Endurance exercise intensity determination in the rehabilitation of coronary artery disease patients: A critical re-appraisal of current evidence

Sports Medicine

Volumn 42, Issue 1, 2012, Pages 11-30

  Hansen, Dominique ^a,b,c   Stevens, An ^a,c   Eijnde, Bert O ^b,c   Dendale, Paul ^a,b,c  

^a Jessa HospitalHeart Centre Hasselt   (Belgium)

^b PHL University College   (Belgium)

^c HASSELT UNIVERSITY   (Belgium)

Author keywords

Cardiac rehabilitation; Coronary artery disease; management; Exercise intensity

Indexed keywords

CORONARY ARTERY DISEASE; ENDURANCE; EXERCISE; EXERCISE TEST; HEART RATE; HUMAN; KINESIOTHERAPY; METHODOLOGY; PATHOPHYSIOLOGY; PHYSIOLOGY; REVIEW;

CORONARY ARTERY DISEASE; EXERCISE; EXERCISE TEST; EXERCISE THERAPY; HEART RATE; HUMANS; PHYSICAL ENDURANCE;

EID: 83455171857     PISSN: 01121642     EISSN: 11792035     Source Type: Journal    
DOI: 10.2165/11595460-000000000-00000     Document Type: Review

References (85)

1. Dendale P, Dereppe H, De Sutter J, et al. Position paper of the Belgian Working Group on Cardiovascular Prevention and Rehabilitation: cardiovascular rehabilitation. Acta Cardiol 2008; 63 (6): 673-81
2. Giannuzzi P, Saner H, Bjö rnstad H, et al. Secondary prevention through cardiac rehabilitation: position paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology. Eur Heart J 2003; 24 (13): 1273-8 (Pubitemid 36834643)
3. Clark AM, Hartling L, Vandermeer B, et al. Meta-analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med 2005; 143 (9): 659-72
4. Giannuzzi P, Temporelli PL, Marchioli R, et al. Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian Cardiac Rehabilitation Network. Arch Intern Med 2008; 168 (20): 2194-204
5. Hansen D, Dendale P, Leenders M, et al. Cardiac rehabilitation reduces the cardiovascular event rate differently in CABG and PCI patients. Acta Cardiol 2009; 64 (5): 639-44
6. Bjarnason-Wehrens B, Mayer-Berger W, Meister ER, et al. Recommendations for resistance exercise in cardiac rehabilitation. Recommendations of the German Federation for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2004; 11 (4): 352-61 (Pubitemid 39150099)
7. Piepoli MF, Corrà U, Benzer W, et al. Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur Heart J 2010; 31 (16): 1967-74
8. Franklin B, Gordon S, Timmis GC. Diurnal variation of ischemic response to exercise in patients receiving a oncedaily dose of beta-blockers. Chest 1996; 109 (1): 253-7
9. Dufour Doiron M, Prud'Homme D, Boulay P. Time-of-day variation in cardiovascular response to maximal exercise testing in coronary heart disease patients taking betablocker. Appl Physiol Nutr Metab 2007; 32 (4): 664-9
10. Salvadori A, Fanari P, Giacomotti E, et al. Kinetics of catecholamines and potassium, and heart rate during exercise testing in obese subjects. Heart rate regulation in obesity during exercise. Eur J Nutr 2003; 42 (4): 181-7 (Pubitemid 36999069)
11. Carvalho VO, Mezzani A. Aerobic exercise training intensity in patients with chronic heart failure: principles of assessment and prescription. Eur J Cardiovasc Prev Rehabil 2011; 18 (1): 5-14
12. Brawner CA, Vanzant MA, Ehrman JK, et al. Guiding exercise using the talk test among patients with coronary artery disease. J Cardiopulm Rehabil 2006; 26 (2): 72-5
13. Buckley JP, Sim J, Eston RG. Reproducibility of ratings of perceived exertion soon after myocardial infarction: responses in the stress-testing clinic and the rehabilitation gymnasium. Ergonomics 2009; 52 (4): 421-7
