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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!
ROM MachineAll the exercise you need in exactly 4 minutes a day!
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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
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