Published Online
on June 4, 2007

A more recent version of this article appeared on June 19, 2007

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Submitted on November 9, 2006
Accepted on March 30, 2007

Superior Cardiovascular Effect of Aerobic Interval Training Versus Moderate Continuous Training in Heart Failure Patients. A Randomized Study

Ulrik Wisløff PhD^*, Asbjørn Støylen MD, PhD, Jan P. Loennechen MD, PhD, Morten Bruvold MSc, ivind Rognmo MSc, Per Magnus Haram MD, PhD, Arnt Erik Tjønna MSc, Jan Helgerud PhD, Stig A. Slørdahl MD, PhD, Sang Jun Lee PhD, Vibeke Videm MD, PhD, Anja Bye MSc, Godfrey L. Smith PhD, Sonia M. Najjar PhD, yvind Ellingsen MD, PhD, and Terje Skjærpe MD, PhD

From the Department of Circulation and Medical Imaging (U.W., A.S., M.B., .R., P.M.H., A.E.T., J.H., S.A.S., A.B., .E.) and Department of Laboratory Medicine (V.V.), Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Cardiology (U.W., A.S., J.P.L., .E., T.S.) and Department of Immunology and Transfusion Medicine (V.V.), St. Olav’s Hospital, Trondheim, Norway; Institute of Biomedical and Life Sciences (G.L.S.), University of Glasgow, United Kingdom; and Department of Physiology, Pharmacology, Metabolism and Cardiovascular Sciences (S.J.L., S.M.N.), Medical University of Ohio, Toledo, Ohio.

^* To whom correspondence should be addressed. E-mail: ulrik.wisloff{at}ntnu.no.

Background--Exercise training reduces the symptoms of chronic heart failure. Which exercise intensity yields maximal beneficial adaptations is controversial. Furthermore, the incidence of chronic heart failure increases with advanced age; it has been reported that 88% and 49% of patients with a first diagnosis of chronic heart failure are >65 and >80 years old, respectively. Despite this, most previous studies have excluded patients with an age >70 years. Our objective was to compare training programs with moderate versus high exercise intensity with regard to variables associated with cardiovascular function and prognosis in patients with postinfarction heart failure.

Methods and Results--Twenty-seven patients with stable postinfarction heart failure who were undergoing optimal medical treatment, including -blockers and angiotensin-converting enzyme inhibitors (aged 75.5±11.1 years; left ventricular [LV] ejection fraction 29%; VO_2peak 13 mL · kg^-1 · min^-1) were randomized to either moderate continuous training (70% of highest measured heart rate, ie, peak heart rate) or aerobic interval training (95% of peak heart rate) 3 times per week for 12 weeks or to a control group that received standard advice regarding physical activity. VO_2peak increased more with aerobic interval training than moderate continuous training (46% versus 14%, P<0.001) and was associated with reverse LV remodeling. LV end-diastolic and end-systolic volumes declined with aerobic interval training only, by 18% and 25%, respectively; LV ejection fraction increased 35%, and pro-brain natriuretic peptide decreased 40%. Improvement in brachial artery flow-mediated dilation (endothelial function) was greater with aerobic interval training, and mitochondrial function in lateral vastus muscle increased with aerobic interval training only. The MacNew global score for quality of life in cardiovascular disease increased in both exercise groups. No changes occurred in the control group.

Conclusions--Exercise intensity was an important factor for reversing LV remodeling and improving aerobic capacity, endothelial function, and quality of life in patients with postinfarction heart failure. These findings may have important implications for exercise training in rehabilitation programs and future studies.

Key words: endothelium • exercise • remodeling • heart failure

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