14. Buckley JP, Davis JA, Simpson T. Cardio-respiratory responses to rowing ergometry and treadmill exercise soon after myocardial infarction. Med Sci Sports Exerc 1999; 31 (12): 1721-6 (Pubitemid 30012887)
15. Dickstein K, Barvik S, Aarsland T, et al. Validation of a computerized technique for detection of the gas exchange anaerobic threshold in cardiac disease. Am J Cardiol 1990; 66 (19): 136-7
16. Dickstein K, Barvik S, Aarsland T, et al. A comparison of methodologies in detection of the anaerobic threshold. Circulation 1990; 81: II-38-46
17. Gondoni LA, Nibbio F, Caetini G, et al. What are we measuring? Considerations on subjective ratings of perceived exertion in obese patients for exercise prescription in cardiac rehabilitation programs. Int J Cardiol 2010; 140 (2): 236-8
18. Goodman LS, McKenzie DC, Taunton JE, et al. Ventilatory threshold and training heart rate in exercising cardiac patients. Can J Sport Sci 1988; 13 (4): 220-4
19. Hansen D, Dendale P, Berger J, et al. Low agreement of ventilatory threshold between training modes in cardiac patients. Eur J Appl Physiol 2007; 101 (5): 547-54 (Pubitemid 47517196)
20. Joo KC, Brubaker PH, MacDougall A, et al. Exercise prescription using resting heart rate plus 20 or perceived exertion in cardiac rehabilitation. J Cardiopulm Rehabil 2004; 24 (3): 178-86 (Pubitemid 38703111)
21. Magal M, Zoeller RF. A pilot study comparing physiological responses of phase III cardiac patients to recumbent and upright exercise using the RPE scale. Percept Mot Skills 2005; 100 (2): 357-61 (Pubitemid 40758876)
22. Nieuwland W, Berkhuysen MA, Van Veldhuizen DJ, et al. Individual assessment of intensity-level for exercise training in patients with coronary artery disease is necessary. Int J Cardiol 2002; 84 (1): 15-20 (Pubitemid 34718083)
23. Omiya K, Itoh H, Osada N, et al. Impaired heart rate response during incremental exercise in patients with acute myocardial infarction and after coronary artery bypass grafting: valuation of coefficients with Karvonen's formula. Jpn Circ J 2000; 64 (11): 851-5
24. Shimizu M, Myers J, Buchanan N, et al. The ventilatory threshold: method, protocol, and evaluator agreement. Am Heart J 1991; 122 (2): 509-16
25. Squires RW, Rod JL, PollockML, et al. Effects of propranolol on perceived exertion soon after myocardial revascularization surgery. Med Sci Sports Exerc 1982; 14 (4): 276-80 (Pubitemid 13245176)
26. Tabet JY, Meurin P, Teboul F, et al. Determination of exercise training level in coronary artery disease patients on beta-blockers. Eur J Cardiovasc Prev Rehabil 2008; 15 (1): 67-72 (Pubitemid 351263257)
27. Tabet JY, Meurin P, Ben Driss A, et al. Determination of exercise training heart rate in patients on beta-blockers after myocardial infarction. Eur J Cardiovasc Prev Rehabil 2006; 13 (4): 538-43 (Pubitemid 44162154)
28. Whaley MH, Brubaker PH, Kaminsky LA, et al. Validity of the rating of perceived exertion during graded exercise testing in apparently healthy adults and cardiac patients. J Cardiopulm Rehabil 1997; 17 (4): 261-7 (Pubitemid 27449030)
29. Chaloupka V, Elbl L, Nehyba S, et al. Exercise intensity prescription after myocardial infarction in patients treated with beta-blockers. J Cardiopulm Rehabil 2005; 25 (6): 361-5 (Pubitemid 44510065)
