High Intensity Exercise Training in Clinical Populations

Interval Training

Do you use interval training?

Interval Training

Do you use interval training? PAD?

Interval Training

Do you use interval training? PAD? HF?

Interval Training

Do you use interval training? PAD? HF? Deconditioned?

Interval training is about 2 things: Managing energy Building strength

Interval Training

Steady state exercise

Interval training

Anaerobic Threshold

Steady state exercise

Interval training

We’ve Come a Long Way

Strict bedrest – prior to 1950 Arm chair method - 1952

Levine Systematic aerobic exercise - 1957

Hellerstein Marathon running for patients - 1973

Kavanagh High intensity exercise training - 1973

Smodlaka

VN Smodlaka: Interval Training in Rehabilitation Medicine Arch Phys Med Rehabil 54: 428-431, 1973

Work/Rest=30s/30s

Washington University School of MedicineEhsani, Hagberg, Holloszy – 1981-1983

12-month training study 10-12, young uncomplicated MI patients 3 months at 50-70% VO2max 9 months – intensity increased to 70-80%

VO2max, interspersed with 2-3 intervals at 80-90% VO2max, each lasting 2-5 minutes in duration

Ehsani et al., 1981 Hagberg et al., 1983

Katharina Meyer, Ph.D.

Krozingen, Germany Interval Training in

post CABG patients and patients with CHF

1990’s

K Meyer et al.: Interval vs Continuous Exercise Training After CABGS: A Comparison of Training Induced Acute Reactions with Respect to the

Effectiveness of the Exercise MethodsClin Cardiol 13: 851-861, 1990

Uncomplicated Post (3-4 wk) CABGS Patients

60s/60s INT

0.27--1.19 W/kg 0.27--1.46 W/kg 0.27—1.66 W/kg

CONT 0.77 W/kg 0.95 W/kg 1.09 W/kg

Interval vs Continuous Training in CHD

0

0.5

1

1.5

2

Continuous Interval

Po

wer

Ou

tpu

t (W

/kg

) +21%

+53%

People got stronger!!!

Interval training is safe: No adverse events HIIT was well tolerated No significant arrythmias or abnormal

blood pressure responses None of the patients developed serious

ventricular arrythmias, had an MI, or cardiac arrest during the study

K Meyer et al. Comparison of left ventricular function during interval training vs steady-state exercise training in patients with chronic congestive

heart failureAm J Cardiol 82: 1382-1387, 1998

INT vs CONT 16 min 30s/60s 50% of PPO during steep

ramp test

Aerobic Interval TrainingWisloff et al., Norway (2007)

Uphill treadmill walking 10-minute warm-up at 50-60% HRmax 4, 4-minute intervals at 90-95% HRmax;

separated by 3 minutes of active rest 3-minute cool-down at 50-70% HRmax Total exercise time of 38 minutes

Aerobic interval training compared to steady state exercise:

Greater increase in aerobic capacity (46 vs. 14%)

35% increase in ejection fraction Lower ED and ES volumes 40% lower BNP levels Better endothelial dysfunction Improved QOL

Guiraud et al., Canada (2011)

• 10 min warm-up at 50% PPO

• 2 sets – 10 min each

- 15 sec at 100% PPO

- 15 sec passive recovery

• 4 min passive recovery

between sets

• 5 min cool-down

How do you do it?

Mayo Clinic (Ray Squires)

5 min warm-up; RPE 10-11 20 minutes steady-state exercise; RPE 12-13 4-5 intervals – typically 30 sec/90 seconds;

RPE 16-17 (can start at 10-15 sec with longer rest period; can build up to 60 sec/60 sec)

5 min cool-down Total exercise time - ~ 40 min

Are their patients who should not perform HIIT?

Basically people who are unstable Those with orthopedic concerns

High Intensity Exercise Training Long history Good safety record Many ways to do it Improvement typically

better than steady state exercise

Patients seem to enjoy it

Thank you!

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Gibala et al., Canada (2007)

6-week study 4-6 “all-out” 30 second bouts, separated by 4

minutes of rest, 3 days per week 40-60 minutes of cycling at 65% VO2max, 5 days

per week Despite a 10 fold greater energy expenditure with

the steady-state exercise (225 vs 2250 kjoules), changes in aerobic capacity were the same for both groups

Meyer et al.: Physical responses to different modes of interval exercise in patients with chronic heart failure—application to exercise training

Eur Heart J 17: 1040-1047, 1996