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High intensity interval training versus moderate intensity continuous training on exercise capacity and quality of life in patients with heart failure with reduced ejection fraction: A systematic review and meta-analysis

  • Mansueto Gomes Neto
    Correspondence
    Corresponding author at: Departamento de Fisioterapia, Universidade Federal da Bahia- UFBA, Instituto de Ciências da Saúde, Av. Reitor Miguel Calmon s/n - Vale do Canela, Salvador, BA CEP 40.110-100, Brazil.
    Affiliations
    Physical Therapy Department, Federal University of Bahia – UFBA, Salvador, Bahia, Brazil

    Programa de Pós-Graduação em Medicina e Saúde - UFBA, Salvador, BA, Brazil

    Physiotherapy Research Group, UFBA, Brazil

    The GREAT Group (GRupo de Estudos em ATividade física), Brazil
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  • André Rodrigues Durães
    Affiliations
    Programa de Pós-Graduação em Medicina e Saúde - UFBA, Salvador, BA, Brazil
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  • Lino Sergio Rocha Conceição
    Affiliations
    The GREAT Group (GRupo de Estudos em ATividade física), Brazil

    Physical Therapy Department, Federal University of Sergipe - UFS, Aracaju, SE, Brazil
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  • Micheli Bernardone Saquetto
    Affiliations
    Physical Therapy Department, Federal University of Bahia – UFBA, Salvador, Bahia, Brazil

    Programa de Pós-Graduação em Medicina e Saúde - UFBA, Salvador, BA, Brazil

    Physiotherapy Research Group, UFBA, Brazil
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  • Øyvind Ellingsen
    Affiliations
    K.G. Jebsen Center for Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway

    Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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  • Vitor Oliveira Carvalho
    Affiliations
    Physiotherapy Research Group, UFBA, Brazil

    The GREAT Group (GRupo de Estudos em ATividade física), Brazil

    Physical Therapy Department, Federal University of Sergipe - UFS, Aracaju, SE, Brazil
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      Highlights

      • HIIT improves peak VO2 and should be considered as a component of care of HFrEF patients.
      • An important caveat is uncertainty and variation of actual training intensities compared to program targets.
      • This review highlights the paucity of high-quality research addressing HIIT versus MICT in HF patients.

      Abstract

      Objective

      The aim of this study was to investigate the effects of high intensity interval training (HIIT) versus moderate intensity continuous training (MICT) in heart failure patients with reduced ejection fraction (HFrEF).

      Background

      Despite the well-known positive effects of exercise in heart failure patients, the best mode of exercise is still under discussion.

      Methods

      We searched Pubmed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to October 2017) for randomized controlled trials that evaluated the effects of HIIT versus MICT in HFrEF patients. Weighted mean differences (WMD) with 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the I2 test.

      Results

      13 studies met the study criteria, including 411 patients. Compared to MICT, HIIT resulted in improvement in Peak VO2 WMD (1.35 mL·kg−1·min−1 95% CI: 0.03 to 2.64 N = 411). HIIT resulted in no difference in VE/VCO2 slope WMD (−1.21 95% CI: −3.0 to 0.58 N = 135), and quality of life measured by Minnesota Living with Heart Failure questionnaire WMD (1.19 95% CI: −5.81 to 8.19 N = 79). Sub-group analyses comparing studies with and without isocaloric exercise training protocol also showed a nonsignificant difference in peak VO2 for participants in the HIIT group compared with MICT group.

      Conclusions

      HIIT improves peak VO2 and should be considered as a component of care of HFrEF patients. However, its superiority versus MICT disappears when isocaloric protocols are compared. An important caveat is uncertainty and variation of actual training intensities compared to program targets.
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