patients with left ventricular assist devices: A pilot randomized controlled trial

J Heart Lung Transplant. 2020 Dec;39(12):1380-1388. doi: 10.1016/j.healun.2020.08.005. Epub 2020 Aug 20.

Authors

Affiliations

¹ School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
² Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Australia.
³ Heart Failure and Transplant Unit, Victor Chang Cardiac Research Institute, St Vincent's Hospital, University of New South Wales, Sydney, Australia.
⁴ Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Australia.
⁵ Department of Cardiology, The Alfred Hospital, Melbourne, Australia.
⁶ Department of Cardiology, The Alfred Hospital, Melbourne, Australia; School of Health Sciences, Swinburne University, Melbourne, Australia.
⁷ Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Australia; Cardiovascular Research Group, School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia; Allied Health Department, Fiona Stanley Hospital, Perth, Australia.
⁸ Cardiovascular Research Group, School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia.
⁹ School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia; Advanced Heart Failure and Cardiac Transplant Service, Fiona Stanley Hospital, Perth, Australia; Allied Health Department, Fiona Stanley Hospital, Perth, Australia. Electronic address: Andrew.Maiorana@health.wa.gov.au.

PMID: 32958408
DOI: 10.1016/j.healun.2020.08.005

Abstract

Background: Left ventricular assist device (LVAD) implantation is an established treatment for patients with advanced heart failure. To date, studies evaluating the impact of aerobic training in patients with LVADs have focused on moderate-intensity exercise.

Methods: This pilot randomized controlled trial compared the effects of high-intensity interval training (HIIT) with those of moderate-intensity continuous training (MICT) on peak oxygen consumption (V̇O₂ peak) in patients with LVADs. Secondary outcomes included 6-minute walk test distance, flow-mediated dilation, and anthropometry. Assessments were conducted at baseline and after 12 weeks of supervised training performed 3 times weekly. Participants were randomized to HIIT (4 sets of 4 minutes at 80%-90% V̇O₂ reserve, alternating with 3 minutes at 50%-60% V̇O₂ reserve) or MICT groups (28 minutes continuously at 50%-60% V̇O₂ reserve). Within and between-group differences were analyzed using linear mixed models. Data are expressed as marginal means with 95% confidence intervals or as mean ± SD.

Results: A total of 21 participants were randomized (HIIT: age 57.7 ± 13.1 years; n = 11 and MICT: age 55.6 ± 14.2 years; n = 10) (mean ± SD). No major adverse events occurred in response to training in either group. HIIT significantly improved V̇O₂ peak (15.6 [13.2-17.8] to 18.4 [16.0-20.8] ml/kg/min) (marginal mean [95% CI]) compared with MICT (16.2 [13.8-18.7] to 17.2 [14.6-19.7] ml/kg/min; p < 0.05 between groups). No significant group differences were detected in secondary outcomes.

Conclusion: In patients with LVADs, HIIT was well tolerated and increased aerobic capacity more than MICT. These preliminary findings support the prescription of high-intensity exercise in clinically stable patients with LVADs but warrant validation in a larger sample and across a broader range of physiologic and clinical outcomes.

Clinical trial registration: URL: https://www.anzctr.org.au, unique identifier: ACTRN12616001596493.

Keywords: aerobic capacity; anthropometry; endothelial function; exercise training; high intensity; left ventricular assist device; six minute walk test.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Exercise / physiology*
Exercise Therapy / methods*
Female
Follow-Up Studies
Heart Failure / physiopathology
Heart Failure / rehabilitation*
Heart Rate / physiology*
Heart Ventricles / physiopathology*
High-Intensity Interval Training / methods*
Humans
Male
Middle Aged
Oxygen Consumption / physiology
Pilot Projects
Prospective Studies
Treatment Outcome
Ventricular Function, Left / physiology*

Associated data

ANZCTR/ACTRN12616001596493