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High Intensity Exercise Training in Clinical Populations

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?

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High Intensity Exercise Training in Clinical Populations

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  1. High Intensity Exercise Training in Clinical Populations

  2. Interval Training • Do you use interval training?

  3. Interval Training • Do you use interval training? • PAD?

  4. Interval Training • Do you use interval training? • PAD? • HF?

  5. Interval Training • Do you use interval training? • PAD? • HF? • Deconditioned?

  6. Interval training is about 2 things: • Managing energy • Building strength

  7. Interval Training

  8. Interval training Steady state exercise

  9. Anaerobic Threshold

  10. Interval training Steady state exercise

  11. 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

  12. VN Smodlaka: Interval Training in Rehabilitation Medicine Arch Phys Med Rehabil 54: 428-431, 1973 Work/Rest=30s/30s

  13. 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

  14. Ehsani et al., 1981Hagberg et al., 1983

  15. Katharina Meyer, Ph.D. • Krozingen, Germany • Interval Training in post CABG patients and patients with CHF • 1990’s

  16. 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 People got stronger!!!

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. How do you do it?

  23. 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

  24. Are their patients who should not perform HIIT? • Basically people who are unstable • Those with orthopedic concerns

  25. 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

  26. Thank you!

  27. ROM Machine All the exercise you need in exactly 4 minutes a day! Manufactured in California since 1990. Price $14,615!

  28. 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

  29. Meyer et al.: Physical responses to different modes of interval exercise in patients with chronic heart failure—application to exercise trainingEur Heart J 17: 1040-1047, 1996

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