30. Dwyer J. Metabolic character of exercise at traditional training intensities in cardiac patients and healthy persons. J Cardiopulm Rehabil 1994; 14 (3): 189-96 (Pubitemid 24182882)
31. Brubaker PH, Rejeski J, Law HC, et al. Cardiac patients' perception of work intensity during graded exercise testing: do they generalize to field settings? J Cardiopulm Rehabil 1994; 14 (2): 127-33 (Pubitemid 24127481)
32. McConnell TR, Clark BA, Conlin NC, et al. Gas exchange anaerobic threshold: implications for prescribing exercise in cardiac rehabilitation. J Cardiopulm Rehabil 1993; 13 (1): 31-6 (Pubitemid 23081674)
33. Zanettini R, Centeleghe P, Ratti F, et al. Training prescription in patients on beta-blockers: percentage peak exercise methods or self-regulation? Eur J Cardiovasc Prev Rehabil. Epub 2011 Feb 28
34. Albert CM, Mittleman MA, Chae CU, et al. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med 2000; 343 (19): 1355-61
35. Frese F, Seipp P, Hupfer S, et al. Insufficient control of exercise intensity by heart rate monitoring in cardiac patients. Eur J Cardiovasc Prev Rehabil. Epub 2011 Apr 4
36. Bartsch P. Platelet activation with exercise and risk of cardiac events. Lancet 1999; 354 (9192): 1747-8
37. Cadroy Y, Pillard F, Sakariassen KS, et al. Strenuous but not moderate exercise increases the thrombotic tendency in healthy sedentary male volunteers. J Appl Physiol 2002; 93 (3): 829-33 (Pubitemid 34919651)
38. Hilberg T, Menzel K, Glaser D, et al. Exercise intensity: platelet function and platelet-leukocyte conjugate formation in untrained subjects. Thromb Res 2008; 122 (1): 77-84 (Pubitemid 351601845)
39. Ikarugi H, Shibata M, Shibata S, et al. High intensity exercise enhances platelet reactivity to shear stress and coagulation during and after exercise. Pathophysiol Haemost Thromb 2003; 33 (3): 127-33 (Pubitemid 38698113)
40. Thompson PD, Franklin BA, Balady GJ, et al. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation 2007; 115 (17): 2358-68 (Pubitemid 46685905)
41. Amundsen BH, Rognmo O, Hatlen-Rebhan G, et al. Highintensity aerobic exercise improves diastolic function in coronary artery disease. Scand Cardiovasc J 2008; 42 (2): 110-7 (Pubitemid 351465760)
42. Blumenthal JA, Rejeski WJ, Walsh-Riddle M, et al. Comparison of high-and low-intensity exercise training early after acute myocardial infarction. Am J Cardiol 1988; 61 (1): 26-30
43. Jensen BE, Fletcher BJ, Rupp JC, et al. Training level comparison study: effect of high and low intensity training on ventilatory threshold in men with coronary artery disease. J Cardiopulm Rehabil 1996; 16 (4): 227-32 (Pubitemid 26281891)
44. Moholdt TT, Amundsen BH, Rustad LA, et al. Aerobic interval training versus continuous moderate exercise after coronary artery bypass surgery: a randomized study of cardiovascular effects and quality of life. Am Heart J 2009; 158 (6): 1031-7
45. Oberman A, Fletcher GF, Lee J, et al. Efficacy of highintensity exercise training on left ventricular ejection fraction in men with coronary artery disease (the training level comparison study). Am J Cardiol 1995; 76 (10): 643-7
46. Rognmo O, Hetland E, Helgerud J, et al. High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease. Eur J Cardiovasc Prev Rehabil 2004; 11 (3): 216-22 (Pubitemid 38870069)
47. Warburton DE, McKenzie DC, Haykowski MJ, et al. Effectiveness of high-intensity interval training for the rehabilitation of patients with coronary artery disease. Am J Cardiol 2005; 95 (9): 1080-4 (Pubitemid 40544313)
