High intensity interval training after cardiac resynchronization therapy: An explorative randomized controlled trial

Background: CRT leads to improvement in exercise capacity, cardiac function and mortality in selected CHF patients. Exercise capacity improves even greater when combining CRT with moderate-intensity exercise training (ET). However, high-intensity interval training (HIT) as additional therapy to CRT has not yet been established. Given the complementary physiological effects of HIT, we hypothesized that HIT after CRT may have additional effects on exercise capacity. Methods: 24 CHF patients, NYHA class II/III and accepted for CRT underwent an echocardiogram, QoL questionnaire and CPET with cardiac output (CO) measurements before implantation, at 3 and 6 months. After 3 months, patients were randomized to usual care (UC) or HIT, consisting of 36 sessions at 85–95% of peak V̇O ₂. Results: Peak V̇O ₂ increased after CRT (17±5.3 to 18.7±6.2 ml/kg/min, p < 0.05); after HIT there was a non-significant increase of 1.4 ml/kg/min (p = 0.12). Peak workload increased after CRT (109±45 to 118±44 W, p = 0.001). An additional significant within- and between group increase after HIT was found in the intervention group (128±42 to 148±48 W, versus 110±50 to 110±50, respectively, p = 0.03). Peak CO did not change significantly after CRT or HIT. V̇O ₂ recovery kinetics speeded by 27% after CRT (p = 0.04), no further improvement after HIT was observed. LVEF increased 25% after CRT (p = 0.0001), no additional increase was seen after HIT. Conclusion: This study demonstrates that HIT provides additional improvement of exercise capacity without a concomitant change in peak V̇O ₂ or CO suggesting that the additional effect of HIT is mainly mediated by an improvement of anaerobic performance.