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Original Investigation
February 9, 2021

Effect of High-Intensity Interval Training, Moderate Continuous Training, or Guideline-Based Physical Activity Advice on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial

Author Affiliations
  • 1Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
  • 2DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
  • 3Heart Center Dresden–University Hospital, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Dresden, Germany
  • 4Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
  • 5Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
  • 6Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
  • 7DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
  • 8Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
  • 9Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California
  • 10Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
  • 11The Cardiac Exercise Research Group at Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
JAMA. 2021;325(6):542-551. doi:10.1001/jama.2020.26812
Visual Abstract. Effect of High-Intensity Training, Moderate Training, or Guideline-Based Physical Activity on Peak V̇o2 in HFpEF
Effect of High-Intensity Training, Moderate Training, or Guideline-Based Physical Activity on Peak V̇o2 in HFpEF
Key Points

Question  Is there a difference in change in peak oxygen consumption (V̇o2) among patients with heart failure with preserved ejection fraction (HFpEF) treated with differing modes of exercise?

Findings  This randomized clinical trial included 180 patients with HFpEF assigned to high-intensity interval training, moderate continuous training, or a control of guideline-based physical activity advice. At 3 months, the changes in peak V̇o2 were 1.1, 1.6, and −0.6 mL/kg/min, respectively. There was no statistically significant difference between high-intensity interval and moderate continuous training, and neither group met the a priori–defined minimal clinically important difference of 2.5 mL/kg/min compared with the guideline control.

Meaning  These findings do not support either high-intensity interval training or moderate continuous training compared with guideline-based physical activity for patients with HFpEF.

Abstract

Importance  Endurance exercise is effective in improving peak oxygen consumption (peak V̇o2) in patients with heart failure with preserved ejection fraction (HFpEF). However, it remains unknown whether differing modes of exercise have different effects.

Objective  To determine whether high-intensity interval training, moderate continuous training, and guideline-based advice on physical activity have different effects on change in peak V̇o2 in patients with HFpEF.

Design, Setting, and Participants  Randomized clinical trial at 5 sites (Berlin, Leipzig, and Munich, Germany; Antwerp, Belgium; and Trondheim, Norway) from July 2014 to September 2018. From 532 screened patients, 180 sedentary patients with chronic, stable HFpEF were enrolled. Outcomes were analyzed by core laboratories blinded to treatment groups; however, the patients and staff conducting the evaluations were not blinded.

Interventions  Patients were randomly assigned (1:1:1; n = 60 per group) to high-intensity interval training (3 × 38 minutes/week), moderate continuous training (5 × 40 minutes/week), or guideline control (1-time advice on physical activity according to guidelines) for 12 months (3 months in clinic followed by 9 months telemedically supervised home-based exercise).

Main Outcomes and Measures  Primary end point was change in peak V̇o2 after 3 months, with the minimal clinically important difference set at 2.5 mL/kg/min. Secondary end points included changes in metrics of cardiorespiratory fitness, diastolic function, and natriuretic peptides after 3 and 12 months.

Results  Among 180 patients who were randomized (mean age, 70 years; 120 women [67%]), 166 (92%) and 154 (86%) completed evaluation at 3 and 12 months, respectively. Change in peak V̇o2 over 3 months for high-intensity interval training vs guideline control was 1.1 vs −0.6 mL/kg/min (difference, 1.5 [95% CI, 0.4 to 2.7]); for moderate continuous training vs guideline control, 1.6 vs −0.6 mL/kg/min (difference, 2.0 [95% CI, 0.9 to 3.1]); and for high-intensity interval training vs moderate continuous training, 1.1 vs 1.6 mL/kg/min (difference, −0.4 [95% CI, −1.4 to 0.6]). No comparisons were statistically significant after 12 months. There were no significant changes in diastolic function or natriuretic peptides. Acute coronary syndrome was recorded in 4 high-intensity interval training patients (7%), 3 moderate continuous training patients (5%), and 5 guideline control patients (8%).

Conclusions and Relevance  Among patients with HFpEF, there was no statistically significant difference in change in peak V̇o2 at 3 months between those assigned to high-intensity interval vs moderate continuous training, and neither group met the prespecified minimal clinically important difference compared with the guideline control. These findings do not support either high-intensity interval training or moderate continuous training compared with guideline-based physical activity for patients with HFpEF.

Trial Registration  ClinicalTrials.gov Identifier: NCT02078947

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