48. Adachi H, Koike A, Obayashi T, et al. Does appropriate endurance exercise training improve cardiac function in patients with prior myocardial infarction? Eur Heart J 1996; 17 (10): 1511-21 (Pubitemid 26345140)
49. Helgerud J, Karlsen T, Kim WY, et al. Interval and strength training in CAD patients. Int J Sports Med 2011; 32: 54-9
50. Munk PS, Breland UM, Aukrust P, et al. High intensity interval training reduces systemic inflammation in post-PCI patients. Eur J Cardiovasc Prev Rehabil. Epub 2011 Feb 18
51. Wisløff U, Nilsen TI, Drøyvold WB, et al. A single weekly bout of exercise may reduce cardiovascular mortality: how little pain for cardiac gain? 'The HUNT study, Norway'. Eur J Cardiovasc Prev Rehabil 2006; 13 (5): 798-804 (Pubitemid 44454854)
52. Moholdt T, Wisløff U, Nilsen TI, et al. Physical activity and mortality in men and women with coronary heart disease: a prospective population-based cohort study in Norway (the HUNT study). Eur J Cardiovasc Prev Rehabil 2008; 15 (6): 639-45
53. Cornish AK, Broadbent S, Cheema BS. Interval training for patients with coronary artery disease: a systematic review. Eur J Appl Physiol 2011; 111: 579-89
54. Perri MG, Anton SD, Durning PE, et al. Adherence to exercise prescriptions: effects of prescribing moderate versus higher levels of intensity and frequency. Health Psychol 2002; 21 (5): 452-8 (Pubitemid 34921078)
55. Lee JY, Jensen BE, Oberman A, et al. Adherence in the training levels comparison trial. Med Sci Sports Exerc 1996; 28 (1): 47-52 (Pubitemid 26031722)
56. Aamot IL, Morkved S, Stoylen A. Exercise compliance after cardiac rehabilitation [abstract]. Eur J Cardiovasc Prev Rehabil 2010; 17 (2): S47-50
57. Hansen D, Dendale P, van Loon LJC, et al. The effects of training modalities on clinical benefits of exercise intervention in cardiovascular disease risk patients or type 2 diabetes mellitus. Sports Med 2010; 40 (11): 921-40
58. Karvonen J, Vuorimaa T. Heart rate and exercise intensity during sports activities: practical application. Sports Med 1988; 5 (5): 303-11
59. Bogaty P, Poirier P, Boyer L, et al. What induces the warmup ischemia/angina phenomenon: exercise or myocardial ischemia? Circulation 2003; 107 (14): 1858-63 (Pubitemid 36444125)
60. Faude O, Kindermann W, Meyer T. Lactate threshold concepts: how valid are they? Sports Med 2009; 39 (6): 469-90
61. Conconi F, Grazzi G, Casoni I, et al. The Conconi test: methodology after 12 years of application. Int J Sports Med 1996; 17 (7): 509-19 (Pubitemid 26360095)
62. Borg G. Perceived exertion as an indicator of somatic stress. J Rehabil Med 1970; 2: 92-8
63. Shah ND, Dunlay SM, Ting HH, et al. Long-term medication adherence after myocardial infarction: experience of a community. Am J Med 2009; 122: e7-12
64. Hansen D, Dendale P, Raskin A, et al. Long-term effect of rehabilitation in coronary artery disease patients: randomised clinical trial of the impact of exercise volume. Clin Rehabil 2010; 24 (4): 319-27
65. Parfitt G, Rose EA, Burgess WM. The psychological and physiological responses of sedentary individuals to prescribed and preferred intensity exercise. Br J Health Psychol 2006; 11 (1): 39-53 (Pubitemid 43333365)
66. Wasserman K, McIlroy MB. Detecting the threshold of anaerobic metabolism in cardiac patients. Am J Cardiol 1964; 14: 844-52
67. Beaver WL, Wasserman K, Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol 1986; 60 (6): 2020-7 (Pubitemid 16066969)
68. Buchfuhrer MJ, Hansen JE, Robinson TE, et al. Optimizing the exercise protocol for cardiopulmonary assessment. J Appl Physiol 1983; 55 (5): 1558-64 (Pubitemid 14231465)
69. Vanhees L, Lefevre J, Philippaerts R, et al. How to assess physical activity? How to assess physical fitness? Eur J Cardiovasc Prev Rehabil 2005; 12 (2): 102-14 (Pubitemid 40571524)
70. Meyer T, Lucia A, Earnest CP, et al. A conceptual framework for performance diagnosis and training prescription from submaximal gas exchange parameters: theory and application. Int J Sports Med 2005; 26: S38-48 (Pubitemid 40288362)
71. Balady GJ, Arena R, Sietsema K, et al. Clinician's guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation 2010; 122 (2): 191-225
72. Ades PA, Savage PD, Brawner CA, et al. Aerobic capacity in patients entering cardiac rehabilitation. Circulation 2006; 113 (23): 2706-12 (Pubitemid 43947988)
73. Gordon NF, Duncan JJ. Effect of beta-blockers on exercise physiology: implications for exercise training. Med Sci Sports Exerc 1991; 23 (6): 668-76
74. Todd IC, Ballantyne D. Antianginal efficacy of exercise training: a comparison with b blockade. Br Heart J 1990; 64: 14-9 (Pubitemid 20222208)
75. Opasich C, Riccardi G, Assandri J, et al. The effects of physical training in post-myocardial infarction patients with exercise-induced silent ischaemia. Eur Heart J 1988; 9 Suppl. N: 176-80 (Pubitemid 19084650)
76. Hambrecht R, Walther C, Mö bius-Winkler S, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation 2004; 109 (11): 1371-8 (Pubitemid 38387823)
77. Bogaty P, Kingma Jr JG, Robitaille NM, et al. Attenuation of myocardial ischemia with repeated exercise in subjects with chronic stable angina: relation to myocardial contractility, intensity of exercise and the adenosine triphosphate-sensitive potassium channel. J Am Coll Cardiol 1998; 32 (6): 1665-71 (Pubitemid 28545206)
78. Garber CE, Carelton RA, Camaione DN, et al. The threshold for myocardial ischemia varies in patients with coronary artery disease depending on the exercise protocol. J Am Coll Cardiol 1991; 17 (6): 1256-62
79. Goode RC, Mertens R, Shaiman S, et al. Voice, breathing, and the control of exercise intensity. Adv Exp Med Biol 1998; 450: 223-9 (Pubitemid 28530964)
80. Vanhees L, Stevens A. Exercise intensity: a matter of measuring or talking? J Cardiopulm Rehabil 2006; 26 (2): 78-9 (Pubitemid 44474299)
81. Reid RD, Morrin LI, Pipe AL, et al. Determinants of physical activity after hospitalization for coronary artery disease: the Tracking Exercise After Cardiac Hospitalization (TEACH) study. Eur J Cardiovasc Prev Rehabil 2006; 13 (4): 529-37 (Pubitemid 44162153)
82. Ekkekakis P. Let them roam free? Physiological and psychological evidence for the potential of self-selected exercise intensity in public health. Sports Med 2009; 39 (10): 857-88
83. Ilarraza H, Myers J, Kottman W, et al. An evaluation of training responses using self-regulation in a residential rehabilitation program. J Cardiopulm Rehabil 2004; 24 (1): 27-33 (Pubitemid 38168818)
84. Beckers PJ, Denollet J, Possemiers NM, et al. Maintaining physical fitness of patients with chronic heart failure: a randomized controlled trial. Eur J Cardiovasc Prev Rehabil 2010; 17 (6): 660-7
85. Hansen D, Dendale P, Berger J. Exercise type affects VE/VCO2 slope inCADpatients. Int J Sports Med 2009; 30: 302-6